More than a hospital: Q&A with Richard Beeken

Richard, what do you mean when you describe this as ‘more than a hospital’?

There's a couple of things that define it. It is a beautiful architectural thing itself with a unique community space within it. 

It's a hospital whose care model is based on community-based admission avoidance and attendance avoidance that we've been very successful in achieving to ensure that we can safely occupy the building. 

And it's more than a hospital because it is already proving to be a trigger point, a catalyst for regeneration of a very economically deprived post-industrial area. We've got strategic agreements with both councils that we work with and the combined authority to deliver on those promises.

So it's more than a hospital in many, many ways.

Can you tell us what you're most proud of?

Personally, I'm most proud of leading an executive team that has held itself together and kept clinical services and clinical support services on the on the road, delivering against the whole expectations of the wider NHS, while at the same time redesigning services and, and planning to occupy a new building and managing a management to change process with 5,900 staff.

That's a remarkable achievement.

"My pride is in that team of mine and what they have achieved collectively together"

My pride is in that team of mine and what they have achieved collectively together.

There's a phrase that is often used: they have been landscaping the garden for the future while putting the fire out in the house at the same time. And they've done that for years.

Now we're finally in, we can turn our attention to really releasing the benefits of this place.

Can you tell us about the journey to get to where you are today?

It's been not always an easy one. Before I arrived in the organisation, my predecessor had to deal with the collapse of Carillion, who were the PFI-appointed contractors that were to build the hospital. The hospital got one third built and then they went bust. A number of significant factors affected us: 

• The COVID-19 pandemic had a massive impact on the availability of sub-contractual labour and the materials and the pace of which we worked.
• Brexit had its own impact on material and sub-contractual labour availability. Even HS2 being done locally took sub-contractual labour away from us as well. So, there were multiple delays and people got very frustrated.
• The whole issue of revising the care model to occupy the building safely and get bed occupancy down, meant transformation on a significant scale in both community services and the way we handled urgent care patients at the front door.
• The issue with regard to how the revenue costs of the hospital, the increased rates and energy bills and the increased costs of a seven-day staffing model to ensure that we safely occupied the building were going to be covered?

The negotiations regarding all of that and resolving that issue was torturous at times. That's been that's been the journey in managerial terms, as it were.

The wider community's been on a journey with this, with many people believing that it would never happen. So now that it has happened, there's a lot of smiles on a lot of people's faces.

What have been some of the biggest lessons that you've learned throughout that period?

The biggest lesson I've learned is that when you are conducting something of this size and scale, redesigning services, building a new building, practising, occupying that building, all of that practical and deeply time-consuming stuff, the show still needs to be kept on the road. Your hospital and community and primary care services need to continue to be delivered.

"I think we've proven that if you invest in something and do it carefully, it can deliver benefits. It doesn't always have to be seen as a waste of money"

The NHS wheel doesn't stop turning and it continues to expect you to deliver on your waiting time standards and respond to CQC report expectations and all of that stuff. You are not allowed to prioritise what you do as easily as you would like to.

Another point of learning is that I think we've proven that if you invest in something and do it carefully, it can deliver benefits. It doesn't always have to be seen as a waste of money.

Two quick examples: one, the investment we made in community services. It's not been a huge investment, but we deliberately and consciously and unapologetically closed community hospital beds and reinvested that money and those staff into community, urgent community response, admission and attendance avoidance. That's worked.

The second investment we've made is in team development, leadership development and organisation development to bring two very different hospitals with different cultures together. In terms of sickness rates, turnover rates and so on, there's a palpable impact that that's happening as well.

You have a consciously community-first approach. Can you tell us more about that?

What it has looked like up until now has been focusing on quite prosaic stuff: avoiding attendance and admission to hospital, keeping people at home, care home admission avoidance and so on.

Going forward, anticipating what the ten-year plan is going to be needing us to do, it's much more about trying to avoid chronic disease or, if we can't avoid it, try to manage chronic disease better so that acute exacerbations of chronic disease are reduced.

The route to that is the neighbourhood team approach managing health, social care and third sector wrap-around support to individuals at risk of deteriorating in populations of around 50,000 people.

That's what we need to anticipate and we need to start investing time and resources in.

To what extent does the route you are already taking embody what the government is trying to achieve?

Everything you've heard from Wes Streeting and his ministers so far, and NHS England nationally in response to them, is hospital to community; analogue to digital; treatment to prevention.

We've anticipated many years ago on this journey the first of those three things.

"...two out of three ain't bad"

We've got a hospital here that is smart enabled and is starting to adopt new technology in the provision of healthcare, such as a digital end-to-end provision of medicines management, for example, and the use of automated guided vehicles to deliver goods and services from our receipts and distribution service to our wards and department.

We're not delivering the third of those things yet, the treatment to prevention.

That's where the Town Team work, the work of general practice with community teams – with specialist input - will come in. But two out of three ain't bad.

How has the design of the hospital itself been important in achieving better outcomes?

Firstly, it’s designed by our clinicians.

This is the probably one of the last, if not the last, truly bespoke new hospital designs in the UK because we're going to be moving to a more standardised design in the future, quite rightly to get a get good value for money.

But what we've got here is a massive increase in side-room provision – 50 per cent of the beds in the hospital are in side rooms. That brings huge infection control benefits because of isolation rooms and side-room provision, circulation space on the grand scale, 180-degree views from many, many wards and departments so that you've got a therapeutic environment driven by natural light and space.

Where we're sat here now, the fifth floor of the hospital is a community facility, both outside and inside. We've got different retail outlets, lots of space, lots of natural light and the ability for people to decompress.

One of my colleagues only the other day saw a family of 20 people whose father was acutely unwell and in intensive care, but they were able to gather and have memories of him and talk about him in this space here.

Not many hospitals that I know have that.

What impacts are you already seeing?

Sandwell Borough is the only borough in the Black Country, and to the best of my knowledge the only part of the West Midlands at the moment, whose admissions to hospital for those over the age of 65 is actually going down over a statistically significant period of time. That hasn't happened by accident.

We've reduced unnecessary admissions to hospital from care homes by over 80 per cent over the last two years.

Since moving into the building only six weeks ago, we've seen a three per cent improvement in our four-hour performance at the front door.

"...are we providing a perfect urgent and elective care service in this hospital yet? No. Have we made significant improvements because we've moved into this hospital and because of the care model? Yes"

We have maintained a marginal reduction in our length of stay, while the rest of the country has seen a circa one-day mean average increase in medical non-elective length of stay over the last 12 months.

And we've reduced the number of patients waiting over 12 hours in the emergency department and the number of people whose ambulance transfer has taken over one hour.

We've reduced both of those measures, the numbers of people in those categories by roughly 50 per cent since we moved in.

So, are we providing a perfect urgent and elective care service in this hospital yet? No. Have we made significant improvements because we've moved into this hospital and because of the care model? Yes.

Can we talk about the impact on the wider area - how important is this for the wider community?

Hugely. This is this is a post-industrial area, Smethwick. Hundreds of years ago it was a small market town in South Staffordshire, but as Birmingham expanded, it's just become part of the West Midlands conurbation. There was a lot of heavy industry around here and that's all closed down now.

What you're dealing with is the post-industrial legacy in terms of the local environment, closed down factories and so on. You're dealing with the post-industrial legacy in terms of health and healthy life expectancy, which is going backwards in this part of the world.

There's a significant ethnic diversity as well, which is a strength for us in terms of the staff that we can employ. That gives us the opportunity to provide culturally sensitive, culturally safe services.

Ultimately this hospital has already proven to be a trigger for regeneration.

We've got a learning campus opening next year on the hospital campus site that will provide 1,200 learning opportunities per annum to people in terms of vocational training and health and social care professions.

That's been done in partnership in Sandwell College and with the University of Wolverhampton and with Aston University.

The other big thing that we're working on is the so-called corridor between here and the city centre of Birmingham. It's only 1.5 miles away. A canal and improved cycle paths now link the two.

We've got an opportunity to work, and are working, with both councils and the combined authority and hopefully some independent investment as well to redevelop that corridor with affordable housing, green spaces, community spaces and transform this part of the world for people and future generations.

Why is it important for the NHS to be doing that?

We are an anchor institution. We are one of the biggest, if not the biggest employer around. We touch everybody's lives at least twice.

We are a significant part of people's lives either through their own experience or through their employment.

The NHS itself is a religion in this country and it shouldn't stand alone. It should work with other organisations to provide opportunity. 

The NHS should be - not just through new projects but through ongoing work - thinking about that responsibility all the time.