Chief Executive's Report January 2025
Chief Executive’s Report January 2025
Reflecting on 2024
The start of a new year is a good opportunity to consider what lies ahead and reflect on recent achievements. In 2024, we left special measures ; we were the most improved trust in England for A&E performance in 2023/24; and we opened two new theatres at our Elective Surgical Hub in King George Hospital (KGH), a Women’s Health Hub in Ilford, an Ageing Well Centre in Hornchurch and Community Diagnostic Centres (CDC) at Barking Community Hospital and at St George’s Health and Wellbeing Hub in Hornchurch.
These CDCs are open 12 hours a day, 7 days a week (in line with the requirements of The Elective Reform Plan published this month by NHS England) and will provide an extra 88,000 scans a year. The Google Maps listing for the Barking CDC has been viewed more than 60,000 times which gives an indication of the interest there is in this community facility. We are now a trust that operates on several sites in all three of our main boroughs to the benefit of residents who can access care closer to where they live.
Over the past 12 months , 9,312 surgeries were performed at our KGH Elective Surgical Hub (I spoke about its work recently on Radio 4’s PM programme ); 825,198 outpatients appointments took place; and 7,015 babies were born – including Callum and Connor , identical twin brothers, who arrived on Christmas Eve.
I have many personal highlights when I look back on the year just gone, including the fact that we’ve been able to support Barts Health and provide a 24/7 mechanical thrombectomy service (a life-saving procedure that removes blood clots from the brain during a stroke) to a population of nearly 10 million people living in north east London (NEL), Kent and the East of England. We’ve been doing this in recent months while equipment is repaired and replaced at The Royal London Hospital.
Our finances
2025 promises to be another exciting year in which we continue to progress and improve, not least with the introduction of an electronic patient record (EPR) that will be transformative for our staff and beneficial for our patients. As well as EPR, a key focus this year will be our finances with money tight in NEL and across the NHS.
We are on course to deliver a second year of £30m of savings which represents 3% of our income. More than £3m of that total has come from corporate teams, with more to follow. We have also cut our spend on high-cost agency employees, down from £45m three years ago to £18m, and we have increased our substantive staff.
For example, in our Surgery, Critical Care and Anaesthetics departments we’ve welcomed 94 new doctors. We’re on track to recruit an additional 17 anaesthetists in the next few months when the overall medical vacancy rate in these departments will fall below 3%.
In terms of productivity, we are the most improved trust in London and the second most improved in England (when compared with before the pandemic). We are delivering more care for our money thanks, in part, to our reduction in agency spend and our focus on ensuring our operating theatres are in use as much as possible.
Despite these achievements we will be expected to deliver more from April - a third year of £30m savings will not be enough. We will have to find at least £50m of financial improvement in the 2025/26 financial year. I have had several meetings with colleagues to discuss how we deliver the estimated £20m of extra savings. Each clinical group is looking at how they spend money and how they reduce waste.
I have been transparent about the challenges we face. We need to minimise, as best we can, the impact on residents while also deciding what we’re going to stop doing.
We cannot just ‘salami slice’ services. The reward for any short-term pain is a future for BHRUT where we have autonomy and financial control and we banish the prospect of returning to financial special measures because we couldn’t balance the books.
£35m campaign for a new A&E at Queen’s Hospital
An obvious saving will be delivered when we end corridor care in our A&Es which mostly takes place at Queen’s when demand is high. It costs us £100k a month in additional staffing to care for patients on beds in the corridors.
Queen’s, at the moment, is a hospital of contrasts. The entrance has been cleared of clutter and queues and a brand new reception desk has been installed. That sense of space dissipates the moment you turn the corner into the A&E where the physical layout is utterly inadequate.
When the hospital was opened in 2006, the A&E department was built to accommodate a maximum of 325 people a day who were seeking urgent and emergency care. Now, it sees at least double that number. On one day in December, 752 patients came through its doors.
This is why we need to transform the department and get rid of corridor care. It will improve the experience of our patients and provide our staff with a better working environment.
We’re launching a campaign with posters across Queen’s to encourage everyone who uses the hospital to contact their MP and ask them to support our bid to secure the £35m needed to carry out the vital improvement work. I’m grateful for the backing we’ve received already from several of our MPs who represent constituents living in Barking and Dagenham, Havering and Redbridge.
Improving urgent and emergency care
December was our busiest month ever with 30,834 people attending our A&Es. On Boxing Day, we cared for 126 patients aged over 75 including one person who was 100 years old and two people aged 99. Their presence in our crowded and noisy departments reinforces why our Ageing Well Centre in Hornchurch is so important.
Our frail, elderly residents receive the care they need at the purpose-built centre and avoid having to be admitted to hospital. In its first week our multidisciplinary team, including a consultant geriatrician, saw 23 people in person and spoke to four others on the telephone.
Wes Streeting, the Health Secretary and MP for Ilford North, saw Queen’s A&E for himself, just before Christmas, on what staff described to him as a “fairly good day”.
Mr Streeting told LBC Radio that he went through a section of the department “where there were lots of frail elderly people, including people with dementia, who were very confused, very distressed, crying out, not so much in pain as much as confusion. And as I walked around these conditions, I was looking around thinking: This is a good day?”
The increased demand we experienced last month wasn’t a one off. It’s continued in January (we had 90 patients with flu in our hospitals in the first week of the new year) and the numbers were going up throughout last year.
In November, we saw 30 extra ambulances arriving at our sites each day compared with November 2022. Despite this, one in two of the handovers of patients to our staff were completed in under 30 minutes at Queen’s and more than 8 out of 10 took place within this timeframe at KGH. For most of these patients, at both hospitals, the handover took place within 45 minutes.
Our overall (All Types) performance in November was 77%, one percentage point off the current NHS target for the number of patients to be admitted, transferred or discharged within four hours. We saw an extra 100 patients a day when compared with the same month the year before. It placed us 3rd out of 18 acute trusts in London and 16th out of 122 in England. Our Type 1 performance (the most seriously ill patients) was 53.6%.
We’ve set up a new phone line, staffed by consultants, for GPs and our partners in the community to call and receive advice to prevent unnecessary visits to A&E. We’ve also improved our Same Day Emergency Care (SDEC) department at KGH and when the renal service, run by Barts Health moves to the St George’s Hub this month we’ll use the vacated space for our Queen’s SDEC. These departments enable patients to be moved out of A&E to be assessed and have their treatment (including diagnostics) start on that same day.
GPs in our A&Es
We’re inviting some of our GPs to work alongside colleagues in A&E, in a supernumerary capacity. The first GP to do a shift was Ruth Crowley , one of our associate non-executive directors. We want to learn from their experience in primary care and see how we can improve our discharge of patients, especially at busy times.
Patients with mental health needs
We continue to spend around £500k a month on registered mental health nurses, additional health care assistants and security guards to care for patients with mental health needs in our A&Es while we find them better, much more suitable places to receive the support they need.
In November, we referred 363 patients from A&E to mental health services. They waited with us for an average of 22 hours. Even though it’s not a specialist provider, KGH receives a significant number of Section 136 patients – the total in November was 21.
There are plans to increase capacity at Goodmayes Hospital , which is next door to KGH and run by NELFT , a mental health and community services provider. This will, hopefully, reduce the time these patients spend in our A&Es and the number who come to us in the first place.
Our cancer performance
We met all three of the cancer targets in October that cover diagnosing as quickly as possible and starting treatment within an agreed timeframe. We also met the target for diagnostic waiting times for a seventh consecutive month. We’re constantly looking for ways to improve this performance so I’m pleased we’re part of a project, run by the North East London Cancer Alliance , that is using Artificial Intelligence (AI) to reduce significantly the time it takes to share chest X-ray results.
Other initiatives that will help our cancer patients include our use of AI to assist our oncologists ; the opening of a new CT scanner at Queen’s; and the innovative scheme we are running at our Barking Community Hospital CDC that is using clinical photography to cut backlogs and speed up the time it takes to diagnose mouth cancer .
Cutting our waiting lists
There is now a renewed focus on trusts meeting the constitutional standard, by March 2029, of 92% of patients waiting no longer than 18 weeks from referral to treatment. It was last achieved in 2015. NHS England has set an initial target of getting to 65% by March next year with every trust required to deliver a minimum 5% improvement by that deadline.
In November we were at 66.3% and this represents a 4% improvement on the year before. The total number of residents who were referred was 60,170, with 9 out of 10 of them requiring an outpatient appointment with one of our specialists. 1,082 of these patients have waited more than a year. One of our latest drives to tackle waiting lists was undertaken by our Ophthalmology department who carried out more than three times the usual number of cataract surgeries in one day.
The coming months
I’m entering 2025 with a refreshed senior leadership team. Andrew Deaner is our new Chief Medical Officer and Nic Kane will start in April as our Chief Nursing Officer (CNO). We will ensure we celebrate the significant contribution Kathryn Halford, our departing CNO, has made to our Trust. One of the many things I hope we build on in the year ahead is the very successful event we held in December to mark the contribution of our international workforce (our staff come from 146 different countries) and the work colleagues carry out, in their spare time, across the world.
Matthew Trainer
Chief Executive
January 2025