Chief Executive’s report May 2025

The new financial year

It will be a difficult 12 months during which we will deliver a savings programme on a scale we’ve not attempted before. We will do it from the vantage point of being an organisation that continues to improve. The latest evidence of this transformation is our submission of a compliant operating plan for 2025/26. 

We believe we will hit all the government targets for cancer, treating people on our waiting list and urgent and emergency care. It’s a moment to savour for BHRUT as we’ve not been in this position before. It’s down to the hard and focused work of a wide range of staff in recent years, overseen by Fiona Wheeler, our Deputy Chief Executive and Chief Operating Officer.   

Our savings programme

We have delivered £30m of savings in each of the past two financial years. Like many other trusts in north east London and elsewhere, we now need to go further. Our budget for 2025/26 is £1bn, up from £930m last year. However, demand for our services continues to increase and our costs have gone up. 

In the last financial year, almost 25,000 more people came to our hospitals seeking urgent and emergency care compared with the previous 12 months and we carried out 20% more operations at our Elective Surgical Hub in King George Hospital (KGH) between 2023 and 2024. 

Our focus is on meeting government expectations that all trusts balance their books. It’s a task that is made harder to achieve because of the growing demand and rising costs. We need to save £61m this year which means we must spend, on average, £5m less each month than it currently costs to run our hospitals. 

To help achieve this, we will reduce our headcount by removing 115 whole time equivalent posts in our corporate services. This will be a combination of redundancies and removing vacant posts. It will save £7.5m and will be on top of the £3.5m we saved in 2024/25 when we took out 40 corporate posts. 

The improvements we’ve delivered in recent years have made us a more attractive employer and boosted our ability to recruit substantive staff. Our problem is that, up until now, we have continued to use significant numbers of bank staff, despite having the highest number of permanent employees in our history. 

Our recently available year-end figures for 2024/25 show we spent £84.4m on bank and high-cost agency staff. We intend to cut these overtime shifts by more than a third as we need to reduce our pay bill by more than £40m. We will offer bank shifts to our permanent staff before they are made available to those who only do bank work at our Trust. 

We are working on more savings plans and will share the details at Board meetings. We will mitigate any risks to patients as best we can and ensure we continue to have properly skilled clinical staff delivering good quality care to the patients that need it, in the right environment. 

The goal of this painful process is to avoid ending the year in deficit. The prize is that we will become a financially solvent, independent organisation that has moved on from its years in special measures and has the freedom to make decisions about the future. 

Our staff

As well as being mindful of any adverse effects on patients, we also have to be aware of how tough this will be for our staff. They will continue to do fantastic things every day and deliver a much appreciated service to the public, while also seeking better value for the taxpayers’ money we receive.   

With my senior leaders, we are always looking for ways of supporting our colleagues. One in 20 of them are on apprenticeship courses and I’m delighted our Apprenticeship and Careers Hub was rated good by Ofsted after our first ever inspection. 

I’m also pleased we’ve increased the salaries of our lowest paid healthcare assistants (HCAs) and maternity support workers (MSWs) to properly reflect the work they do. All our Band 2 HCAs and MSWs have been re-banded to Band 3 and will receive backpay to cover the period since October 2021. 

Our staff survey

The results of the 2024 NHS staff survey have been published and our completion rate of 55% (number of staff who took part) is our best in over five years. For the first time, more than half of colleagues in every staffing group (including senior doctors) and every demographic filled out the survey. It shows that people are more confident to speak up and influence decision making.

The results reveal that more of our staff are happy with the standard of care we provide and would recommend our Trust as a place to work. The areas where we need to continue to improve include staff burn out, discrimination because of ethnic background and violence and aggression at work. 

We will spend the coming months ensuring we act on what we have been told. Each clinical group will create an action plan specific to their area and the Board will be provided with regular updates on progress. 

Improving urgent and emergency care

March was our busiest month ever, with 31,186 A&E attendances. On one day alone, 813 people came to Queen’s Hospital seeking urgent and emergency care. Despite this, our overall (All Types) performance was 78.4%. We saw an 11% improvement between 2023/24 and 2024/25. 

The NHS target is for 78% of patients being admitted, transferred or discharged within four hours. We were one of only 32 acute trusts to achieve this. Our March performance placed us 6th out of 18 acute trusts in London and 28th out of 121 in England. 

We have more work to do on our Type 1 performance (the most seriously ill patients) which was 54.7%. We saw a 7% improvement between 2023/24 and 2024/25, however our March figures show that one in two patients waited more than four hours. 

£35m campaign for a new A&E at Queen’s Hospital 

One of the ways in which we will improve our Type 1 performance, eradicate corridor care and reduce long waits is by transforming the A&E at Queen’s which is one of the worst designed in the country. It will also save around £100k every month, which is the cost of the additional staff we are using to care for patients on beds in the corridors of the A&E at Queen’s. 

We’ve launched a campaign to secure the £35m needed and have commissioned architects to draw up detailed designs. A full business case will be ready later in the year.  

We’re grateful to our MPs for their support. Margaret Mullane (Dagenham and Rainham) has set up a petition and Julia Lopez (Hornchurch and Upminster) raised the issue in the House of Commons. 

In his response , Wes Streeting, the Health Secretary and MP for Ilford North, said: “As she alluded to, this A&E serves my constituents too, so this will be a rare occasion where, at the dispatch box, I urge her and encourage her to lobby My Honourable Friend the Minister of State for Health, because in such decisions I must recuse myself, but she’ll know where my sympathies lie”. 

Patients with mental health needs

The experience of patients with mental health needs who wait in our A&Es, before being transferred to a more appropriate provider, continues to be unsatisfactory and there is no obvious resolution in sight. We hope the opening of additional assessment capacity at Goodmayes Hospital (a specialist mental health provider next door to KGH), which is run by NELFT, will have a beneficial impact. The ambition is to ensure suitable patients go there, rather than to one of our A&Es. 

In March, we referred 389 patients to mental health services. They waited an average of 23 hours in our A&Es, before being moved to somewhere that could offer them the support they needed. We’ve appointed a senior mental health nurse to help improve the experience of these patients and deliver some therapeutic benefit while they are under our care. 

KGH and Queen’s receive a significant number of Section 136 patients , even though we aren’t a specialist mental health provider. The figures for April 2023 to March 2025 show that 251 patients were brought to Queen’s; 272 to Goodmayes; and 435 to KGH. 

One positive development is that we are opening a dedicated room in the A&E at Queen’s for children and young people experiencing mental health issues. In a busy, noisy department where the lights are on 24/7, this safe space will provide a much needed, calmer environment. It’ll be run by mental health colleagues who will provide the necessary specialist care. 

Cutting our waiting lists

We continue to perform strongly when it comes to our provision of elective (planned) care. NHS England has set us a target, to be achieved by March 2026, of 71.4% of patients waiting no longer than 18 weeks from referral to treatment (RTT). 

In March this year, we were the best acute trust in London for RTT performance. Ours has been improving month on month since last July and was 69.85%, an 8.7% improvement on the year before. 

The biggest challenge to our hitting the 71.4% NHS target is the introduction, in the autumn, of our much needed electronic patient record (EPR) and the adverse impact it will have temporarily on performance, as colleagues adjust to working digitally. The benefits of EPR for patients and staff will be significant. At the moment, we have nearly 600 different paper forms across our organisation that are produced, printed and administered manually. 

The total number of residents on our waiting list increased slightly in March to 57,240. Nine out of 10 of them need an outpatient appointment with one of our specialists. Another of the NHS elective targets that we must achieve is for no more than 1% of the people on our waiting list remaining in this position for more than a year. 

In March we were at 1.03%, with 590 patients waiting more than 52 weeks for their first treatment. This is an impressive and sustained improvement, especially when you consider we had 1,934 people waiting more than a year in May 2024. 

Our cancer performance

At any one time, we have around 4,500 residents who are either waiting to find out if they have cancer, waiting to start treatment or undergoing treatment. Our priority is to tell people as speedily as possible whether they have the disease and, when necessary, to start treatment as quickly as possible. 

We met all of the cancer targets in February and expect to do the same for March. We will need to improve our cancer performance to meet the new targets the government has set for March 2026 and we will work with each tumour group to identify ways of improving the care we offer. 

We also met the target for diagnostic waiting times for an 11th consecutive month. Our Community Diagnostic Centres at Barking Community Hospital – which has been open for a year - and at St George’s Health and Wellbeing Hub in Hornchurch will allow us to carry out an extra 94,000 scans and tests a year. 

Our Chief Nurse Kathryn Halford  

Kathryn is leaving our Trust after nearly a decade as Chief Nurse . At a recent staff meeting, a senior nurse spoke of how Kathryn had “changed the face of nursing at BHRUT”. She has promoted opportunity through the apprenticeship scheme and had an unrelenting focus on quality. She was the backbone of the organisation’s leadership throughout some very testing times, including the Covid pandemic. 

I’ve really enjoyed working with Kathryn and will miss her. On behalf of the Trust, I’d like to wish her the very best with all of her new endeavours, including taking on a key role at the Care Quality Commission. 

Matthew Trainer

Chief Executive

May 2025