I am pleased to provide my update for February 2020 for the Board’s attention, my second since my arrival at our Trust. I continue to be welcomed warmly wherever I visit and to be impressed with much of what I have been observing. One of the events that I attended recently that has particularly stuck in my mind was a celebration of our apprentices and what they bring to our Trust. It was a really inspiring occasion. We have 302 members of staff currently undertaking an apprenticeship. This number includes those recruited as apprentices and existing employees who are using the scheme to further their development.

It is still early days and I remain keen to listen and learn. However, it is already obvious to my senior colleagues and I that there are three crucial priorities for us to focus on in the coming months – operational excellence, culture and partnership with purpose.

Operational excellence

We need to ensure we don’t lose sight of our core business and we need to manage our hospitals better. It is our responsibility and when we get it right, I am confident we will be at the front of the queue when we request funding for the digital transformation that will have to take place in this new decade. Some of our performance data is rightly a cause for concern for the politicians and the campaigners who hold us to account for the services we provide.

Constitutional standards

Our performance against the four-hour target is not where it should be. In January the figure was 69.52% which is a two per cent improvement on the month before, however it still falls short of our agreed target set with our local system of 80%. 

We have established a unit for our frail elderly patients at King George Hospital (KGH) to help to address our performance.  One of its objectives is to prevent unnecessary admissions. Within the first three weeks of its opening, we saw an increase in the number of patients being discharged on the same day and a reduction in the number that were admitted. 

Improving our urgent and emergency care performance will feature prominently in our Operational Plan for 2020/21 which we are working on at the moment. The plan will also capture the work we will be doing on quality, culture, training and our finances. It will be drawn up with our divisions so they have a sense of ownership of what they will be delivering in the next financial year.

One of the consequences of our emergency performance has been that the Care Quality Commission (CQC) carried out unannounced inspections of our two Emergency Departments (ED) last month. We were one of nine Trusts who have been inspected in this way during the winter. As with previous visits there are areas for improvement and we are working with the CQC on our action plan. 

Financial recovery

Our year to date results for January show a deficit of £41.9m which is £7.1m behind our plan for this financial year. The underlying trend is of £5m deficit per month.

We are not delivering the transformational change that is required to support our financial recovery. So we are now looking to free up some of our staff, including clinicians, from their day jobs so they can help to design our future. I am acutely aware of the inevitable tension this creates between our need to stabilise the organisation on a day to day basis while also attempting to transform it for the years ahead.

Our programmes of work will focus on reducing the number of unnecessary outpatients’ appointments; reducing waste and improving inefficiencies in planned care which will see savings through better use of our theatres; and on urgent and emergency care where we need to reduce our spend on premium staffing costs.

One of the many ways that we are attempting to reduce our expenditure is by taking a fresh and forensic look at our PFI contract for Queen’s Hospital. The contract runs for 36 years, costs us £64m a year and the contract itself fills over 25 thousand pages! We have an excellent relationship with our contractor Catalyst that we want to sustain, but we are also duty bound to deliver value for money to our organisation.

Coronavirus (Covid-19)

As you will be aware, cases of a novel coronavirus, which originated in China, have now been diagnosed in the UK. The coronavirus is a respiratory infection, similar to the flu. The latest strain of the virus has now been named Covid-19. (You can view the latest information from the Department of Health).  We have processes in place in line with national guidance; we are carrying out training with a range of staff; and we are continuing to monitor and review the situation.

Maternity

We continue to be concerned about the growing numbers of women who are choosing to have their babies at Queen’s Hospital. The increase is being driven by women who are outside of our catchment area who are booked to deliver with us. I know my predecessor, Chris Bown wrote to our commissioners last year. I will be doing so again as I seek a system-wide solution to this issue.

Culture

I want to build on the work that has already begun to transform the culture of our organisation. We need to address behaviours, accountability and how we recruit and retain our workforce. Our PRIDE Way improvement methodology will underpin all of this. An important first step is to re-set our clinical engagement.

Caring for doctors, caring for patients

It is indisputable that if we get our staff experience right then the experience of our patients improves. It’s a topic that has come up in several of my conversations across our organisation. Added to this, the General Medical Council has decided to extend its enhanced monitoring of our acute internal medicine programme to the foundation trainees in the department. We are using the fact that we sometimes don’t care for our junior doctors as best we could as a springboard for a deeper conversation about fashioning a radically new approach to medical engagement. It is a conversation that has our divisional directors at its heart. Together we will produce a plan that won’t flinch from looking at workloads and safe medical staffing, team working and training and the importance of consultant leadership.

Recruitment and retention

It is an issue that bedevils many NHS organisations and I am pleased with the progress we are making on many fronts to secure a sustainable workforce. Last year we recruited 23 substantive consultants, ten more than the year before. However, we still have 40 consultant vacancies at our Trust. Three of our new consultants, who joined in January, are Dr Taha Aldeen who is a dermatologist; Dr Ranjith Varkey Joseph, a paediatrician with an interest in paediatric oncology; and Dr Lunik Sarder who works in emergency medicine.

The nature of the work we do at our Trust is obviously one of the factors that influences potential future employees. I am therefore delighted that following a re-organisation of primary brain cancer treatment in north east London (to create a shared, integrated pathway between us and Barts Health) some Barts Health patients will have their main surgical treatment at our Trust and some of our patients, depending on their clinical need, will have their procedures at the Royal London Hospital. Together, over the longer term, we will form a joint Neurosurgery Centre.  Clinicians from both trusts have worked for some time with the local cancer alliances, commissioners, patients, the public and the wider health economy to achieve this first step on the path to realising this goal.  

Our nursing workforce has been bolstered by 48 recruits from the Philippines who started working with us since the end of last year. An additional 32 recruits will join us this month.

Staff survey

 

I mentioned last month that close to six out of every ten members of our staff took part in the annual NHS Staff Survey which is our highest completion rate in fifteen years. The results have just been published and are very pleasing. They show what I would call “green shoots” as we are beginning to head in the right direction. Out of the 11 themes considered in the survey (covering such topics as team working, morale and health and wellbeing) ten have shown an improvement and seven have shown a significant improvement on the year before.

Staff Awards

I am looking forward to attending my first annual PRIDE Awards next month when we will recognise those members of our staff and volunteers who have gone above and beyond what would be expected of them normally to care for our patients. We received 130 nominations for categories that include Outstanding Leader, Team of the Year and Collaborative Working.  

Partnership with purpose

As well as meeting as many members of staff as possible, I have been meeting a wide range of our stakeholders and also some of our residents when I attended listening events in each of our three boroughs as part of our continuing work on our clinical strategy.

Clinical Strategy

We are getting to the position where we will soon be able to share our latest thinking and use it as a catalyst for on-going conversations with our politicians and residents as we engage with them on what we are proposing to do. While this is going on, work will also need to begin on an out of hospital strategy for Barking and Dagenham, Havering and Redbridge (BHR).

Time and again, in my conversations with those in local government, with residents and with GP representatives, the frailty of the primary care provision in BHR has come up.  Our plans to develop an integrated provider group with our neighbours, the North East London Foundation Trust (NELFT), does provide us with an opportunity to address this challenge together. The exciting plan to set up a BHR health and social care academy to train NHS, local authority and primary care staff, should also help in this regard.

Group Model

We are in the process of appointing a Director of Transformation and a small team that will drive forward greater collaboration between us and NELFT. Among their tasks will be to ensure we are crystal clear on the benefits to our patients of this move and to establish the priorities of the new group. I will provide updates on their progress in the months ahead.

Tony Chambers   
Interim Chief Executive      
February 2020