“I feel like I am now living my second life” is the inspiring way Rohit Patel characterises his existence after three months as one of our Covid-19 patients. Rohit’s story of recovery – and those of many other patients including Steve Attfield – helped to sustain us during the difficult times of the crisis when we paused to remember the 418 patients who tested positive for Covid-19 and died.

I will be forever grateful to all staff and partners who helped us navigate a way through the first peak of the pandemic. At its height, we had 20 Covid-19 wards. We now have four. We have tried to capture what worked for teams and we have drawn these lessons together in a No Going Back delivery programme. It is a manifesto for change, and I owe it to my colleagues to deliver it. Several of them, such as Ed Bettany, a long-standing consultant, have taken the time to reflect on the experience of working at BHRUT at this time. 

Risk assessments

An obvious and painful outcome of Covid-19 - that the NHS is currently grappling with - is the fact that it has had a disproportionate impact on BAME communities. One of our practical responses has been to ensure that all relevant staff have completed risk assessments. Bev Thomas, Divisional Director of Nursing for Acute Medicine, wrote a blog in which she stressed the importance of the assessments and reflected on the death of George Floyd ; her message was reinforced by Farukh Hussain, the Co-Chair (with Bev) of the Ethnic Minority Network;  and Rosemary Idiaghe, Consultant Midwife for Midwife-led Care, told staff about the work she is doing around cultural awareness.   

Along with all other trusts, we have been compiling our data on how many risk assessments have been undertaken. We are striving to get them all completed, and we will provide a verbal update at the Board meeting. We have a BAME Task and Finish Group established to oversee this and we will continue to work with our Ethnic Minority Network to ensure it is done. I really appreciate the commitment of all those involved, and we will evaluate the risk assessments so we can learn from the information that has been provided.

It goes without saying that the risk assessments are just one aspect of the work the Trust needs to undertake. A glance around the Board table – even when it is meeting virtually – shows that it is not truly representative of the workforce, or of the communities we serve. 

Living with Covid

The risk assessments are a crucial part of what we are doing as we continue to adjust and reset BHRUT to living with Covid for the foreseeable future, and as we prepare for the onset of winter and the possibility of a second surge in the number of virus cases in Barking and Dagenham, Havering and Redbridge (BHR). All of this must be done in step with our plans to reduce the deficit, year on year, which in the first instance requires us to deliver a monthly run rate of £4m by March 2021. We must also spend wisely the £35m of capital we have been allocated.

Since last month, the UK’s Covid-19 alert level has been downgraded from four to three, indicating that the virus is considered to be in general circulation. Under level four, transmission was judged to be ‘high or rising exponentially’. We are treating four Covid-19 positive patients (at time of writing) at Queen’s Hospital and we have none at King George Hospital (KGH). This is a significant reduction when compared with the peak.

In the coming months, we need to plan for winter; exploit the opportunity offered by the reduction in the number of Covid patients to clear as much of our planned surgery backlog as possible; and stay alert in case the status quo changes and we need to react, in partnership with our BHR public health colleagues.

Even though the first peak has passed, the two hospitals continue to look and feel very different to how they were before the virus struck. Infection prevention and control (IPC), quite rightly, dictates how we operate now and will operate, well into the future. The differences are most obvious at KGH. We introduced coloured zones at KGH so we could restart the routine, planned surgery that we had to pause during the peak.

Resuming planned operations

Ana Duarte was one of the first patients we treated and her message about her positive experience  was helpful as we are still encountering people who are scared and unwilling to come in for necessary treatment. We started off slowly and now have seven theatres and eight ITU beds available at KGH so we can undertake more complex, planned surgery.

We are also working with Care UK colleagues at the North East London NHS Treatment Centre (NELTC) to use four of their theatres. To support all of this work, we installed a dedicated CT scanner in just a few days which was no mean feat and a credit to those involved. The creation of zones, so we can carry out planned operations safely, will also take place at Queen’s where we have recently created a so called ‘green’ pathway so we can carry out endoscopies at the hospital.

Waiting lists

In this way, across both hospitals, we will start to reduce waiting lists. We are prioritising patients in terms of clinical urgency and identifying those who need to be seen within two weeks, four weeks and three months. Given the understandable national focus and concern there is around waiting lists, we are working with other acute trusts in north east London (NEL) to ensure we manage our shared resources as efficiently as possible.

None of the trusts can do this on their own, but together, Barts Health, Homerton and BHRUT are making a concerted effort to co-ordinate and deliver the care our populations need. This emerging, executive-led alliance is a practical example of the partnership with purpose that I am keen to see taking place across NEL and across BHR. 

We understand that the extra waiting time can cause anxiety and we have written to those affected. We have faced particular challenges in our breast and skin cancer specialties where, last month, we increased capacity and recruited locum staff to help to deal with these particular backlogs.  

Endoscopy

Endoscopy is another area of national focus. The IPC measures we must follow have resulted in a significant reduction in the capacity available to do such work. To mitigate this, we are working with the private sector; carrying out such procedures over 12 hours in any given day, rather than just eight; and working with NHS England to develop community diagnostic hubs to increase capacity. The plan is to base the NEL hub at KGH which will complement the planned Mile End Diagnostic Centre and the proposed development at the St George’s Hospital site in Hornchurch.

Paediatric services

One of the consequences of all of the constraints we are operating under is that inpatient paediatric services continue to be at Queen’s. Another paediatric challenge we are facing is that a few consultant paediatricians are shielding and may continue to shield for some time.

Mechanical thrombectomy

A service that is going from strength to strength is the one we offer to acute stroke patients. We are now providing a mechanical thrombectomy service (a procedure where blood clots are removed from the brain) seven days a week at our Hyper Acute Stroke Unit at Queen’s. Loren Dixon is testament to the life changing benefits of this procedure.

ED performance

The wellbeing of patients like Loren is, and always will be, our number one priority and this is why we are redoubling our efforts to improve waiting times in the Emergency Departments (ED). We accept the status quo isn’t good enough and we need to do better.

By September, we want to be seeing 90 per cent of all ED patients within four hours. To help us achieve this, we’ve opened a same day emergency care service at Queen’s and we’re working with community healthcare colleagues to ensure the most appropriate care is in place for patients who need urgent and emergency treatment. 

KGH Frailty Unit

Our Frailty Unit, which we’ve just re-opened at KGH (it was closed during the height of Covid) should also help with our ED access times. It brings together experts from across the clinical teams who will provide rapid intervention to help frail and elderly patients avoid long waits in ED and, where possible, return home on the same day. We’re working with partners to ensure such patients only stay in hospital when absolutely necessary.

Pioneering BHR Health and Social Care Academy

I have mentioned the priority we place on patient care. We must also place a similar one on the wellbeing of our staff and on retaining them once they have been recruited. This is why I am excited by the plans for the development of the BHR Health and Social Care Academy. Working with BHR partners, the goal is to help those involved offer productive and interesting careers for people living in the communities we serve and to recruit and retain staff.

Nurse retention on the BBC

A ground-breaking scheme to retain our nurses was filmed by the BBC and each of the five programmes, broadcast in the morning on BBC One, was watched by an average of nearly 900,000 people with the episodes performing well among younger viewers.

On the subject of media coverage, I was pleased that ITV London wanted to spend time with our critical care staff and I would really recommend that you read this article in the Evening Standard that captures the dedication and resilience of some of my colleagues.

Happy Hospitals

I want our hospitals to become the happiest and healthiest ones in the UK. Staff happiness and organisational success are inextricably linked, and success can be measured by the care patients receive. As my report shows, the pandemic has cast a light on the amazing work colleagues do every day. They deserve to work in an environment where they can be at their best and we know patients will benefit as a result.

We have learnt that if we give freedom to the front-line; connect people with a common purpose; look after their wellbeing; break down hierarchy; lead compassionately and inclusively; and empower teams to collaborate and innovate, we can achieve much more.  Our staff do not want to go back and, as I have stressed already in this report, I am determined to deliver on this desire.

To help us achieve a safe and respectful environment, which is a pillar of The PRIDE Way, we will analyse our staff experience pulse check and this, alongside our culture programme, will inform our first manifesto. It will outline a vision for happy and healthy hospitals and the role of the leader in making them a reality. In the coming months, our priorities will be supporting individual and team wellbeing; developing compassionate leadership; improving diversity and inclusion; and building the BHR Health and Social Care Academy.

Support of West Ham United

Throughout Covid-19 we have received an amazing level of support from a wide range of individuals and organisations, including the donations of more than 100,000 meals for staff. One of the organisations that has decided to support us on an ongoing basis is West Ham United. The club has agreed to raise awareness for our charity and help them with their fundraising.  

We have many ‘Hammers’ fans among patients and staff and the team’s left-back, Aaron Cresswell made a video call to some of them – including, as you can see, one particularly passionate individual who hasn’t yet taken to wearing a claret and blue scarf when chairing the Board meetings!

Tony Chambers
Chief Executive   
July 2020