I am pleased to provide my update for March 2020 for the Board’s attention and as you can imagine there has been an increasing focus on ensuring we are as well placed as we can be to deal with the ongoing coronavirus (COVID-19) outbreak. Across our hospitals, we are following the national guidance to keep our patients and our staff safe, including training staff in managing suspected and confirmed cases. At the time of writing, we have made the decision to cancel all routine elective surgeries. We will still carry out cancer, day case and emergency surgeries.

We have set up an Incident Coordination Centre at Queen’s Hospital which will help us to respond to any eventuality. Our incident response team will co-ordinate our management of the situation, as well as making sure we are aligned with the rest of the NHS. We are also working closely with our healthcare partners to ensure we have everything organised that needs to be.

Last week, one of our patients - who tested positive for COVID-19 – sadly died. They were very unwell and had significant other health conditions. Our thoughts and condolences are with the patient’s family and loved ones at this difficult time.

As you know, the situation is constantly changing. You can visit the NHS website and our Trust website for information.

Operational excellence

Constitutional standards

Towards the end of last year, we saw a decline in our four-hour emergency access performance which we have begun to redress. In February the figure was 70.33% which falls short of our agreed target set with our local system of 80%. The improvements we are seeing, so far, are down to the changes we have made at KGH where we have established a unit for our frail elderly patients. One of its objectives is to prevent unnecessary admissions. We have also just launched an acute frailty service at Queen’s Hospital which has the same goal.  

We want to relieve the congestion in our two EDs and to encourage our specialist doctors to see and treat the patients who have been referred to them away from these very pressurised areas of our hospitals. This way we will only have those patients in the emergency departments who absolutely need to be there. I accept that, at the moment, the experience in our EDs for our patients and our staff is not as good as it should be. The work we are undertaking should mean we are in a better position to face the inevitable pressure that will continue to occur this winter. 

Ward accreditation

We have introduced a ward accreditation programme to improve the quality of the care we provide, to promote better patient safety, and to share best practice. Wards will be assessed and graded and given extra support for any areas where they are found in need of improvement. They will be assessed on patient experience, patient safety, staff experience and efficiency. Assessments will involve patient and staff interviews; observing the ward in action; and reviewing documentation and data packs.

Financial recovery

Our year to date results for February show a deficit of £49.9m which is £3m behind our plan for this financial year and includes £7.9m of non-recurrent adjustments (including £5m of support from the wider system). When our position is adjusted, for these non-recurrent items, the deficit stands at £57.8m which is £10.9m behind plan. To achieve a sustainable financial future, we need to reduce our agency spend; remove waste from the elective pathway which would result in greater utilisation of our theatres; and reduce the number of unnecessary outpatients’ appointments.  

Annual Plan

Many of the topics I have written about in this section of my report were discussed at length during a meeting of our senior leaders we had last week where we worked on our Annual Plan for the next financial year. It will contain five key goals: sustainable finances; operational excellence; reducing unwarranted clinical variations; daily management of wards; and transforming our culture, so the experience of patients and staff continuously improves. It is being drawn up with our divisions and I am determined to further strengthen the way our senior Executives and our Divisional Directors work together.

Robotic surgery

As a Trust we are always delighted when we can introduce new equipment that will improve care, enhance the skills of our clinicians, and make our hospitals attractive places to work. Thanks to the generosity of our charity we have now joined those other hospitals who have a da Vinci Xi robot that can be used to perform complex operations. Our staff are currently being trained to use it and, so far, we have performed four colorectal resections. Three of the operations were for colonic cancers and all four of the patients have recovered well. Our intention is to use the da Vinci Xi shortly for rectal cancer and pelvic cases.

Culture

Respect for People

We will soon enter the next crucial stage of our ongoing work to transform the culture of our organisation - into one where people are eager to join and keen to stay - when we launch our Respect for People behaviour framework. The ten behaviours are the foundation for how we should work together and provide the framework against which we will hold each other to account. They will apply to everyone, regardless of their position. The intention is that we all build on our own strengths and improve on the areas where, at the moment, we, as individuals and as teams, don’t always do as well as we should, so that we foster a culture where all our staff feel included, valued, and comfortable to challenge and raise concerns safely.

Virginia Mason Institute

Our Respect for People framework has been adapted from the one that is being used successfully by the Virginia Mason Institute (VMI) in Seattle. We have been working with them in recent years to embed what we have called The PRIDE Way, which focuses on leaders empowering and supporting their staff to identify and implement improvements, and to do this consistently through a range of standardised tools. With our Chief Operating Officer, Shelagh Smith, I was fortunate to visit VMI a few weeks ago. It was a thought-provoking trip that demonstrated what can be achieved when an organisation’s leadership is focused and consistent. VMI have aligned their vision, goals and daily management with a well-defined report out structure, all of which I am keen to replicate at our Trust.

Volunteers and patient partners

The culture of our Trust is nurtured and enhanced not just by our staff but also by our volunteers and patient partners. Whilst I would not usually single out individuals, I would like to on this occasion because one of our patient partners will have marked two key milestones in her life by next month. Sara Turle, who works with our Cancer and Clinical Support colleagues, has celebrated a significant birthday and in April it will be ten years since she first went to her GP with a lump in her breast. After her successful cancer treatment, she has dedicated herself in recent years to supporting us. I am grateful for what Sara and all our volunteers and patient partners do for us at our Trust.

Recruitment and retention

To achieve the ambitious goals that I referenced earlier that will be in our Annual Plan we need to recruit permanent staff (so we are less reliant on more expensive agency workers) and we need to retain them. I am therefore pleased to report that last month Dr Adam Ainley joined us as a respiratory consultant and Dr Abbas Zaidi moved from being a locum in haematology to a substantive position. We have also appointed Dr Ignatius Postma and Dr Suhier Elshowayay as clinical leads, for the next six months, in the Emergency Department and in Acute Medicine. 

Partnership with purpose

Primary care

We will continue to improve the way we work with and support our GPs in Barking and Dagenham, Havering and Redbridge (BHR). We need world class primary care in our three boroughs, otherwise our hospitals will struggle. We are open to joint roles that straddle primary and secondary care and to aligning our leadership structures where it makes sense.

With NELFT, we are working closely with the Primary Care Networks (PCNs) - and with the GP Federations – to support their development. Our two organisations are developing a strategy for how the acute sector, mental health and community care supports primary care in the future.   

Working with our partners across north east London

The aim of this work is to establish areas where we can work together, with trusts like Barts Health, to improve and jointly deliver some specialist services. The ongoing conversations this month have touched on a range of specialties including neurosurgery, vascular and thrombectomy.

The BHR system

It came together recently for what was called a ‘simulation workshop’ that was attended by all the key representatives of the organisations that provide health and care in our three boroughs. The purpose of the exercise was to imagine that a BHR system was up and running and to work through some of the issues – how would the money flow when local councils and the NHS would be working more closely together? How would decisions be made? I felt it was a very productive event and I sensed a real willingness in the room to make it work for the benefit of our patients.

Group Model

I am really pleased that we have successfully appointed Caroline O’Donnell as Deputy Director of Transformation for the group we are forming with NELFT. Caroline currently works at NELFT and will take on this new role in May, for the next 18 months. Caroline will work with others on driving forward our collaboration and further developing the benefits for patients of the new group and its priorities.

Tony Chambers   
Interim Chief Executive       
March 2020