It is really heartening to report that the number of Covid-19 patients continues to reduce, and we are now down to nearly a tenth of the figure we had at the height of the second wave. The fact more than 4,000 of those we treated recovered and went home is a considerable fillip for our staff who have had to contend with so much. When Frederick Stratford was discharged, he told us “I’ve been married for 60 years and I cannot wait to get home and cuddle my wife”.

While the virus may be in retreat – and we can see a future where freedoms we once took for granted are returned – its impact is still being felt by those who are recovering and by those who have been bereaved. In the coming days at our Trust, we will mark the first anniversary of when the World Health Organisation declared the outbreak a pandemic.

Our vaccination programme

The reason many of us are feeling more optimistic about the future is due, in no small measure, to the ongoing success of the vaccination programme. We are grateful for the support we have received to set up our hubs at Queen’s Hospital and King George Hospital (KGH), including from Sharon Wright who came to our aid after she couldn’t return to her home in Barbados.  At both hubs, we have started to offer the second dose within the agreed 12-week timeframe. This month we have vaccinated our 20,000^th person.

So far, three out of every four of our substantive staff have been jabbed. We have devoted a lot of our efforts to working with those who are hesitant. In a video - that has been shared widely across north east London (NEL) - Aruna Ramineni, one of our gynaecologists, addressed concerns about fertility and her colleagues, Remi Odejinmi and Anushka Aubeelack spoke about why it was so important for them to be vaccinated.

The wellbeing of our staff

We are very conscious of the fact we must do more than just talk about the priority we are placing on ensuring our staff recover from the impact of Covid, at the same time as we attempt to return our services to how they were before the virus struck. So, I am pleased concrete measures have begun to be put in place, and more will follow.

Our immediate focus is on psychological support; improved provision of food and drink; and rest areas receiving a makeover. We are talking with our staff to ensure that what we are proposing is what will actually improve their day to day working lives. Our staff survey results, published this month, will provide us with another opportunity to listen, to learn and to improve. In the longer term, we will need to consider how we best recognise the extraordinary contribution our employees have made during the course of what has been a punishing twelve months.

Four-hour emergency access standard

We owe it to our residents and to those who become our patients to stabilise our performance in our two Emergency Departments (ED) and to reduce variation. We are seeking a week-on-week reliable increase in the numbers of people we admit, discharge or transfer within the required four hours. To help us arrive at this goal, we have a whole hospital improvement plan. It includes work on the culture of our organisation and on improving behaviours such that an ED consultant is empowered to admit a patient to a ward without hurdles being placed in their way.

We also need to address the mismatch that exists – and is evident in our data - between the demand for beds and our current capacity. The status quo adds to delays. Across Barking and Dagenham, Havering and Redbridge (BHR) we are working with partners to review capacity and opportunities to manage the demand. We will look at the workforce that would be required, physical capacity and models of care.

Planned (elective) care

We have started to resume services – in surgery, diagnostics and outpatients – that we had to pause during the height of the second wave. All planned (elective) work at both hospitals stopped at the end of last year so that staff could be redeployed to Covid wards. Face to face outpatient appointments were limited to urgent ones and 2 week wait cancer appointments.

Endoscopy is now back at Queen’s; cancer and urgent diagnostic endoscopies have continued at KGH; and, towards the end of last month, some of our higher priority planned surgeries resumed.

The challenges we face are considerable and we will be helped by the fact our recovery programme will be aligned with others across NEL and we will work with partners including GPs and the North East London NHS Foundation Trust (NELFT). After the first wave, we spent three months reducing our numbers waiting more than 52 weeks. It took just three weeks, during the second wave, for it to return to the level it was at before our remedial work had begun last summer. We now have more than 2,000 patients in this category.

Our initial focus, for the next three months, will be on clearing our backlog of priority patients (known as P2 patients). Our target, for the end of May, is to be at 70 per cent of the business-as-usual activity we achieved in the same month, two years ago.

Our finances

Our financial position is neither fair nor sustainable. We spend just over £1m, each and every week, more than we receive. We intend to breakeven by the financial year 2024/25. One significant way of doing this will be to remove the excess £20m we currently spend each year on agency and bank staff. These premium costs are significantly higher when compared with most other trusts in London. As we reduce such staff and replace them with permanent ones, we are determined to ensure we don’t end up increasing our headcount.

We also believe we can save £20m each year by carrying out our planned surgeries more efficiently. Once again, we will build on the strong relationships we have established, not least with our place-based partners, to deliver a joint financial recovery plan that will have the backing of our partners in BHR and NHS England.

When it comes to our capital expenditure, the picture is an improved one. We have moved from a history of underinvestment – we received just £7m in 2018/19 – to funding projects in this financial year totalling £46m. Some of this work includes relocating the Urgent Treatment Centre at KGH and creating a Children’s and Young People’s Assessment Unit at Queen’s.

A new BHRUT – working in partnership to improve health and care

If delivering these four recovery programmes were not enough – the wellbeing of our staff, urgent and emergency care, elective care and our finances – we also need to re-imagine the role of modern acute hospitals and our relationship with the populations we serve.

Covid-19 has had a devastating impact on BHR, three London boroughs where deprivation and inequality are significant factors. Our hospitals have witnessed unprecedented pressure as we’ve dealt with two significant surges in demand caused by the virus. The long-term impact on our staff, who have responded phenomenally well, isn’t yet fully known. They are exhausted and we are asking for more.

Change, against the backdrop of a pandemic, won’t be easy. But change – where we build on recent collaboration – and establish, for example, better children’s services across NEL is an exciting prospect.

It is our duty to strive to provide improved health and care. The latest reforms planned by the government are designed to ensure health and care services work more closely together and for the NHS, in the words of the Health Secretary, to become “more integrated, more innovative and more responsive”.

The internal case for change

We need to be honest about shortcomings in recent years as we fashion a more attractive future. At times, those working at our Trust have been failed. They are less happy than most and more pressurised than most. Our annual staff survey results have shown occasional green shoots and plenty of evidence of discontentment.  Some of our staff have been victims of bullying, discrimination and racism. Our diversity – within our staff and the people we serve – must become our strength. We need to address past failings and we need to deliver on equality and equity, so they’re not just hollow words.

We must demonstrate how – with aligned locality delivery structures in place – we will hold people, at all levels, accountable for their actions.

The external case for change

As little as ten per cent of our health and wellbeing is linked to access to healthcare. We can no longer function just within the physical confines of our two hospitals. We want to be part of a future where we can exercise a positive influence on health inequality and where, crucially, we help to keep our residents well so that we don’t end up treating them when they become unwell. We can do this by working even more closely with our GPs, community services, local authorities and the voluntary sector.

We are facing significant population growth in BHR. There is too much unwarranted variation across NEL when it comes to productivity, service quality and clinical outcomes. Someone shouldn’t receive a poorer service just because of the street in which they live. Care is fragmented in the three BHR boroughs and too many people end up in hospital rather than being treated in the community or at home.

Our longer term goals

Our short-term priorities have been articulated earlier in this paper. When it comes to our longer-term goals, we want to continue to provide high quality care; reduce inequalities; and improve access by working even more collaboratively than we do now, across organisational boundaries. The evidence is there for how it is already working, in practice, when you look at the way all partners have come together to manage emergency flow and at the fact there’s a unified NEL approach to recruiting Covid vaccinators.

We want to play our part in developing new models of care – rooted in neighbourhoods – that are of a consistently high standard in all three boroughs. We want to reduce variation in clinical practice and make better use of a workforce that is currently employed by different parts of the health and care sector. One of the prizes would be to achieve transformational improvements in the way all the different parties manage someone with a chronic disease.

Underpinning all that we do will be a focus on better health, better care and better value. These principles will apply whether we’re working with other health and care providers at a borough level, where we will help to develop locality leadership, with our Trust as the place-based NHS leaders; with fellow NHS providers at a BHR level; or with the other acute trusts in NEL, where there is the potential for very strong collaboration with Barts Health and the possibility of shared clinical roles and ‘back office’ services. This will deliver both quality improvements and efficiencies.

We see a future where this place-based care will encapsulate the London vision for starting well, keeping well and ageing well. KGH should grow into a leading centre providing elective (planned) care; Queen’s will be a significant setting for urgent care, children and young people, chronic diseases and the neurosciences; the Goodmayes campus could become a centre for rapid diagnostics, integrated health and care, and education; and there’s an opportunity at Barking Hospital to think about how we might provide a broader range of services closer to where the borough’s residents live.

We must also harness, as we become more digitally mature, the significant opportunities that will be open to us with virtual services, while also ensuring we use our data to support population health.

The benefits of change

Moving our thinking away from the confines of hospital walls means we will focus more on our residents in BHR and NEL. As a result, we will actively tackle health inequalities, and not just pay lip service to them, and we will improve the health and life chances of many more people than currently cross the thresholds of Queen’s and KGH.

Our staff will, hopefully, be energised by our acknowledgement of what has gone wrong and our determined efforts to put things right. A future, where organisational barriers in NEL are broken down, will offer exciting new career opportunities for our employees. These outcomes - including improving our finances and the quality of care provided across BHR and NEL – will be measurable and demonstrable to our residents.

A future within our grasp

It’s a future with tangible benefits and it’s a future that should be attractive to our staff who have lived through a national crisis. It’s one where fewer babies are born with a low birth weight; those with long-term conditions feel more supported managing their situation; and where our residents can continue to lead independent lives, at home, for as long as they are able.

Thank You

I would like to close with a word of thanks to two of my senior colleagues - Shelagh Smith, our Chief Operating Officer and David Amos, our interim Director of People and Organisational Development - who are both leaving.

Shelagh’s five-decade long career has encompassed work as a radiographer, where she helped pioneer the introduction of CT scanning; a spell in the private sector that included scanning sheep on Stornoway; and 14 years with us as a senior manager. Being Chief Operating Officer at our Trust is a very demanding role, even in non-Covid times, and Shelagh has responded with enthusiasm, passion and equanimity to all of the many and varied challenges that have come her way including, during her last weekend on call, dealing with the failure of one of the water tanks at Queen’s.  One of our senior doctors has spoken of his admiration for the way Shelagh has carried “an immense load, lightly and with humour”.

David’s work has included paving the way for the intense focus we now have on the wellbeing of our colleagues; under his watch, we’ve increased significantly the number of our substantive staff, reduced vacancies and improved retention; and he helped to ensure all our lower paid workers, employed by Sodexo and Mitie, now receive the London Living Wage.

The personal support I have received from Shelagh and David has been invaluable as we navigated Covid, and I am very grateful to have had the opportunity to work alongside them for the past year.