Making progress

When Caroline Clarke, the Regional Director of the NHS in London, visited us recently she spoke of how there was an energy about the place. We are building confidence in our ability to deliver change and we’re making demonstrable progress, as I hope is clear from this report. Our latest adult inpatient survey showed we had improved in nine out of the 10 areas where we were assessed. We’ve moved from the bottom 20 per cent of all trusts, to the middle 60 per cent of trusts who are performing at the same level.

Some of the transformation work has been helped by our collaboration with Barts Health. (The next stage of our closer working – one group, two trusts, seven hospitals – is set out in another of this month’s Board papers.) We received invaluable support from Barts for our successful bid to secure an electronic patient record. It’s a major £44m investment that will improve patient safety by reducing errors and make it better for colleagues to work here. We’ll finally be joining acute hospitals across the capital in moving away from patient records on paper.

We will use the same system as Barts Health and Homerton Healthcare and it’ll mean that medical records will be available to clinical teams across north east London. Our joint working with Barts Health has also extended to improving the transport provided to and from hospital for those who need it.

I’m pleased with what we’ve achieved at BHRUT during my two years as Chief Executive and mindful of how much more needs to be done to ensure all our patients and staff have a good experience. The difficulties we encounter as a Trust are reflected in the Care Quality Commission’s annual assessment of the state of health and adult social care in England.

Our finances

One of the criteria by which we will be judged is whether we deliver our plan and reduce our deficit. We’ve made headway in the first six months of this financial year and we’re on track to exit financial special measures next year.

Half of the overspend is within our direct control and the use of more expensive temporary rather than permanent workers has been a longstanding, contributory cause. We’ve made real inroads here and we received an award last month for this work that has seen our temporary staffing costs cut by around £10m a year.

Additional savings will be realised once we recruit permanent consultants into 70 posts. Our drive to eliminate costly agency nursing will be helped by the fact 281 nurses will join us by December. Inflation and the strikes by senior and junior doctors are having a significant impact. In October, the total cost so far of the industrial action was £8.3m.

Cutting our waiting lists

The strikes have also resulted in the cancellation of 13,036 outpatient appointments and 1,039 non-urgent surgeries. I’ve expressed repeatedly my concern about the affect this lengthy dispute is having on patients and staff - especially our junior doctors - and I remain frustrated by the lack of meaningful negotiations to resolve it.

When Sky News filmed at King George Hospital on one of the strike days I spoke about how preparing for winter, in the teeth of industrial action, was like going into a really tough battle with one arm tied behind your back.

Despite all this, the number of people waiting more than a year for treatment has started to show some encouraging signs of improvement and has reduced to 1,381. In total, we had 64,129 people seeking treatment in September, a slight reduction since July. The majority are waiting for an outpatient appointment with one of our specialist teams.

Those needing planned (elective) surgery continue to be well served. Our elective work is at 108% (when compared with productivity before the pandemic) and our teams have an unrelenting focus on increasing activity and reducing waits. For a second time in two months our ENT (Ear, Nose and Throat) team ran a TonKIDZ week that resulted in 111 children, who’d faced long waits, having their tonsils removed.

We are seeing an improvement in our cancer performance, though we are not yet compliant on the key standards that we are measured against. Some patients experience longer waits for diagnosis prior to treatment and we are working tirelessly to minimise such delays. The state-of-the-art radiotherapy unit at Queen’s Hospital is the first in the UK to receive an upgrade to one of its machines which means detailed images can be taken in six seconds compared to 43 seconds in the past.

Community Diagnostic Centre

Our ability to diagnose promptly will be greatly enhanced when our new Community Diagnostic Centre (CDC) at Barking Community Hospital (BCH) opens next year. The modular building was constructed in Gloucester and delivered, by 23 trucks operating in wet and windy conditions, to BCH at the end of last month. An extra 72,000 scans a year will be available at the CDC and it will offer residents -  particularly those living in Barking - access to CT, MRI, cardiology, ultrasound, ophthalmology and phlebotomy services. Those undergoing more than one investigation will also see improvements in the way their care is provided.

Urgent and emergency care

We are no longer the lowest performer in London when it comes to treating the most seriously ill patients (Type 1) - having moved ahead of six other trusts - and we are out of the bottom 20 per cent nationally. Our Type 1 performance has increased by 20.5 per cent over six months. While this represents a welcome move in the right direction, I know we must do better and I’m sorry too many people still wait too long.

The national standard is for at least 95 per cent of all patients attending A&E to be admitted, transferred or discharged within four hours. A recovery target of 76 per cent has been set with the expectation it will be hit by March 2024.

Our Type 1 performance of 51.3 per cent in September is ahead of trajectory. However, for us to achieve 76 per cent performance for all patients in five months time, we need our Urgent Treatment Centres (UTC) – where the less seriously ill Type 3 patients are seen – to achieve 98 per cent.

Roughly half of the patients who visit our A&Es are treated in the UTCs that are run by PELC, a GP cooperative. Type 3 performance was 75.7 per cent in September and has decreased by 12 per cent over the past year.

As well as working closely with our PELC colleagues, we are constantly looking for ways to improve. We’re opening a new £3m Surgical Assessment Unit at Queen’s; we’ve reduced the time it takes for the handover of patients arriving by ambulance and nearly eradicated delays of more than an hour; and our Same Day Emergency Care departments (SDEC) are seeing an average of 128 patients a day.

SDECs are where patients are moved out of A&E to be assessed and have their treatment (including diagnostics) start on that same day.

One crucial constraint on our efforts to improve at Queen’s is the physical layout of the department, as is painfully evident to anyone who visits. When the renal service at the hospital moves to the new St George’s Health and Wellbeing Hub we’ll have an exciting opportunity to exploit the available space and transform the A&E department.  We are planning a major redesign programme to improve it for patient care and provide our staff with a better working environment.

Virtual ward

Another way we’re improving urgent and emergency care is by developing a virtual ward for frail and elderly patients, especially given that three quarters of our beds are occupied by those who are aged over 65. We’re working with partners to run this ‘hospital at home’ where a multi-disciplinary team, made up of senior doctors, nurses, therapists, social workers and support staff, delivers care in the community. Although we only opened this facility in September, we’re already improving the out of hospital care we can offer this group of patients.

Our virtual ward is a different and exciting way of providing clinical care and we’re looking to extend the model to the young people who use our paediatric services as well as adults with respiratory disorders.

Patients with mental health needs

The average length of stay in our A&Es for those waiting for a mental health service is now more than a day. In September we had 346 such patients, 62 of whom (up from 41 in August) waited more than 36 hours to leave our Trust and move to a service better equipped to look after them. I’m grateful to Channel 4 News for spending time at King George Hospital and highlighting this crisis in mental health provision.

NELFT, our local mental health and community trust, are opening 10 additional mental health treatment beds and two beds for patients with learning disabilities. They are also running pilots where they’re placing mental health practitioners in our A&Es to see if patients can be diverted away from us, as they arrive, to a service that is more appropriate to their needs.

The coming months

I began my report in an optimistic vein and I end on a note of caution. Winter is never easy in the NHS and this year it will challenge our ongoing efforts to turn the organisation into a high performing one.

I am very conscious of the strain the coming months will place on colleagues and I’m encouraging them to use the annual NHS Staff Survey to tell us what it’s like to be employed here, so we can improve. I’m also hosting ‘Have a brew with Matthew’ - monthly sessions where staff can have a cup of tea with me (without booking an appointment in advance) and tell me what’s on their mind.

My ability to engage with everyone across our Trust has been greatly helped by our move to Workplace and away from a more traditional intranet. It’s a safe space where, via a desktop computer or their mobile, colleagues can share ideas, ask questions and support one another. More than 80 per cent of staff claimed their accounts in the first year and a significant proportion of them are active on the platform each month.

We’re the only NHS trust in London that is communicating with staff like this and it's just one of the ways we’re trying to make BHRUT a better place to work which, in turn, will improve the care we provide.

Matthew Trainer

Chief Executive

November 2023