I am delighted to have been given the opportunity to lead an organisation with so many passionate staff and so much potential. Some of it was evident and on display at the HSJ Awards this month where our Academy of Surgery was honoured for the innovative work it does recruiting, training and retaining junior doctors from across the world. We’ve attracted trainees from 14 countries including Iraq, Egypt, Pakistan, India and Sri Lanka.

Improving our culture

I have devoted as much time as I can to getting out and about across the Trust. I’ve met people who enjoy the teams they are a part of, and I’ve been reminded of the life changing procedures we do each day. Many of my conversations with colleagues have touched on the need to improve the overall culture. There is no quick fix, it will take time.

Our staff are entitled to work in an environment where they are treated with dignity and respect; there is a clear understanding of what is expected of them; and they’re given the tools they require to do their job. If the wellbeing of staff is properly addressed, the quality of care for patients is enhanced.

One of my goals is to secure an improvement in the staff survey results. I want us to transform into a high performing trust in which people don’t feel excluded because of a lack of fairness or a lack of opportunity. We must celebrate our diversity and our differences. I will not tolerate bullying, discrimination or racism.

As a first step, I will build a strong and permanent senior leadership team and I will be recruiting, in an open and transparent way, a Chief Operating Officer, a Chief People Officer and a Director of Strategy and Partnerships - I’d like to wish Hannah Coffey all the very best as, next month, she will be leaving us to become the Deputy Chief Executive at Mid and South Essex NHS Foundation Trust.

Partnership working

Another of my goals is to ensure we look outwards as well as inwards. I have met the Healthwatch leads from Barking and Dagenham, Havering and Redbridge (BHR) and I was also pleased to have discussions with many of the senior politicians and leaders in the three boroughs within my first fortnight. We will work with them to establish what services would better serve residents if they were delivered in the community, rather than at Queen’s Hospital or King George Hospital (KGH). In partnership with BHR, we will look at prevention, public health and housing.

As public servants, our responsibility is to the population of north east London and we will care for them better if we develop a mindset that is open to embracing what we can provide from beyond the confines of hospital walls.

Closer collaboration with Barts Health

Our relationship with Barts Health is one that will develop in the coming months. The Right Honourable Jacqui Smith will be our Chair in common from October and she will help the two organisations further the partnership. Clinicians at the two trusts already collaborate in several areas. BHRUT cardiologists helped the Barts Heart Centre address its backlog by setting up a complex device service from scratch and treating more than 40 patients at KGH who needed implantable defibrillators or pacemakers.

As two independent trusts, we will explore where else we can come together to provide this sort of tangible patient benefit. The emphasis will be on improving outcomes and not on changing organisational structures, especially given the challenges facing both trusts in the months ahead.

Urgent and emergency care

A practical and beneficial example of the collaboration can be found in our Emergency Department (ED) where Dr Karim Ahmad has joined us, on secondment from Barts, as the Medical Improvement Director for Emergency Care. Karim will work with our teams as we strive to improve quality and safety in an area where demand continues to be high – in June we saw the highest number of people since the winter of 2019. We regularly remind residents to seek advice before coming to our emergency departments.

The problems run deep and the solutions we are pursuing are wide-ranging.  They require a concerted response from across the hospitals with teams on wards ensuring beds are available in a timely manner. Improving performance against the four-hour emergency access standard is a shared responsibility. Too many people, of all ages, are waiting for too long. This is unfair to them and to our staff who are having to treat people in a difficult and stressful environment. We need to be in a position where we are consistently providing care that we would feel proud to offer to a member of our own family.

We are continuing to improve the way we work with PELC who provide the urgent treatment centres at both sites.  We have implemented Same Day Emergency Care (SDEC) at Queen’s  so we can reduce the amount of time some people spend waiting in ED (and the SDEC should reduce the need for some patients to be admitted to hospital); we are running a training programme for our middle grade ED doctors; and the ED at KGH is being upgraded. It is one of the best designed emergency departments I have seen, and the investment is a reminder that both KGH and its ED will play an important part in the future of the Trust.

In my first week I visited the Beech Frailty Unit and was struck by its warm, compassionate and caring culture. Beech, along with a similar facility at Queen’s, is designed for the elderly to bypass our EDs and be looked after in a setting more conducive to their needs. It offers us an opportunity to improve performance and we need to increase the number of eligible patients it cares for. We also now have a Children and Young People’s Assessment Unit at Queen’s that is improving the experience of our younger patients.

Reducing our waiting lists

We are doing impressive work to reduce backlogs, and this was acknowledged when Professor Neil Mortensen, President of the Royal College of Surgeons, gave evidence recently to the parliamentary Health and Social Care Committee. The number of people waiting 52 weeks or more has fallen from 1,938 in April to 1,188 in July – we remain on track to cut this to zero by May next year.

The key to our success has been the focus on a multi-disciplinary approach where the input of administrators has been just as vital as that of the doctors. One of those we helped was Mark Wells-Bolger who had two operations in nine months. He said his treatment was “top notch”. The Trust’s community rehab team has played an invaluable role helping prepare patients for discharge and then working with them on their recovery at home.

Our teams have come up with a wide variety of initiatives to respond to the needs of those whose surgery has been delayed by Covid-19. The benefits for patients are obvious. The Ophthalmology department has kept the waiting time – from listing to surgery – to less than two months. We continue to treat more than 40 thousand patients in Outpatients each month and see more than 3,500-day case patients. Since June we have carried out more than 300 endoscopies on patients who have been referred to us by Whipps Cross Hospital.

The treatment we offer people with suspected cancer has been enhanced by the opening of our Rapid Diagnostic Centre and by the collaboration with Barts and the Homerton at the Mile End Early Diagnosis Centre. A recent ITV Tonight documentary that covered its work featured an interview with Sas Banerjee, one of our colorectal surgeons.

Given all that we have done to drive forward our elective (planned) recovery, I was proud to host Sir David Sloman, NHS Regional Director for London, during his visit to KGH earlier this month. Much of the elective work, in dedicated Covid secure ‘green’ zones, is taking place at KGH where we are focusing on the six specialties that make up 50 per cent of our waiting lists - general surgery, ENT (ear nose and throat) trauma and orthopaedics, ophthalmology, urology and gynaecology.

Sir David heard about the initiatives to cut backlogs; toured the KGH ‘green’ zone; and unveiled a new surgical robot that has acquired the nickname, Slobot, in his honour. Afterwards, Sir David spoke of how he’d been struck by “a sense of team, mutual respect and professional pride”.

Covid-19

We are determined to improve our performance against the four-hour emergency access standard and reduce waiting lists while also readying ourselves for any future surges of Covid-19 and other illnesses that may affect our communities this winter. The continuing success of the vaccination programme will help us achieve this and last month we jabbed our 100,000^th person. Dr Magda Smith, our Chief Medical Officer, took part in an NHS England campaign designed to encourage the young to get the vaccine. In August, the majority of Covid patients in critical care were unvaccinated.

The prevalence of the virus within BHR remains stable, but there is an expectation that it will increase now that children have returned to school. We publish our data each week on our website and, despite the relaxation of restrictions elsewhere, we expect everyone in the hospitals to wear masks and we are encouraging visitors to take lateral flow tests.  We are also investing £11.5m to expand and enhance our critical care departments.

Refreshing our clinical strategy

Understandably, given the pressures we’re facing, much of my report has dealt with what I see as our immediate priorities for the next six months. However, for us to be a truly outstanding organisation we need to have a vision for where we want to be in the coming years. The work we’re currently doing to refresh the Trust’s clinical strategy will help. We need to determine how and where we will deliver services that best suit our communities. We are keen for as many residents and stakeholders to take part as possible. We have an online survey and next month we will be holding public meetings. The details will be on our website and publicised widely.

Our finances

It’s one thing to draw up a clinical strategy, it’s quite another thing to implement it - to do it properly, we will need to be in a more financially stable position. Each month, we are spending £6m more than we receive and this is not sustainable. We want to reduce this figure to £5m a month by the end of the financial year. To do this, we must deliver £20m of savings by carrying out planned surgeries more efficiently and reducing the amount we pay for expensive agency and bank workers. We spend around £80m annually on temporary staff and a quarter of that amount covers the cost of premium rates.

Our staff and volunteers

One of the joys of my role is the opportunity it gives me to meet some amazing individuals and learn about their achievements. For example, two of our nurses, Ray Goto and Angel Toledo, are taking part in a unique training programme; Sara Turle, a Patient Partner, has donated two light boxes to improve the waiting areas for cancer patients; and, recently, Colleen Sanderson, a biomedical scientist, was reunited with Grace, a baby whose life she helped save.

As I hope is clear from this report, my first as Chief Executive, I intend to use it as an opportunity to provide you with an honest appraisal of current issues; a celebration of achievements; and an assessment of the risks and opportunities on the horizon.

Matthew Trainer
Chief Executive
September 2021