Chief Executive’s Report July 2023

Urgent and emergency care

Many of the complaints I receive are about delays, so it’s heartening that I can report some encouraging improvement in our A&E performance. The national standard is that 95 per cent of patients should be seen, treated and either admitted or discharged within four hours. A recovery target of 76 per cent was set last year with the expectation it will be hit by March 2024.

At Queen’s Hospital in May, our A&E performance for those who were most seriously ill (Type 1) was 47.9 per cent. This was our best month since August 2019 (if you remove the lockdown periods from the comparison) and it occurred after we opened a new, larger Same Day Emergency Care (SDEC) department at Queen’s.

It’s where patients are moved out of A&E to be assessed and have treatment (including diagnostics) starting on that same day. This improves their experience and reduces unnecessary hospital admissions. We’ve also opened an SDEC at King George Hospital (KGH) which has resulted in an almost 20 per cent improvement in Type 1 performance during its first few weeks. I know these changes aren’t yet benefitting everyone and I am sorry too many people are still waiting too long.

Among those worst affected by A&E delays are patients with mental health needs. We saw 349 in May and their average length of stay was more than 19 hours. 39 of these patients waited more than 36 hours to leave our Trust and move to a service better able to care for them.

The green shoots I described above need to be seen in the context of the performance of our Urgent Treatment Centres (UTC) that are run by PELC, a GP cooperative. For us to achieve 76 per cent by March 2024 we need the UTCs (where the less seriously ill Type 3 patients are treated) to achieve greater than 90 per cent performance. In May it was 69.4 per cent. Our overall four-hour performance is split roughly down the middle between PELC and our Trust, so we both need to play our part to achieve 76 per cent.

We continue to work closely with PELC to improve and speed up the triaging of those who need to be seen in A&E. They have recently opened a separate, dedicated waiting area for children and parents at the UTC in the Queen’s foyer.

Another significant way in which we will reduce A&E waits is if we improve what the NHS calls flow – the smooth and continuous movement of patients out of the department, onto the wards and back to their homes.

To help with this, we are doing some targeted work with staff on the wards and we’ve opened a bedded discharge lounge at Queen’s. It’s an impressive facility for those waiting to leave the hospital.

We’re also working with colleagues at NELFT, our local mental health and community trust, to develop a frailty strategy. Part of this will include the opening, by August, of a virtual ward. This has the potential to transform flow to the benefit of patients and staff.

Reducing our waiting lists

I’m really pleased we’ve appointed Fiona Wheeler as our new Chief Operating Officer to oversee all of this work. For the first time in a while, my senior leaders are substantive appointments and I hope this will bring greater stability to the Trust. During the past year, Fiona has been in charge of our drive to cut waiting lists. She has done a fantastic job on this and we are already seeing the benefits of her approach as we start our winter planning.

Our success means we’ve been asked to take part in Further Faster – a national programme to deliver improvements in waiting times ahead of targets set by NHS England. When Professor Sir Mike Richards visited KGH he spoke of how impressed he was with our initiatives, including transnasal endoscopy and the robotic colonoscopy.

A Gynaecology ‘Perfect Week’ in May saw double the number of patients compared with a normal week; a focus, last year, on using our theatres more efficiently has saved more than £500,000 and reduced waiting times; and the £14m expansion of our Elective Surgical Hub continues apace, with a topping out ceremony taking place in June to celebrate the fact the new building has reached its highest point.

Our diagnostic and radiology services have been strengthened by the appointment of two colleagues. Imran Ellahi is our Radiology Improvement Director and Chrissy Zelenyanszki is our Programme and Service Development Lead for Community Diagnostics. Residents will soon benefit from the new Community Diagnostic Centre (CDC) at Barking Community Hospital, which featured in a case study published by NHS Providers.  

Strike by junior doctors

The three junior doctors’ strikes have had an inevitable impact on our efforts to reduce the number of people on our waiting lists – the total was 65,151 in May. It’s to the immense credit of all our teams that in June we cancelled 997 fewer outpatient appointments and 242 fewer non-urgent surgeries compared with the earlier strike in April.

We remain committed to reducing to zero, by the end of the year, the number of people waiting more than 52 weeks for treatment. May’s total was 1,052. This work will be imperilled by future strikes.

At the time of writing, a fourth strike by junior doctors is planned for this month as well as one by consultants which will result in one in three working days in July being a strike day.

It is evident that a significant number of doctors, at all stages of their careers, are unhappy with NHS pay and conditions. The risk in the medium to long term is that they will be less likely to commit to a future in the health service. I am not alone in wishing the government would start meaningful talks with the relevant unions as soon as possible. This needs urgent resolution.

Our finances

The strikes by junior doctors have also had an adverse impact on the work we’re doing to reduce our deficit. During this financial year, we have spent close to £1m on staffing to fill the rotas and we’ve lost a similar amount in income for work that couldn’t take place during the industrial action. This, coupled with the adverse effect of inflation, means that we are almost £6m behind on our plan to cut what we spend.

Other contributory factors are within our hands to remedy. We must reduce our expenditure in corporate areas and we’re still spending too much on staffing. It’s promising that last year we cut our agency spend by £11m (a more than 10 per cent reduction) and we’ve not used any high-cost agency nurses (known as off framework) since May. More than 100 permanent nurses from abroad will be joining us soon.

We have the next three months in which to get into better financial shape – and avoid more draconian action – before winter is once again upon us. It’s clear from all the conversations I’ve had with colleagues across north east London about challenges in social care, community services, primary care and mental health that we are likely to face another very difficult winter.

Our staff and volunteers

It’s always great when we have an opportunity to thank those who have given so much to our organisation. I attended our long service awards with Jacqui Smith, our Chair, where we celebrated the careers of 50 colleagues who, between them, have clocked up 1,100 years of NHS experience.

Last month, we marked the contributions of more than 300 volunteers during national Volunteers’ Week. As Jacqui said at a special afternoon tea for some of our longest serving volunteers, they make our hospitals better places to receive care and to work.

The NHS calendar is full of special days when we can acknowledge the contributions of different groups of employees. We’ve recently marked National Healthcare Estates and Facilities Day – 1,450 colleagues do vital work in this department; International Nurses’ Day - 40 per cent of our workforce are nurses, nurse associates and healthcare assistants; and International Day of the Midwife – around 7,000 babies are born each year at Queen’s.

I was very struck by a video message from Sabrina, one of our mothers. She said, "As a black woman, I had such a positive experience and I had two midwives that looked like me, who understand my cultural values and my cultural background and I can't stress enough what an asset they were to both me and my partner during my labour…they contributed to my positive birth experience."

My colleagues are constantly looking for innovative ways of engaging with patients to improve their health and wellbeing. Anjum Misbahuddin, one of our neurologists, organised a ‘Run with your Doctor’ event at Raphael Park in Romford. This brilliant event helped to break down barriers between the care we provide in hospital and the communities in which our patients live. I’d like to thank Anjum for her efforts in turning her vision into a reality.

The coming months

We are edging closer to being in a position to say something concrete about introducing an electronic patient record at our Trust. Our work with Barts Health as an integrated group has proved invaluable in this regard.

As we head into the autumn, I intend to make myself available regularly at both hospitals so residents and staff can chat to me; we will improve significantly the welcome new joiners receive on their first day; and we’re hoping for success in not one, but two upcoming awards.

In my next Board report I will provide an update on all the events we’ve been holding in the week of our July Board meeting to mark the NHS’s 75^th birthday. More than 5,000 colleagues and family members will enjoy a range of activities including an evening party where the Pfizer Chiefs, a band I’m a member of, will perform. I’m confident our Chair will be displaying some ‘strictly’ moves on the dance floor.

Matthew Trainer

Chief Executive

July 2023