Chief Executive’s Report May 2024

Urgent and emergency care

I want to begin by thanking all my colleagues across our hospitals who have worked hard to make sure that BHRUT was the most improved Trust in England for A&E performance in 2023/24. This is welcome news for the increasing number of patients we are treating within four hours – 7,300 in March alone, when compared with the year before. However, we have a lot more to do for our sickest patients who still face long waits to get a bed.

In March, our All Types A&E performance was 77.6%. The national standard is for at least 95% of all patients attending A&E to be admitted, transferred or discharged within four hours. A national recovery target of 76% was set, with the expectation it would be hit by March.

Our 77.6% performance placed us 6^th out of 18 acute trusts in London and 29^th out of 122 in England. Our Type 1 performance (the most seriously ill patients) was 54.4% which represents a 20% improvement on the year before, when we were ranked bottom nationally for Type 1.

Our overall A&E performance has been helped by the way our GP colleagues at  PELC have transformed the service they offer in the Urgent Treatment Centres (UTC) they run for us. The UTCs see the less seriously ill (Type 3) patients and their March performance was 97.5%. It was 70% in March 2023.

PELC have benefitted from the relocation of the UTC entrance away from the main atrium at Queen’s Hospital and an increase in the number of doctors at both sites. This has been made possible by additional investment from NHS North East London. Ongoing extra funding will be necessary if we are to maintain our improved performance.

Busiest month on record

March was a record month with more than 30,000 patients seeking treatment in our UTCs and A&Es. We have also seen a large and sustained increase over the past year in the number of ambulances arriving at our hospitals – there were 371 more in March compared with twelve months previously.

The sad reality is that the more people we are seeing in a timely fashion, the more people are making their way to our hospitals. This increase is being experienced across healthcare in north east London (NEL) and while our primary care colleagues are offering more appointments than ever before, demand continues to grow.

For us, the rate at which we discharge patients isn’t keeping up with the growing number of people being admitted. For our patients, it can mean long waits - sometimes in a bed in an A&E corridor when wards are full - for those adults needing care on a general medical ward and for the frail elderly.

Virtual ward

Those who are frail and elderly are continuing to benefit from our virtual ward. It is going from strength to strength and has been seeing up to 50 residents at any one time. Under this ‘hospital at home’ scheme, a multi-disciplinary team - made up of senior doctors, nurses, therapists, social workers and support staff - is delivering care in the community and ensuring these patients don’t have to seek treatment in crowded and noisy A&Es.

The virtual ward will operate from the St George’s Health and Wellbeing Hub when it opens later this year. The team will work alongside colleagues who will be running a large, dedicated frailty unit at the Hub. Their focus will be on providing wellbeing services and proactive care that reduces A&E attendances and emergency hospital admissions.

Improving urgent and emergency care

We have a new Same Day Emergency Care department (SDEC) at King George Hospital (KGH) that saw 65 patients in its first week. SDECs help reduce A&E overcrowding and are where patients are moved to be assessed and have their treatment (including diagnostics) start on that same day.

The contrast between the improved layout at KGH and the more cramped conditions at Queen’s is now stark. When the renal service at Queen’s moves to the new St George’s Hub we’ll have an exciting opportunity to exploit the available space. We need to improve the A&E for patient care and provide our staff with a better working environment. This will be part of our drive to reduce overcrowding, cut long waits for admission and put an end to corridor care.

We’ve begun preliminary discussions with NHS England about securing the estimated £35m we will need to redesign the department. When Queen’s was opened in 2006, it was built to accommodate around 300 patients a day who were seeking urgent and emergency care. In March, it averaged 612 people a day – peaking, on one day, at 751.

I’ve written repeatedly about patients with mental health needs who continue to be poorly served, despite the best efforts of our partners in NEL. During March, 346 patients (some of whom were very long waiters) were referred by us to mental health services and they spent an average of nearly 22 hours waiting in A&E before leaving our Trust and moving to a service better equipped to look after them.

Our finances

We ended the financial year with a deficit of £15.7m which was in line with our forecast and we delivered £27m of recurrent savings. Four years ago, the Trust needed cash support of £104m and our deficit stood at £60.3m.

We need to carry on reducing waste and deliver more recurrent savings; keep our headcount under control; and continue to increase the amount of planned care (outpatients, day cases, surgery) that we deliver. We must do all this against the backdrop of the current financial year that will be even tougher than the previous one.

In this context, I will not be filling - at Executive Director level - the two vacancies I will soon have among my group of nine Executive Directors who oversee the running of our hospitals. Louise Dark, our KGH Managing Director has been appointed Chief Executive of the Integrated and Specialist Medicine clinical group at Guy’s and St Thomas’ NHS Foundation Trust. Ann Hepworth will be leaving her strategy role with us to become Group Director of Strategy and Partnerships at Barts Health.

Ann and Louise have been great colleagues and I’m grateful to them for all they’ve done to help deliver the improvements we’ve made. I’d like to wish them well in their new roles.

Cutting our waiting lists

Our teams are continuing to deliver initiatives that reduce the time residents wait for treatment. Our third Gynaecology Week saw 60 operations carried out in six days, including 38 major surgeries. We became the first trust in London to trial a new treatment for patients with aneurysms when our Neuro Interventional Radiology team held two focused days where they used this minimally invasive procedure. 

Despite these innovative schemes our waiting lists have increased. The total number of residents who have been referred and are waiting for treatment was 68,281 in March. Nine out of 10 of them require an outpatient appointment with one of our specialist teams.

Industrial action by junior and senior doctors in the last financial year meant we had to cancel 17,283 outpatient appointments and 1,244 non-urgent surgeries. 976 patients have moved to us from Barts Health to help them tackle their delays. Their medical teams will be providing treatment each week for 20 of our neurology patients.

The number of people waiting more than a year for their first treatment was 1,784 in March. Our priority is to reduce to zero, by September, those who have been waiting more than 65 weeks. The relevant teams are working collaboratively and meeting regularly to ensure we remain on track.

Those who need surgery will soon have access to the two extra theatres at KGH that will be officially opened later this month. The £14m extension to the KGH Elective Surgical Hub will allow for 100 additional operations each week. This will benefit residents across NEL, as part of the work we’re doing as members of what’s known as an acute provider collaborative with Barts Health and Homerton Healthcare.

Our cancer performance

In March, we had 5,117 residents on our cancer waiting list. 95.1% of them were seen by a specialist within two weeks of an urgent cancer referral by their GP; 75.4% were told their diagnosis within 28 days; and 96.6% were treated within 31 days of diagnosis. Behind these significantly improved percentages are many patients who’ve benefitted from the fact we have delivered on several of the cancer waiting time standards set by the NHS.

However, we are still struggling to achieve the target of 85% of patients waiting no more than two months from the date we receive an urgent referral to the start of their treatment. In March, our performance was 71.2%.

One of our challenges is that there is a national shortage of histopathologists. Our solution has been to ‘grow our own’. We’ve created a training programme and have attracted international students and those from other medical disciplines. We should have the correct number of staff in the coming months and we’ll then begin to see our diagnostic waiting times reduce.

The year ahead

Our Annual plan (contained in the Board papers that we’ll be considering at this month’s meeting) paints a picture of the year ahead where we’ll improve our performance and the care we provide; there’ll be additional theatres at KGH and a new Community Diagnostic Centre at Barking Community Hospital; and, with the help of Barts Health, we’ll introduce an electronic patient record.

In the coming months, I will continue to benefit from the fresh perspectives offered by our innovative Shadow Exec that provides a forum for more junior members of staff to influence decision making. Its members are drawn from groups that are under represented at the top of the Trust. They provide senior leaders with insights from the ‘shop floor’ on the impact of their decisions.  One of the Shadow Exec members, Hina Khalil, spoke recently of how she wanted to deliver change and help staff “have their voices heard”.

Matthew Trainer

Chief Executive

May 2024