Chief Executive’s Report November 2024
Chief Executive’s Report November 2024
Our purpose
We’re entering a period of potentially significant change in the NHS and at our Trust, a state of affairs that is familiar to anyone who’s worked in the health service for a number of years. After the General Election Lord Darzi, a former government minister, was asked to review the NHS. On the day his report was published I appeared on the BBC’s Newscast podcast and Fiona Wheeler, my deputy, was on ITV News to discuss its findings.
Lord Darzi’s conclusions will inform the government’s 10-year plan for the health service that will be published next year and which will include a shift in resources away from acute hospitals to services in the community. You can submit your thoughts and ideas for the future via the online portal at change.nhs.uk.
At BHRUT, we’ve been working on our own plan, our organisation strategy, to give us a shared direction over the next few years. At its heart, is our new purpose:
We want our hospitals to deliver care that our staff are proud of and that our patients are happy with.
We will achieve this goal by really listening to our staff and residents and acting on what they tell us.
Ward accreditation programme
One way of ensuring our patients are happy is by providing care of a consistently high standard across our hospitals. Our ward accreditation scheme is designed to deliver just that with wards assessed on a range of measures including patient experience, safety and staff morale. Wards are rated as bronze, silver or gold. In September, Daisy - a stroke rehabilitation ward - achieved the highest accolade and became the second ward to do so.
We’ve also run a pilot initiative on Cornflower B, a renal ward, where we created the role of Unit Business Manager to reduce the amount of time nurses spent on administrative tasks. I’d like to see this pilot extended to other areas as it frees up staff to focus on patients and it’s a practical example of our desire to be a listening organisation where we act when colleagues suggest ways of improving how we operate.
Chloe Every
The recent inquest into the death of Chloe Every at Queen’s Hospital in 2019 was a sobering reminder of what happens when we don’t provide consistent, high quality care and we don’t listen as well as we should to patients and to their relatives.
I have apologised publicly for our failings five years ago and for the fact our initial investigation into Chloe’s death wasn’t thorough enough. I am grateful to Dr Mamta Shetty Vaidya, our departing Chief Medical Officer, for all the work she has done with Chloe’s family and with our teams where the focus has been on improving the care we offer those with a learning disability (LD) and/or autism.
We’ve implemented mandatory LD and autism training for all staff; we’ve introduced an LD and autism strategy; and we are trying to recruit more nurses with LD qualifications and experience. Our challenge is to ensure that we constantly strive to improve the way we communicate (especially with relatives after someone has died) and that everyone is comfortable responding to patients with a learning disability when one of our LD specialists isn’t available.
Our finances
All of our improvement work, whether it’s enhancing our LD provision or transforming the way our wards are run, has to be carried out against the backdrop of the difficult financial position of the NHS. The majority of all new spending at the Trust over £50,000 has to be signed off at a senior level internally, at the North East London ICB and by the London region of NHS England.
Our overall deficit is £10m worse than we had planned for at this point in the financial year, though our average monthly deficit has reduced in the second quarter and our current productivity, when compared with before the pandemic, is the most improved of any trust in London.
Staffing represents 70% of our outgoings and we will stop the use of high cost agency nurses this month. By the end of December, 130 newly qualified, permanent nurses will have joined us. The majority have done their work placements with us, while others have trained at universities across the country including Southampton, Sunderland and Nottingham.
Their arrival marks a shift away from previous international recruitment campaigns to employing staff in the UK who are attracted by the support we offer and the changes we’ve made as a trust. We are indebted to our international nurses for the fantastic contribution they’re making to our organisation and for the fact they’ve helped reduce our nursing vacancy rate from 27% to 11%.
The most striking figure in our accounts, given we are not a specialist mental health provider, is the roughly £6m we spent last year on caring for patients with mental health needs. This expenditure, on registered mental health nurses, additional health care assistants and security guards in A&E, is being repeated this year and is significantly more than we spend on extra staff to care for patients in our A&E corridors.
Patients with mental health needs
At last month’s meeting of the Joint Health Overview and Scrutiny Committee for outer north east London, Councillor Beverley Brewer spoke of mental health provision as a “dire situation for all concerned”. Our growing concern is for those who come through our A&Es before being referred to mental health services. In September, there were 347 such patients and they waited, on average, almost a day in facilities that were ill suited to their needs. 172 of them spent more than 12 hours there.
Since April 2022, one in five of all Section 136 patients in north east London have been taken to King George Hospital (KGH). On one weekday morning recently, there were nine security guards in the KGH A&E keeping patients with mental health needs, and those around them, safe.
Of even greater concern is the number of young people with mental health needs we’re seeing and the number of looked after children who have no physical healthcare needs but are brought to us after their residential placement has broken down.
While they are in our A&Es, sometimes for very long periods of time (in September’s CEO Board report I gave the example of a child who waited 44 days) they often require a high level of one-to-one staffing and security guards. They remain with us while several health and social care agencies work together to establish where would be best for them to receive the right care.
We will open a ‘safe space’ room at Queen’s to try and mitigate the impact of the A&E environment where the lights are on 24/7, but it is not the solution to the fact our two acute hospitals have become the default location for children with mental health and other complex needs when all else has failed.
Our priority this winter will be to do all we can to reduce harm to patients and staff in our A&Es. In doing so, our performance may well be adversely affected.
Improving urgent and emergency care
Up until now, our A&E performance has held steady with our overall (All Types) September performance of 78.4% being higher than the average in London and nationally. It placed us 2nd out of 18 acute trusts in the capital and 16th out of 122 in England.
The current NHS target is for at least 78% of patients to be admitted, transferred or discharged within four hours. We are helped by our GP colleagues at PELC who run our Urgent Treatment Centres. They see the less seriously ill (Type 3) patients and their September performance was 99.22%.
Our Type 1 performance (the most seriously ill patients) was 56.1% which represents a dip at a time when we’re seeing growing demands. There was no lull over the summer and the number of people seeking urgent and emergency care has increased by almost 40% over the past 13 years. In April 2011 we had 20,704 attendees; that figure had risen to 28,430 by April this year.
We’ve also witnessed a significant rise in the number of patients being brought to us by ambulance. At Queen’s, the total number of Type 1 patients who came via ambulance was 669 more in September and October (an average of an extra 84 patients each week), when compared with the same two months in the year before. 542 of them didn’t need to be admitted to hospital after receiving A&E treatment.
Despite this increase, we remain determined that patients spend as little time as possible in the back of an ambulance and we were delighted to win an award, with the London Ambulance Service, for the work we’ve done together to reduce handover delays at KGH.
St George’s Health and Wellbeing Hub
The opening of the St George’s Health and Wellbeing Hub, in time for winter, will benefit our frail, elderly residents who’ll be able to visit our Ageing Well Centre in Hornchurch and avoid receiving treatment in a noisy and crowded A&E. The centre has been co-designed with our GP colleagues and we’ll run it alongside them.
The move of the renal service, run by Barts Health, out of Queen’s to St George’s will free up the space required to carry out a desperately needed £35m redesign of the Queen’s A&E that will help render the undignified practice of providing care in corridors a thing of the past.
We have detailed plans. We have the political support. We now just need the funding.
Cutting our waiting lists
As we tackle our waiting lists we have a particular focus on those who have waited more than a year for their treatment. Over a five month period we cut that figure in half, down to 1,100 by September. In the same month, the total number of residents who have been referred to us stood at 64,792, with 9 out of 10 of them requiring an outpatient appointment with one of our specialist teams.
Women, many needing gynaecological appointments, account for 79% of those who’ve waited more than 52 weeks. The provision of gynaecology services is a challenge across London. Growing demand, staff shortages, industrial action and patients transferred to us from Barts Health have contributed to our backlog.
Recent initiatives to address this have included our Gynaecology ‘super month’ when 123 women were treated at the weekends throughout September. By the end of the year, we plan to have reduced the number of people who have been waiting for more than 65 weeks to zero.
Women’s Health Hub
We are constantly looking for fresh ways of working with partners to reduce delays and provide more accessible care. Our Women’s Health Hub, at the new health centre inside the Ilford Exchange shopping centre, is an exciting example of such collaboration. At the Hub, we’re offering support to women with urogynaecology issues and running specialist menopause clinics. It’s already providing better and quicker care for women who have waited far too long to be seen.
Our cancer performance
We continue to make good progress on delivering against the cancer waiting time standards set by the NHS and we’ve met the target for diagnostic waiting times for a fourth consecutive month. An extra 88,000 scans a year will be available at our Community Diagnostic Centres (CDC) in Barking Community Hospital and at St George’s Health and Wellbeing Hub. These CDCs will be instrumental in diagnosing more patients, more quickly.
Care Quality Commission
Like many other trusts, our Maternity services at Queen’s have been inspected by the Care Quality Commission. They were with us for two days last month, including one evening when they witnessed the reality of an extremely busy service under significant pressure. They were happy with our response to their immediate concerns and we will receive their report in the coming months.
Transforming the lives of young people
With the support of several vital partners, we run an inspiring scheme to help young people with a learning disability and/or autism find work. Since it was launched, four people have got jobs with us and we now have 24 new interns. Wes Streeting, the Health Secretary and MP for Ilford North, met many of them when he visited KGH.
The transformative power of the programme was captured by Connor who works in one of our admin departments. He said he would “love to live independently, on my own, with my own money”.
Matthew Trainer
Chief Executive
November 2024