Our finances  

The story of BHRUT in recent years has been one of improvement ,  where the focus has been on what we are delivering rather than, as in the past, on what we are  failing to achieve . This progress is measured in our  better  performance, staff  retention  and access to better care. We have 1,600 more staff than five years ago, the vast majority of whom are clinical.   

What continues to elude us is financial sustainability . Living within our means  would guarantee our independence  and give us the freedom to be in control of own destiny.  

With the departure of  Mike Gilham,  our Chief Financial Officer (CFO)  -  he was  headhunted  by  Medivet  as their UK Finance Director  -  we  will be  joined by Kevin Curnow ,  who will be  our  new  CFO ;  he’s  currently CFO at the East London NHS Foundation Trust .  Lorraine Hooper , who was Director of Finance at Norfolk and Norwich NHS Foundation Trust,  is going to be our  Director of Financial Turnaround .   

We are likely to end this  financial year  with a deficit of £65m. This is disappointing, given the  hard work  of colleagues over recent years that saw us  move out of financial  special measures  and deliver cuts in high-cost agency workers and bank staff that were greater than the national requirement.   

Our current deficit needs to be seen in the context of the  time and organisational focus  required  to implement  our   new electronic patient record (EPR) ;  the money  we’ve  spen t on vital maternity improvements and two  Community Diagnostic Centres ;  and the growing   demands  our two hospitals  face .   

Corridor care  

An  unfortunate , and completely undesirable, consequence of the growth in people  seeking  urgent and emergency care is that some of them  have  been looked after  in  A&E  corridors, especially at Queen’s  Hospital . In January,  we invited BBC London  to capture the adverse impact this has   on patients and staff. In the three years since the broadcaster first filmed in the department, the number of people seeking urgent and emergency care at our Trust has increased by an extra 153 a day .    

As well as delivering a poor experience for patients,  there’s  an  additional  cost involved in providing the necessary   extra staff. This averaged £100k a month at the start of this  financial year , with  that figure more than doubl ing  in recent months.   

This increased expenditure is dwarfed by the  roughly £ 6m we spend  each year  on registered mental health nurses,  additional  health care  assistants  and security guards to look after those with mental health needs . They  often  wait  too long  in A& E ,    before  being transferred to  a mental health provider  where their needs can be properly addressed.  

Maternity improvements  

We have  invested  an extra  £5.5m  i n our maternity service  over the last two years . Th is has funded  improvements  that  have included more midwives ,  doctors  and support staff  in our  maternity  triage area (we’re one of only a few units with a dedicated senior doctor in obstetric triage) ;  24 - hour flow coordinators to reduce delays ; and  significantly enhanced  pre-conception support for women with diabetes.   

After the Care Quality Commission  (CQC)  visited last August ,   they   rated us as good  overall.  The  multi-million pound  investment and the improved  CQC  rating have helped the service turn a corner and receive attention for  the positive work  being undertaken in the department.   

We are one of 12 trusts that are part of the  national investigation into maternity services . Baroness Amos p roduced  her  second interim report   in February   and  will publish  her final  recommendations  in the coming months .   

The next financial year   

These ongoing costs (and many others)  mean t  that when we  submitted  our  medium term  plan (covering the next five years) to NHS England ,  we made clear that we  wo uldn’t   succeed in reaching break even at the end of 2026/ 7. W e are working on a savings programme that is consistent with what we have achieve d  recen tly . W e have delivered around £100m of savings over the past three  financial  years  and  we  need to  generate  £40m in the next one.   

We have imposed a recruitment freeze until July and will be e mpowering  colleagues across the organisation to  come up with  ways of saving money ,  without compromising quality of care. I detect, from the conversations I have with members of  our Shadow Exec , a real appetite  at a grassroots level  to understand the cost of the decisions they make and a desire to deliver  better  value  for money for  the taxpayer.   

We will continue to focus on reducing corporate costs where we can do so without causing damage to the delivery of clinical services.  I’m  very aware that we are putting extra pressure on clinical teams  because   of some of our recent corporate cuts, so we need to be careful where we go next.   

When it comes to clinical staffing, we are looking at using fewer bank shifts and  we are  analysing  our benchmarking data to see where we can run our services more efficiently. Our new digital infrastructure, post the introduction of   EPR, should also reduce running costs.   

Improving urgent and emergency care  

An average of 979 people a day came to our hospitals in January seeking urgent and emergency care. These numbers, along with the  additional  pressures of infectious winter bugs and some complex discharges, meant that too many patients experienced longer waits than they should  have done.    

75.4% of them were admitted,  discharged  or transferred within four hours. This placed us  8 th out of 18 acute trusts in London. The NHS target, to be achieved by the end of this month, is 78%.   

Increased  attendances and corridor care have blighted us for  too long . While we wait for approval for the funding we need  to transform Queen’s A&E ,  we’re  working hard  with  NHS colleagues   to improve condition s and reduce waits.   

As well as i ncreasing  the flow of patients being discharged each morning,  w e’ve  introduced a new route to  initial  A&E assessment which has resulted in an average reduction of 37 minutes in the time  taken from when a patient is assessed to when they start to receive treatment.   

We are  very focused  on ensuring frail,  elderly  patients avoid having to  experience prolonged waits in  our noisy A&Es.  Approximately one in three of our A&E patients are aged 65 and over and  nearly one  in five of them are identified as frail .    

We have a frailty line that  GPs, nursing homes and  the London Ambulance Service can call.  It’s  staffed by geriatricians  who  provide advice on alternatives to coming to Queen’s or King George Hospital (KGH) .   Calls to the line went up  from 28 to 114 over a  nine month  period  and 70% of the cases discussed resulted in the frail,  elderly  person receiving treatment somewhere other than an A&E.   

Our Frailty SDEC ( same day emergency care ) is helping reduce the number of older patients being cared for in our corridors. The multi-disciplinary team is focused on offering rapid assessment and intensive support so that  it does offer same day care and  these patients leave hospital as quickly and safely as they can.   

W e launched a pilot last month  wh ich involved frail,  elderly patients  being  seen in A&E  before  they were moved to the Frailty SDEC. The  initial  results have been promising. On the first day, post consultation, seven patients went home and only one needed to be admitted.   

Cutting our waiting list  

The innovative work we do to  improve the experience of patients continues to attract national attention. When  Sir Jim Mackey, NHS England CEO , visited our KGH Elective Surgical Hub in January  he   spoke of the improvements  he’d   witnessed  and how there was “a real sense of pride” among staff.   

More than 10,000 operations were carried out last year in the Hub which has nine operating theatres. During his visit, Sir Jim opened a new ophthalmology waiting area . S ince June 2024 ,  we’ve  carried out more than 4,000 eye operations  -  including on a patient aged 103.   

The  introduction of our electronic patient record has had an adverse impact on our performance. Given   the launch went  relatively smoothly   last November ,  notwithstanding  the delays some patients  experienced,   it’s  easy to forget   just how massive an undertaking this  digital transformation  was for our organisation as we headed into winter.   

There was a  planned slowdown of activity around go live and  we  modif ied  t he design of outpatient clinics as our staff got to grips with the new system. We also  had to  navigate the impact of  two strikes by resident doctors .   

With the support of regional and national colleagues, we are working hard to get through the backlog and recover the position. Our teams are running what  they’re  calling a ‘Q4 sprint ’  and   we’re  confident  we’ll  be in a better p lace  by the end of this month.   

Transforming for the future  

There are many promising  instances  of where this is happening at our Trust; whether it’s the  new skills our apprentices  are  acquiring  to equip them to move onto  bigger and better things  – which  we celebrated at the House of Commons  last month with two of our local MPs, Nesil Caliskan and Wes Streeting -  or  the part we are playing in an exciting new national programme in Barking and Dagenham .    

It  is focused on bringing services for those with long-term conditions closer to their homes. It will help them manage their health better and avoid unnecessary hospital admissions.  It’s   a great example  of where we can , by collaborating with partners,  move  services  out of hospitals, improve  care  and save money.   

Matthew Trainer  

Chief Executive  

March 202 6