Dear colleague,

Our Board meeting takes place on Thursday 7 May in the Boardroom at Queen’s Hospital. It starts at 13.15 and you are welcome to join in person or virtually.

Ahead of next week’s meeting, I thought I would share my report that covers the transformational work we’re doing to get rid of corridor care; our concern at the numbers of looked after children we’re seeing in our A&Es; and the strike by members of the Unite union in our pathology department.

I hope you find it a useful read.

Best wishes,

Matthew Trainer

Corridor care

It’s shocking how quickly caring for people in A&E corridors became an accepted practice across the NHS, especially during the winter months when demand increased. It was undignified for patients and stressful for staff.

We are working hard to make it a thing of the past. When Wes Streeting, the Health Secretary, visited the A&E at Queen’s Hospital in April he was filmed in an empty corridor that once, at peak times, would’ve been full of patients in beds.

Mr Streeting spoke afterwards of the “dramatic” improvements he had witnessed; following a visit in December 2024, on what he was told was a “fairly good day”, the Ilford North MP recalled seeing “lots of frail elderly patients, including people with dementia, who were very confused, very distressed, crying out, not so much in pain as much as confusion”.

Transformational change

We are delivering this transformational change, with the help of NHS England colleagues, despite seeing no let-up in the number of people arriving in the departments at Queen’s and King George Hospital (KGH). March was our busiest month on record with an average of 1,000 people a day seeking urgent and emergency care.

The improvements have lasted six months, and our aim is to embed and sustain them. At Queen’s, where the problem was most acute, we delivered 16,000 fewer hours of corridor care in February and March when compared with the same months the year before.

The key to our success is that it is being tackled as a whole hospital problem, with colleagues on wards being encouraged to move suitable patients to the discharge lounge early each day to free up beds, rather than just left to A&E staff to resolve. We have two same day emergency care units (one medical, the other frailty) at Queen’s where specialists assess, diagnose and treat patients when they arrive so that they can go home on the same day. 

We are working with nursing homes, GPs and the London Ambulance Service to ensure that, when appropriate, frail, elderly people receive their treatment elsewhere and avoid having to visit a noisy and sometimes overcrowded A&E. We’re also running a pilot where these patients are seen by a multidisciplinary team on arrival at Queen’s to establish if they can avoid being admitted.

The benefits of these positive changes cannot be overstated. A&E staff talk of having time to think and breathe; how the atmosphere has improved; and of how patients are getting a much better deal as they’re receiving more dignified care.

Better patient care, Better value for money

Doing the right thing, for the right reasons, also saves money. In March, we used 21 fewer bank staff and saved £160k; across a year, such a reduction in corridor staffing would mean a saving of nearly £2m.

Another way we are saving money in A&E is by reducing our reliance on locum doctors through our Academy of Emergency Medicine. It was set up in 2018 to develop our staff grade, associate specialist and speciality grade (SAS) doctors, with 11 graduating last month.

£42m campaign for a new A&E at Queen’s Hospital

Despite our ongoing work to get rid of corridor care, the department at Queen’s isn’t fit for purpose - as anyone who has visited knows. I remain confident that we will soon be in a position to announce that we have secured the funding to transform the A&E; it will be a great way to mark the fact Queen’s turns 20 in December.

Children and young people in our A&Es

I’ve written repeatedly in my Board reports about my concern for those we see in our A&Es with mental health issues, especially when they are young. They often wait too long, in an inappropriate setting, before being transferred to a mental health provider where their needs can be properly addressed. As was reported in the Health Service Journal, we spend roughly £6m each year on registered mental health nurses, additional health care assistants and security guards to look after these patients while they are waiting.  

Looked after children

Of equal concern is the number of looked after children, with no physical healthcare needs, who are brought to the hospitals after their residential placement has broken down.

They can be with us for extended periods of time (and often require a high level of one-to-one staffing and security guards) while several health and social care agencies work together to establish the best place for them to receive the right care.

Sadly, their complex behavioural needs (one young person assaulted eight members of staff) mean they can’t be moved to our children’s wards and have to remain in A&E. We have a dedicated mental health space for young people at Queen’s, but it can only accommodate one person at a time, and the demand is often high.

I wrote in my Board report in September 2024 about how one child had been with us for 44 days. More recently, we’ve had a young person with us for 77 days and another for 21 days. We’ve estimated that the cost of looking after these two teenagers was more than £270k.

We have become the default place of safety for children and young people with mental health issues and/or challenging behavioural needs. The status quo is unacceptable, distressing and is failing the patients, their relatives and our staff.

I will be writing to my colleague, Dr Nnenna Osuji, Chief Executive of NHS North East London Integrated Care Board, to see if, together, the health and social care system can come up with a better way of responding more quickly to these children’s needs.

Pathology strike

Members of the Unite union in our pathology department have now held three strikes in three months; more than eight hours of protracted and difficult talks have failed to reach an agreement. It’s a department that processes in excess of 40m tests and 17m investigations annually and the demand for the service increases year on year.

One of the sticking points in the dispute is our plan to move away from paying, under a local agreement, for unsocial hours. We want to bring in a 24-hour shift system which will improve patient care and give staff greater certainty over their working hours. We have promised Unite, and our other unions, that we will consult with them about how it will work before it is introduced. We are one of only a handful of trusts that hasn’t yet moved to a standard shift system in pathology covering 24 hours a day, 7 days a week.

Our current, voluntary on call system means we have concerns about the resilience of the service. It also results in high levels of pay to a relatively small group of pathology staff. Last year, eight members of the department took home £358k between them (on top of their salaries) for out of hours work. We want to build a more sustainable future where, instead of a few people getting these large payments, we create more jobs and staff a 24/7 rota.

Pay protection will apply to those who experience a loss of earnings. Unite want up to four years (for those who’ve worked with us for seven years or more). We have offered between 18 months and two years for the majority of staff affected.

Another change we need to introduce, as it’s a requirement of NHS England (NHSE), is that we must move from being an isolated pathology department to being part of a larger pathology hub. We have one of the last stand-alone pathology services in England and we’re keen to see the benefits collaborative working will give us.

Work on establishing a pathology partnership for BHRUT has already begun, with funding from NHSE, and I anticipate we will go out to test the market for partners later this year.

Our finances

We ended the last financial year with a deficit of £65.1m (subject to audit) which was in line with our re-forecast. Our planned deficit for this financial year is currently £41.3m. We’re in conversation with NHSE about this and about our plans for 27/28 and 28/29 which are the years covered by the medium-term plan and our published organisational goals.

We are not where we want to be and we need to save £40m by the end of March. We saved £100m over the past three years during a period of rising demand. We’ve launched a very visible internal campaign - Better patient care, Better value for money - to galvanise the organisation and encourage ideas from the shopfloor.

Colleagues have already come up with several ways to reduce costs including the £300,000 saved by the team in the critical care department. They enabled patients to eat and swallow sooner which reduced the length of hospital stays, improved outcomes and saved money.  

And it’s goodbye from me

This is my last Board report, as in July I will be moving to King’s College Hospital NHS Foundation Trust as their CEO. I have been our longest serving Chief Executive and, in that time, we’ve improved our performance, including through a range of initiatives to cut waiting lists; stabilised our organisation to such a degree that the latest staff survey paints a picture of a Trust that’s getting better, with areas still to improve; and we introduced an electronic patient record which is starting to provide direct benefits to patients.

I’m excited about rejoining King’s (it’s where my hospital career began 10 years ago), but I will miss BHRUT. I’ve been fortunate to work with a fantastic bunch of people, and I’ve felt at home here.