Chief Executive's Board report: February 2021 | Chief Executive's Board Reports

Chief Executive's Board report: February 2021 | Chief Executive's Board Reports

Chief Executive's Board report: February 2021

I am sure I am not alone in starting this year very conscious of the two conflicting emotions of hope and sadness. Few, if any of us, have escaped the devastating impact of Covid-19. The national death toll – likened to a capacity Wembley Stadium with 10,000 waiting outside – is a depressing milestone to have reached. At our Trust we have mourned the passing of more than 1,400 patients (at time of writing). Inevitably, the sense of loss is even more acute when it is those we have worked alongside. In recent months, colleagues have paid tribute to Afzal Ansari, Kandiah Ratnakumar and Robbie Muir (who worked for the London Ambulance Service and was well known by many at Queen’s Hospital).

The second wave

Our staff have suffered at the hands of a virus they have to confront head on, day in, day out. I am in awe of what they have achieved during the pandemic. At the height of the second wave last month, we were treating 519 patients with Covid-19 and we had to cancel leave. We increased the number of our beds (known as general and acute) by 80; redeployed hundreds of staff; and converted a frailty unit at King George Hospital (KGH) into a temporary Oxygen Receiving Unit (for very sick patients) over the four-day holiday weekend.

When our oxygen supply was under pressure, it was clinical staff working alongside finance, operations, security and estates colleagues who delivered a solution. This month the system has been upgraded at Queen’s to allow us to increase the potential flow rate of oxygen when demand is very high.

None of this was straightforward and I am always acutely conscious of the fact those who provide care also need to be cared for. I am grateful one aspect of that support is provided by our Chaplaincy team. Alison Horncastle, one of our chaplains, has spoken very powerfully about how her role is “to help people find moments of beauty within the trauma”.

During this period of intense pressure, some of our GPs came to our aid and worked shifts on our wards. Their acts of solidarity are a tangible sign of the benefits of partnership working. And it was the system wide response – in Barking and Dagenham, Havering and Redbridge (BHR) and across north east London (NEL) – with social care, community care and the acute sector coming together, that helped us when the challenges were most acute.

Just one example of our integrated health and care system in action is the success we’ve had reducing our numbers of what are known as ‘super-stranded’ patients. Another is how, by working with the North East London NHS Foundation Trust (NELFT), we have managed to move our pre-operative assessment to a ward at Goodmayes Hospital. And throughout the pandemic I have kept in regular touch, virtually, with our politicians on our Health and Wellbeing Boards and with our eight MPs.

Critical care

Thankfully, we are seeing a reduction in the number of Covid-19 patients we are treating. It is a slow, but steady decline. However, our critical care units will continue to be busy for some time as we provide beds for hospitals elsewhere in the country who are struggling. We increased our capacity from a baseline in ‘normal times’ of some 35 beds to around 80 beds.

When I visited an intensive care ward at KGH recently, one of the patients was a once fit 38-year-old father of two children, aged three and one. The staff spoke of their tiredness; of how distressing it was when a patient suddenly and catastrophically deteriorated before their eyes; and of the support they derive from the team. Their reality was shared with a wider audience when a colleague,  Victoria Sullivan spoke to the Today programme on BBC Radio 4.

Victoria’s interview reinforced the pride I feel for the way our staff strive, all the time, to provide the best possible care. This was demonstrated when we fulfilled the wish of a family that their mother, who had Covid-19, should be allowed to return home to die. And I am so impressed by the bravery Lucy Eaton, one of our security officers, displayed when she saved the life of a patient.

Covid-19 testing

Towards the end of last year there was a concerted effort to improve the testing we could carry out within our Trust. Our Microbiology team received new equipment and our laboratory healthcare scientists went above and beyond and worked at impressive speed to verify the various devices and deliver high quality testing for our patients. All of this work is done in collaboration with our partners across NEL to share resources and learning. Our testing is sensitive enough to capture new mutations of the virus such as the South African and Brazilian strains.

Asymptomatic staff testing, using lateral flow devices, is embedded across our organisation. We have also begun to offer it to our vulnerable patients, including those with cancer; to our in-patients; and to elective (planned care) patients who are undergoing invasive procedures.

Nosocomial (hospital acquired) infections

We recognise that, like many other trusts, some patients in our hospitals have acquired Covid-19 during their admission. We take all the precautions we can to prevent this happening, including ensuring staff are wearing the correct personal protective equipment; encouraging hand washing and use of alcohol hand gel for both staff and patients; creating barriers between beds with plastic curtains; testing all patients on admission to see if they have the virus; and separating those with Covid, from those who do not. It was particularly challenging in December when the new variant emerged, and we saw a rapid increase in our Covid admissions. The numbers of nosocomial infections have since reduced.

Our vaccination programme

At the start of my report, I mentioned how my sadness is tempered by feelings of hope. These are derived from the rollout of the vaccination programme. We started at Queen’s where we vaccinated 80 on the first day and ensured more than half of those being jabbed in the first week were care home workers. We have now opened at King George Hospital and by the end of January, we had vaccinated 12,250 people. We have offered the vaccine to local authority and NELFT colleagues working in care homes; those working at Barts Health and the East London Foundation Trust (ELFT); home care workers and other frontline healthcare workers including the London Ambulance Service; the clinically extremely vulnerable, such as cancer patients; and our own staff.

The success of our two hubs is another reminder of what can be achieved when different teams work together to deliver a shared goal. It is a goal that includes ensuring the overwhelming majority of our staff are jabbed. We have used a wide variety of methods to encourage take up including videos and a very well attended virtual webinar where questions and concerns were raised and answered by our clinical team. It is also heartening that more than two thirds of my colleagues have had their flu jab.

The wellbeing of our staff

Our attention is now turning, as the numbers of Covid-19 patients reduce in our hospitals, to how we resume services we were forced to pause when the virus was at its most virulent in our three London boroughs. At a senior level, to help with our recovery, I have been joined by Ben Morrin, our Deputy Chief Executive and Hannah Coffey, our Director of Strategy and Partnerships. Part of Hannah’s role will be to focus on the crucial work we need to do to further develop effective and productive partnerships with individuals, communities and organisations across BHR and across NEL. Our CCG colleague, Steve Rubery – who is their Director of Commissioning and Performance - will work alongside our Operations team for two to three days a week to help with our preparations for life after Covid-19.

As we recover, our number one priority has to be and will be, the welfare of our staff. It was something Kathryn Halford, our Chief Nurse, wrote about in an opinion piece for the Nursing Times and a recent paper by the King’s Fund talked of the need to prioritise compassionate support for those on the front line. They are exhausted and are recovering from months of intense demands the like of which they never thought they would be subjected to during their working lives. Some of what they have endured was captured by the London Evening Standard when they returned, for a second time, to speak to colleagues.

We are determined to look after their mental wellbeing. Our psychologists (who are available from 7am to 11pm, 7 days a week) dealt with more than 300 calls last year and we have facilitated more than 80 reflective sessions for teams. We are looking again at the provision of food across our sites; at the number and condition of the rest rooms and wellbeing hubs in our hospitals; and at how we will, as a Trust, recognise the extraordinary contributions all have made during what Vin Diwaker, NHS London’s Medical Director, has called the “biggest health emergency since the Second World War”.

It is a topic that will rightly preoccupy the senior leaders of this organisation in the coming months. When Mike Bell, our Chair and I reflected on the achievements of our staff we were reminded, once again, not to forget the contribution of their relatives, which was why we felt compelled to write to thank them for their ongoing support.

I’d like to take this opportunity to welcome Mike to this his first Board meeting as our Chair. I am looking forward to the benefits we can draw, at both a BHR and a NEL level, from the success Mike has had in Croydon in bringing together the provision of health and social care. We’re also very fortunate that Joan Saddler is back with us as one of our non-executive directors.

Four-hour emergency access standard  

One of the priority tasks for my new colleagues, Ben Morrin and Steve Rubery, is to help us improve our urgent and emergency care performance. I have written before about the history of the problems our EDs face. We need to break free from our recent past and secure a future where many more patients are dealt with within the required four hours. An early focus will be on the infrastructure of our two departments and whether or not we are using the space available in the best way. The newly expanded Rapid Access and First Treatment (RAFT) area at Queen’s ED is a step in the right direction.

Inextricably linked with any work on our four-hour access performance is the need to address our shortfall of beds and the workforce that would be required for any extra beds. When it comes to nurse recruitment, we received recognition last December for the work we have done to recruit from overseas. This project has run for more than a year; involved colleagues from many different departments; and has paid dividends in terms of providing us with additional nurses to care for our patients. 

Planned (elective) care

At the height of the second wave, like most other trusts, we had to postpone non urgent outpatient appointments and non-urgent procedures. Chemotherapy and radiotherapy treatments have continued at Queen’s. The majority of cancer surgery has been moved to the independent sector, with a very small number of procedures taking place at Queen’s and endoscopies at KGH. We now need to resume that which we have paused. The number of people waiting longer than 52 weeks will, inevitably, take some time to reduce. We’ve started a limited number of urgent day cases at Queen’s. We hope to increase the amount of such operations in the coming weeks, and we will restart ‘Covid protected’ elective work at KGH in the near future.

Our finances

As well as consigning to history our poor emergency performance, we want to put behind us the days when we had an inadequate grip on our finances. We will focus on reducing our spend on agency staff; improving efficiency in our planned (elective) work; and moving elsewhere the work that doesn’t need to be done inside a hospital.

We are also embarking on a capital programme costing £47.5m. Our national funding is double what we received in the previous financial year. As we spend this money, improving our services, we need to ensure we do not add to our deficit. It is exciting that one of the schemes we will be funding is the purchase of a second Da Vinci Xi robot. It will be used at KGH and will help us attract high calibre clinical staff.

Confidence in our staff

We are embarking on not one, but four recovery programmes. My confidence we can deliver comes from my faith in our staff. They have displayed enthusiasm and inventiveness in the face of a pandemic that has pushed them to their limits.

In one day, last month, I met a nurse in intensive care whose previous job had been looking after women in our gynaecological outpatients department; a chef who was determined to continuously improve the food he prepared for his colleagues; and a senior manager who knew the first names of all of his 300 team members and who started his working life as a domestic.

Our Trust is an incredible place and I am proud to be its Chief Executive as we work in partnership across BHR and NEL to improve the health of those we serve.

Tony Chambers           
Chief Executive               
February 2021

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