I would like to wish all readers of my report a belated Happy New Year and I hope you managed to rest and recharge over the Christmas period.
For a second year running, the pandemic had an impact on our celebrations. At our Trust, we are responding to the Omicron strain and we are grateful for the continued success of the vaccination programme. We are proud to be playing our part (we administered more than 143,000 jabs last year) and we’re delighted when we can ensure people such as Harley receive the protection they need.
A powerful message about the importance of the vaccine was delivered by one of our patients, 16-year-old Areeb Khan, after she’d spent three months recovering in hospital. It’s a message that needs to be repeated given that many of our patients with the virus in our critical care units continue not to be fully jabbed. In the first week of December, only two of the 29 Covid patients admitted to intensive care across north east London (NEL) had been fully vaccinated.
It’s also a message we are sharing with those colleagues who are still to be vaccinated ahead of it becoming a legal requirement for NHS workers. We are approaching each individual with respect and facilitating conversations with someone they feel comfortable talking to.
This winter we are experiencing increased pressure on our services. We are dealing with the pandemic; responding to high demand on our Emergency Departments (ED); and maintaining the work to reduce backlogs.
In all of this, our staff remain our most precious resource and it’s just one of the reasons why we are committed to paying the London Living Wage. We have allocated budgets to teams to spend on their wellbeing and during the festive period senior leaders recorded messages of thanks. I’ll leave you to work out which one is a former bassist in a famous 80s rock band.
These winter pressures will lead to a need for extra beds, which is something that has rightly concerned the politicians in our boroughs. I’ve written before about the new £7.5m critical care unit at Queen’s Hospital and I was pleased to show the work underway on the facility to the Romford Recorder. Once it’s operational, we will be able to open a new 30 bedded short stay unit at Queen’s. We will also secure extra capacity with the return of NELFT run stroke rehabilitation beds and by operating a nurse-led 15 bedded discharge ward at King George Hospital (KGH). It will be for those who are medically fit and waiting to go to a care home. These changes will be reliant on the necessary workforce being available.
Urgent and emergency care
Too many people are still waiting for too long in our EDs and this isn’t acceptable for our residents or our staff. In October 2021, we dealt with an 18% increase in the number of Type 1 walk ins (those who are most seriously ill) when compared with the same month, two years previously. Last year, more than 280,000 people came to us for urgent and emergency care. Despite these pressures, we know we could be performing better - especially when it comes to people we don’t admit to hospital - and we will look to increase the number of senior decision makers on the ‘shop floor’. Other solutions lie in our partnership working with PELC (who provide primary care in the urgent treatment centres at our hospitals), the ambulance services and with those providing social and community care.
Our new Ambulance Receiving Centre (ARC) at Queen’s is having an impact. Working alongside the London Ambulance Service (LAS) we are reducing the amount of time spent taking patients off vehicles and ensuring they are cared for safely. Since it opened two months ago, the ARC has cared for around 300 patients and provided 1,400 hours of care which is the equivalent of 1,400 hours of paramedic time being released - they are then free to respond to other patients in need. It is a positive innovation, and we are sharing our learnings with interested organisations. The ED team continue to work with LAS colleagues to explore further opportunities to improve capacity and reduce ambulance offload times.
More and more people - particularly those who are quite sick - are using our EDs as their first point of access to care. The CQC commissioned Ipsos MORI to conduct a survey of ED attendees. The findings will help us – and our partners across the system – to better understand why people choose to come to Queen’s and KGH rather than receiving treatment elsewhere.
The CQC also conducted an unannounced inspection of the Queen’s ED two months ago. They highlighted some issues of concern including the length of time people waited and overcrowding. When it was opened in 2006, the Queen’s ED was designed to accommodate 300 attendances a day. Sixteen years on, it’s not uncommon for average daily attendances to be double that figure and it is one of the busiest sites in the country. We’ve responded to the issues of concern raised by the CQC and we are waiting for their final report.
At the end of their time with us the CQC inspectors provided a verbal update, and they made a point of saying that they had been impressed by the resilience and optimism of our staff, the culture in the ED and the leadership they had witnessed.
Reducing our waiting lists
At one point last year, three out of every four admissions from ED into our surgical specialties were for patients who were already on waiting lists for treatment. It’s a reminder of why we must sustain the work to reduce the backlogs. Between January and November 2021, we carried out more than 12,000 surgeries in our Covid secure ‘green zone’ at KGH. In the same period, we completed more than 100,000 CT and MRI scans.
We are one of the best performing trusts in London when it comes to the delivery of high volume, low complexity surgery. Others in the NHS are keen to learn from us. When Professor Neil Mortensen, President of The Royal College of Surgeons of England came for a visit, he said he had been inspired by what he saw.
At the heart of these impressive initiatives is a real commitment to learn, adapt and involve everyone – clinicians, operational managers and administrative staff - in the decision making. During one of our focused weeks, the number of patients who failed to turn up on the day significantly reduced after the orthopaedic surgeon who was conducting their operation rang them on the day before. The use of virtual fracture clinics by our orthopaedic department has cut by 40 per cent the number of actual visits to our hospitals.
This drive to tackle the waiting lists has seen us treat, on one Saturday, three times the normal number of skin cancer patients; on another day, 120 paediatric orthopaedic patients were seen and treated; and over two weekends, 440 patients had their first urology appointments.
The ongoing work has real momentum, and we are making serious inroads into our waiting lists. However, inevitably, we are replacing those once on a list with new people now in need of surgery. We’ve significantly reduced the number of people waiting for more than 52 weeks to well below 1,000 and we remain on track to cut to zero by the middle of the year. Other than anyone who chooses to wait longer, all waits of more than 104 weeks will have been eliminated by March.
As I mentioned when I spoke at our November Board meeting, our performance against the cancer two week wait access standard is below target because of an increase in breast cancer referrals following the death of the singer, Sarah Harding. We have put on extra clinics during the week and at weekends to address this increased demand and we will recruit additional staff.
One of the main ways we will improve our financial position – and improve the care we offer – is by running theatres more efficiently. To address this, the creative minds in our surgery department came up with TOWIE – Theatre Operational Week – Improving Efficiency. It yielded a significant amount of learning that we will act on.
We have seen an improvement in theatre efficiency in recent months and we are determined to build on this progress. The other significant area for financial savings – reducing the amount we spend on bank and agency staff – is proving a tougher target to deliver.
Closer collaboration with Barts Health
Our closer collaboration with Barts Health should help with this by ensuring we agree and stick to the same rates of pay across all of our hospitals. Other areas of closer working that are yielding results include the help we are receiving from them for urgent and emergency care and the mutual aid we’re providing to cut their waiting lists – more than 1,500 Barts patients have had their scans and procedures with us.
We’re also working together to develop green plans to respond to climate change and to play a meaningful role in delivering the world’s first net zero health service. We are a large employer with a significant carbon footprint. A further tangible sign of our collaboration is the move by Magda Smith, our Chief Medical Officer to become Group Deputy Chief Medical Officer at Barts Health. I’m delighted for her, and I know she will thrive. She played a pivotal role helping this Trust navigate the very worst of the pandemic.
We’ve been very grateful in recent months for the support we’ve received from stakeholders and residents as we’ve explored how we should best deliver our services in the future. With all the challenges we’re currently facing we’ve decided to pause this work on the refresh of our clinical strategy. The insights we’ve received will prove invaluable when we resume.
One of the crucial partnerships we must always nurture is the one that exists with our residents. We are a large employer and are often referred to as an anchor institution. An obvious way we can support the health and wellbeing of the communities we serve is by ensuring we offer a wide range of interesting jobs. Our drive to recruit more ward clerks is an initiative that excites me. These roles will give more support to our clinicians, improve communications with families and attract new talent into the organisation. The BHR Academy will also help us offer rewarding careers.
The year ahead
2022 promises to be a year in which we will further showcase how we are turning a corner and embedding the improvements we are making. The changes are visible, as the money we’ve been investing in our sites demonstrates. More than £22m has been spent on our critical care and ED departments and I was pleased to open KGH’s paediatric ED last month.
KGH’s surgical hub is a real asset and a site of growing importance for other NEL providers, including Barts. Our plan to build extra theatres there will help strengthen it.
When I was interviewed by the local newspaper, I told the reporter that “if you’ve got great colleagues and you’re given the resources to do your job properly, people can thrive”. My role is to ensure this is always the case for our existing staff and our new employees. We will be recruiting a permanent Chief Medical Officer to replace Magda; we will fill other senior vacancies; and Dr Kathryn Tompsett, a consultant obstetrician and gynaecologist, is starting as our new Divisional Director for Women and Child Health.
My five months at the Trust have shown me that our staff are inspiring, hardworking and dedicated. I have an enormous amount of respect for my colleagues, and I am confident that we can deliver the significant and necessary changes needed in the months and years ahead.