A new year
I hope you had an enjoyable and peaceful Christmas. Celebrations at the Trust included a party, organised by our charity, for more than 70 children we’ve looked after and a visit by West Ham players to the children’s wards. The relationship with the Premier League club is an invaluable one that we’re keen to deepen.
Entering a new year is always a good time to reflect on what lies ahead and on what has been achieved. Since the start of the pandemic we’ve invested heavily in clinical staff and the size of our permanent workforce has grown by 888 whole time equivalents (including 294 nurses and midwives, 201 doctors, 93 AHPs and 61 healthcare assistants); in 2022 we carried out more than 7,600 surgeries at our King George Hospital (KGH) surgical hub; and in excess of 290,000 people used our Emergency Departments (ED) last year.
At a recent induction I painted a picture for new joiners of the future where they would, finally, benefit from the introduction of electronic patient records, and our residents would have access to more diagnostic services at Barking Community Hospital and a health and wellbeing hub at the old St George’s Hospital in Hornchurch that will open next year. We’re also in discussions about including a health facility as part of the re-development of the ice rink site in front of Queen’s Hospital.
Any time I share with staff my excitement about the future we’re forging together, I temper it with a reminder that we need to reduce our deficit. It’s forecast to be £15m at the end of the financial year and we’ll achieve this goal if we continue to cut our non-pay costs and reduce our reliance on expensive agency workers. In 12 months, our spend on high-cost temporary staff has reduced from £100m to £84m (£52m bank staff, £32m agency). We hope to be in a position soon where nine out of every ten colleagues will be employed directly by the Trust, with bank shifts meeting seasonal demand.
As well as responding at work to the pressures of winter, our staff are dealing with the impact of the recession at home. Throughout last year, we supported more than 1,000 colleagues with a range of initiatives including the provision of free period products and help with the cost of school uniforms. Before Christmas, we ran two marketplaces where staff could collect toys, clothes, food and household items.
The cost-of-living crisis is one of the factors that has led many NHS workers to go on strike. None of our employees have yet done so, but the industrial action last month by the London Ambulance Service placed a considerable strain on our services. The ballot at the Trust by the Chartered Society of Physiotherapy has given them the mandate to take strike action in the coming months.
Patients with mental health needs
I’ve highlighted previously my concern about a shortage of mental health beds that’s resulting in patients with mental health needs having a poor experience in our EDs. They are busy, noisy environments that are often the very last place these patients should be. We’re creating better environments for them there while they wait for the correct treatment elsewhere.
Two months ago, the average length of stay in ED for these patients was 20 hours. We had 40 people (21 at Queen’s, 19 at KGH) who waited more than a day and a half to be transferred to the right service that could care for them properly.
For two months in a row (October and November last year) we had the equivalent of 10 ED cubicles being used round the clock by mental health patients. Given, on average, a cubicle is used three times in a day for those with physical health needs, this equates to the loss of capacity for 30 patients with physical health needs each day.
Care Quality Commission
Mental health provision was one of the issues that came up when we were inspected recently by the Care Quality Commission (CQC) and afterwards the CQC asked NHS London to convene a quality summit to look at ways in which all healthcare providers in north east London (NEL) could work together to improve the provision of urgent and emergency care at our two hospitals. They described it as a ‘pressing concern’.
The summit last month was productive. There was an acknowledgement that urgent and emergency care at the Trust needs more support from outside and a commitment from our NEL partners to help us in the coming months. For example, NELFT, our local mental health and community trust, is opening a range of new services this winter.
The CQC report is due to be published in February and I’ll update you on its recommendations at the next Board meeting. In the meantime, you can watch my presentation to the inspectors in which I set out what I see as our challenges and my grounds for optimism.
Urgent and emergency care
We share the CQC’s concerns about overcrowding and long ED waits which were particularly acute over the festive period. The changes we’ve been introducing are slowly beginning to deliver results. At the heart of this work is a focus on proactively moving patients each hour out of ED and onto the relevant ward. We started with the Frailty Unit and are now doing the same through the Medical Receiving Unit (MRU) at Queen’s to other medical specialties.
Operation Snowball, as it’s known, has resulted in a 21% increase in patients being transferred to the Frailty Unit. The MRU has seen an increase in admissions from 503 in September to 599 in November.
We’ve also opened a surgical assessment unit at Queen’s to take surgical patients out of ED.
And the development of same day emergency care (SDEC) at KGH together with the expansion of the existing SDEC at Queen’s will further help. SDECs, as the name implies, allow people to be seen and treated on the same day. They reduce ED waiting times and cut admissions.
The aim, day in day out, is to deliver the smooth and continuous movement of patients out of ED, through the hospitals and back into the community. A major impediment to what the NHS calls ‘flow’ is when people are medically well enough to leave, but can’t. Delays can be caused by waiting for the correct package of care to be in place, nursing homes having space and the delivery of the right equipment to people’s homes.
Across our hospitals there are typically up to 140 patients who are medically fit to discharge each day and about half of them experience delays.
Reducing our waiting lists
Our work to reduce our waiting lists is going from strength to strength and we continue to be contacted by other organisations who are keen to learn from us. We have been one of the best performing trusts in London for several months.
The total number of people on the waiting lists in December was 60,280, a reduction of more than 3,000 in three months. The vast majority need to be seen in outpatients. The number of people waiting more than a year is also reducing, from 1,928 in June to 1,542 in November. We are facing particular challenges in gynaecology and neurosurgery and we’ll be doing some focused work in these areas in the coming weeks. Referrals from GPs have been improved and the process streamlined with a switch away from paper forms to digital.
It's exciting to see the building work underway at KGH that’ll provide us with two new theatres and other facilities. This is a £14m investment in our surgical hub that focuses on the six specialties that make up 70 per cent of the waiting lists – general surgery, ENT (ear nose and throat), trauma and orthopaedics, ophthalmology, urology and gynaecology.
As part of our drive to reduce waiting times for patients, we operated on triple the number of urology patients we would normally treat in one day; we saw 81 women during a ‘Gynaecology Perfect Week’; and we’ve installed a new MRI machine at KGH. We upgraded three of them last year – two at KGH, one at Barking Community Hospital.
They are faster, less invasive and are helping to cut waiting times. Ensuring we maintain our workforce is also crucial and we’ve opened a training academy for radiographers. In 2022, we carried out 45,956 MRIs and 80,774 CT scans.
Disappointingly, for the first time in 12 months, we didn’t achieve the NHS’s Faster Diagnostic Standard of three out of every four patients being diagnosed or having cancer ruled out within 28 days of being referred to us by their GP. In October we reported 71.26% because of reduced capacity in our dermatology department and delays in diagnostic reporting.
Against the NHS target of 85% of patients waiting no more than two months from the date we receive an urgent referral to the start of their treatment, our performance was 65.35%. This has remained steady since the pandemic and we are working hard to address delays in the cancer pathways with our partners at Barts Health, in primary care and across NEL.
We achieved 89.46% - against the target of 93% - for patients being seen by a specialist within two weeks of an urgent cancer referral. This October figure is a 9% improvement on our August result. To help our cancer patients undergoing radiotherapy, we’ve become the first trust in the country to launch an app they can use to contact those caring for them and find out more about their treatment.
The coming months
As part of our work to transform the organisation we’ve recruited more junior members of staff to a Shadow Exec. Its members have been drawn from groups that are under represented at the top of the Trust. They will influence the way we are run by providing senior leaders with a greater understanding of the impact of their decisions on colleagues.
It’ll also help those involved develop their careers and I was delighted more than 70 people applied. It was a great success when I introduced this at my previous trust.
Our staff continue to be acknowledged for what they achieve, with Gemma Norburn receiving an award for her work in our mortuary and our Enhanced Supportive Care team (the only nurse led such service in the country) were praised recently for the extraordinary lengths they go to for cancer patients.
Those who want to complain about something often, quite rightly, beat a path to my door. I also hear from people keen to praise my colleagues. One that sticks in my mind is a letter from someone who wanted to thank the ED staff who looked after their relative. They wrote about none of the care being rushed; clear communication; and about their loved one being supported compassionately and being able to die peacefully and with dignity.
We’ve relaunched our You Made a Difference Award so that you can nominate a member of staff who has provided great care.