We have all been able to savour the gradual return of much cherished freedoms we lost temporarily as we responded to the pandemic. At our Trust, with Covid-19 infection rates down significantly from the last peak, our attention has been on tackling our waiting lists and we were delighted to have this work featured on the Ten O’clock News on BBC One.
Reducing our waiting lists
In dedicated Covid secure zones we have been focusing on the specialties of general surgery, ENT (ear, nose and throat), trauma and orthopaedics, ophthalmology, urology and gynaecology. These six specialties make up more than 50 per cent of our waiting lists and we were the second highest performing trust in London for this work in May.
At King George Hospital (KGH) we’ve appointed three advanced care practitioners to support the recovery work. Our intense drives to see patients have acquired a plethora of names including Back2Backs, Scalpel Project and Bones R Us.
They’ve delivered impressive results, including a surgical outpatient clinic that saw 162 people on a Saturday; 60 procedures carried out by our trauma and orthopaedic team in five days; and our neurosurgery team saw 119 patients in one day, in advance of their planned surgery.
One of the reasons these initiatives have been successful was because the teams involved – including admin staff, managers, radiographers, porters, healthcare assistants, nurses and doctors – worked cohesively as one for the benefit of the patients.
We are delivering at least 43,000 outpatient appointments each month (the introduction of robotic software has proved timely); we are caring for more than 3,000 day cases and more than 450 inpatients a month; and we remain on track to reduce to zero the number of patients who’ve waited for more than 52 weeks by the end of next March. At the end of May we had more than 1,600 people on this list.
Preparing for possible future surges
The ongoing removal of lockdown restrictions is due largely to the vaccination programme and we are proud to be playing our part. We delivered 38,632 doses at Queen’s Hospital during the five months our hub was open there and we are still offering appointments at KGH via the national booking system.
Despite the successful rollout of the vaccine, we are starting to see an increase in community prevalence in Barking and Dagenham, Havering and Redbridge (BHR) that is translating into a small rise in Covid-19 patients. At one stage last month, five of the six patients in critical care had received no vaccine and the sixth person had had one dose.
The latest modelling suggests that any third wave shouldn’t lead to the same number of hospitalisations as we saw at the start of the year when, at the peak, we treated 519 patients in our hospitals. Our planning for this is also encompassing the work we need to do to prepare for an expected increase in respiratory infections among children.
We know the devastating consequences Covid has had on the bereaved and can have on those who survive. We have appointed a Lead Medical Examiner to provide additional support to bereaved relatives and clinical teams are working to support those with ongoing Covid related difficulties.
The Long Covid clinics we run with our colleagues from the North East London Foundation Trust (NELFT) have attracted international attention and have featured on the ITV News. We also joined forces with Havering Music School, in a pilot scheme, to offer Singing for Health sessions. It’s hoped the scheme will be relaunched in the autumn.
Closer collaboration with Barts Health
Our Long Covid work with NELFT isn’t a one off and collaborative working with partners is what has sustained us in recent months. The Mile End Early Diagnosis Centre is just one example of this work delivering concrete improvements for our residents.
We are currently examining with Barts Health NHS Trust, under the umbrella of the north east London (NEL) integrated care system, what closer working would look like in practice.
Both organisations are exploring with their key stakeholders and their staff the advantages and the challenges of such an undertaking. We are also in the process of recruiting a Chair in common to lead the two boards, though the trusts will remain separate statutory bodies. Running in parallel with this, we intend to revisit and refresh our clinical strategy – work on it was paused when the pandemic struck.
We are determined not to lose sight of what we need to do - with our partners - to develop place-based health and care partnerships in BHR. These developments are in line with the latest NHS thinking on providing truly integrated care and addressing the health needs of the population we serve.
Covid-19 reminded us, once again, of the health inequalities that exist. Just last month we launched a strategy to tackle the health inequalities faced by those with learning disabilities. Collaborative working with other acute and social care providers will help to provide a lasting solution and enable us to transform services, tackle backlogs and improve performance.
Urgent and emergency care
We continue to face enduring problems as we strive to improve our performance. As one of my senior colleagues put it recently, “we have good plans for swimming forward, but there are strong currents pushing us back”.
Our October target of ensuring eight out of every ten of our emergency patients (all types) are admitted, transferred to another provider or discharged within four hours is a stretching one. It is made all the more challenging by the fact we have seen an increase in the number of people, young and old, arriving at our Emergency Departments (EDs). Last month, as promised, we re-opened overnight our paediatric ED at KGH that we’d had to close temporarily as we responded to Covid-19.
We are constantly looking at ways of improving the flow of patients through our hospitals. Recent initiatives that are helping are the Frailty Unit we have opened at Queen’s which enables the elderly to bypass our EDs and receive care in a setting more conducive to their needs; the new Children and Young People’s Assessment Unit; and our HomeFirst Scheme, funded by money raised by Sir Captain Tom Moore, that is designed to ensure the assessment of a patient’s needs are undertaken in their home, after discharge, and not while they are still on a ward.
We have been in financial special measures for three years now and we are keen to increase the confidence NHS England has in us and decrease the level of oversight we need to be subjected to. As a first step, we must improve our four-hour emergency access standard.
We also plan, by the end of this financial year, to reduce our dependency on expensive bank and agency workers and improve the way our theatres are run. Together, these actions should save £20m and help to deliver a monthly underlying deficit that is no worse than £5m.
The picture, when it comes to capital spending, remains a much rosier one. Given the years of, at times erroneous, talk about the future of the ED at KGH and of the hospital itself, it has been heartening to see the significant sums of money we are in a position to invest there.
Overall, we will be spending £39m on capital projects across our Trust including enhancing and expanding our critical care departments. Two years ago, the money made available to us for such improvement work was £7m.
I have written repeatedly about the importance we are placing on the wellbeing of our staff and how our attention to this will be consistent, not episodic. We want all topics and issues of concern to be addressed and a recent article on the menopause by Hazel Melnick, our Deputy Director of Communications and Engagement, was well received by colleagues.
I’m pleased that recent developments will help us maintain this focus. Remi Odejinmi has been appointed our first Director for Equality, Diversity and Inclusion. Remi is committed to promoting a culture that is fair, equitable and inclusive, where every voice counts. Another way we are ensuring that all voices are heard, is by having representatives from our staff networks on our People and Culture Committee which reports into our Board.
Our networks are constantly developing and growing. A Women’s Network has joined our established groups of Black, Asian and Minority Ethnic; Ability not Disability; and the LGBT+ Network which is benefitting from the fact we have signed up to Stonewall’s Diversity Champions programme.
My time as CEO
I joined our organisation in January 2020 on an interim basis and with the appointment of Matthew Trainer as a substantive Chief Executive, I will leave in August. When I arrived at BHRUT, 18 months ago, one of my priorities was to move us into a Group with NELFT. The global pandemic meant priorities changed and our focus has moved to our collaboration with Barts Health and our place-based health and care partnerships with our boroughs.
I remain humbled by the herculean response of our staff to not one, but two intense waves of Covid-19. They were on the frontline, day after day, and could not escape the devastating impact of the virus when they returned home. As a Trust we were severely tested, and we survived. It is only right that the work we are doing to reduce our waiting lists has won plaudits elsewhere in the NHS.
I feel privileged to have spent time with so many dedicated individuals who are committed to caring for our patients. Ours is a Trust that very much gets under one’s skin and I will miss those I have worked alongside. I would like to wish Matthew all the very best as he builds on all the work that I’ve highlighted in this report and as our Trust continues to improve the services we offer.
Our residents deserve nothing less.