We are involved in several long-term projects with our partners that represent a significant investment in healthcare in north east London (NEL). They will have a transformative impact on the lives of patients and staff in the years to come.
One important piece of work we’re doing, with the backing of NHS England, is to introduce electronic patient records. The advantages are obvious and we’ve been in the digital desert for too long. It will take time to introduce a system that is compatible with other providers across NEL. Our unhealthy dependence on paper – we generate 25 million pieces of A4 each year - is captured in this video.
Other developments in the pipeline that will benefit the communities we serve include the planned expansion of diagnostic services at Barking Community Hospital; the creation of a health and wellbeing hub at the old St George’s Hospital in Hornchurch; and we are exploring options for a health facility as part of the re-development of the ice rink site in front of Queen’s Hospital.
We want to move the Queen’s renal service to the new health and wellbeing hub and we are looking at which outpatient services could be relocated across the road in Romford. Such moves would be in the best interests of patients and would free up much needed clinical space at an overcrowded Queen’s, especially in the parts of the hospital where we provide urgent and emergency care.
Urgent and emergency care
The extra space is a long-term goal. In the short-term, we are continuing to focus with colleagues on improving the GP-run Urgent Treatment Centres (UTC) and our Emergency Departments (ED). We’re looking at Queen’s first and then we’ll apply the learning as we make any necessary changes at King George Hospital (KGH).
A strengthened relationship with PELC, who are responsible for the UTCs, has cut the length of the queues at the hospital entrances. We have more senior doctors at the ‘front door’ and our staff work side by side with GPs to reduce the number of times someone is asked the same question by a different person. Three senior GPs are joining the Trust for one day a week, on an interim basis, to help improve the quality of the relationship between us and primary care.
The UTCs and the EDs are very busy and the reality is that anyone who uses the UTC as a way of accessing primary care may well wait a long time to be seen as we respond first to those in greatest need.
We’ve been analysing how patients move through the hospital - from ED to a ward to being discharged back home. We are sending too many people home late in the day when they are ready to be discharged in the morning. This isn’t good for the patient and leads to congestion at our sites. One in two of our beds is occupied by someone who has been with us for more than seven days.
This is an issue across London and we are below the average in the capital. It obviously has an impact on the number of beds that are available for anyone who only needs to be in hospital for a short period of time.
While too many people are still waiting too long when they first arrive seeking treatment, we are starting to see some beneficial changes. There has been a reduction in the number of patients who wait more than an hour to be transferred from an ambulance to our care.
This improvement has occurred at the same time as we have responded to an increase in the number of ambulances being sent to us. The figure for delayed transfers would go down significantly if it included those who are brought by ambulance to our frailty units. These handovers consistently take place within 30 minutes and we’re working to see if the published data can be updated to reflect this.
Since its launch eight months ago, the Ambulance Receiving Centre (ARC) at Queen’s has seen nearly 2,000 patients and returned almost 13,000 hours to paramedics so they can be back on the road, responding to emergency calls. The ARC is an example of innovative partnership working by the Trust and the London Ambulance Service (LAS).
We’ve adjusted how the ARC works and now a senior clinician is available to assess patients as soon as they turn up. The paramedics and the emergency staff are learning new skills and the patients are off an ambulance and being treated in an environment that’s not a hospital corridor. The ARC was featured in an article in the Observer.
Over the next two months we will make changes to the way services are configured in the Queen’s ED department. We’re grateful to senior colleagues at NHS England (the Emergency Care Improvement Support Team) who visited in May and made recommendations as to how we can improve. The changes we’re introducing will ensure patients are seen and treated more quickly.
We’ve seen a significant increase in the number of patients with mental health needs attending KGH compared with two years ago. Across the Trust, in June, half of these patients waited more than 12 hours in the department until they were either discharged or transferred to a mental health facility, with one in ten waiting more than 36 hours.
We’ve also been placed in the difficult position of providing care for teenagers with mental ill health who didn’t need to be in a hospital but alternative, more appropriate provision wasn’t readily available. This was distressing for the young person and staff, especially when our security guards had to help keep them safe.
Reducing our waiting lists
Waiting for any treatment is stressful. I’m proud of the continuing work we’re doing to minimise such uncertainty, particularly for patients undergoing assessment or treatment for suspected cancer. We’re part of the North East London Cancer Alliance and the team work of the clinical experts from trusts and other health and social care organisations has resulted in NEL residents being diagnosed with cancer sooner and receiving faster access to treatment.
Three out of every four patients are being diagnosed or having cancer ruled out within 28 days of being referred to us by their GP, in line with the NHS’s Faster Diagnostic Standard.
In April, we exceeded the target of 93% of patients being seen by a specialist within two weeks of a referral – we see an average of 2,400 such patients each month - and we’re focused on achieving 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. The latest data shows we’re at 74.1% compared with a London average of 67.4% and a national average of 67.6%.
Endoscopy is another area where we are performing well. The waiting list has been cut from 18,000 to 3,000 and we currently have the smallest number of patients in London waiting more than six weeks for a diagnostic test, which is the required NHS standard. A team of external accreditation assessors visited our endoscopy department recently. They were full of praise for the staff and the unit which they described as one of the best in the country.
As we emerge from the worst of the pandemic the number of people on our waiting list has continued to increase with the total, in July, standing at 65,213. Our early success in reducing the numbers waiting for more than a year has not withstood the pressure of increasing referrals and the total has reached 2,160. We continue to prioritise care for those patients who have waited the longest and we will work hard to improve this position.
The upgraded critical care unit at KGH – completed ten months after the first design drawings were created – will help us address the backlog when it comes to complex cases. The investment of £5m is further evidence of KGH’s secure future, a point Jacqui Smith, our Chair, and I highlighted when some of our Redbridge politicians visited the unit. Over the past year, KGH has also seen improvements to its ED and Radiology department and we want to build additional operating theatres at the site.
When we discovered a problem with our waiting list and a spike in the number of those waiting more than two years, we tackled it with considerable vigour. In two months we reduced the number of patients from 218 to just three, all of whom have chosen to delay their treatment for personal reasons. We completed the task in line with a target set by NHS England.
This can-do attitude has been on display for months and was reflected in an article in the Daily Mail. Two focused weeks saw 133 patients receive the surgical care they needed. When I visited the teams involved, the administrative staff spoke of it being a collective effort and of how they were fully involved in delivering these initiatives. Our challenge is to translate this exceptional focused work into what we do each day, so that we can tackle a waiting list that continues to grow.
Closer collaboration with Barts Health
We are pleased 3,000 Barts Health patients were treated more quickly during winter by having their diagnostic scans and procedures at our hospitals. The closer working is benefiting us as we work with Barts on improving urgent and emergency care, digital infrastructure and our finances. We continue to spend more than we receive, a situation that isn’t sustainable.
From next month, Shane DeGaris will be Group CEO of Barts Health and BHRUT. I’ve worked closely with Shane for several years and he knows this area well. As well as being CEO of our Trust, I’ve been asked to take on the role of Group Deputy Chief Executive.
Shane and I will work together to ensure the collaboration delivers the best possible clinical outcomes – the same goal will motivate the work the two trusts will do with Homerton Healthcare NHS Trust, as part of what’s known as an acute provider collaborative. The three trusts will also play their part in NHS North East London, the new integrated care board whose task is to drive the delivery of better, more efficient and joined-up care.
My colleagues are, once again, responding to a rise in Covid infections which is manifesting itself in an increase in the number of people in our hospitals with the virus and the number of staff who are absent. The vaccine remains our best defence and it was good to receive praise for the way the KGH vaccination hub cares for children.
Like everyone else, our staff are working out how best to cope with the cost-of-living crisis. We are maintaining an employee discount in our canteens and looking at extending the hours of the free staff shuttle bus between the sites. We are setting up a ‘BHRUT market place’ where colleagues can swap items, such as school uniforms, to save on buying them brand new for their children.
The best aspect of my role is the opportunity it affords me to meet a quite remarkable range of individuals. As a Trust, we’re keen to share as many of their stories as possible. On International Nurses’ Day, Rosemarie Stewart, who’s newly qualified, spoke passionately about her profession; Khadiza Siddika has been honoured for her work as a student volunteer; and Gabriel Sayer completed a 600km charity bike ride in memory of his daughter Molly.
The talents at the Trust extend to music. A Scottish rocker and a member of the London Welsh female choir have joined me and other colleagues in a band we’ve formed. Pfizer Chiefs - other good vaccines are available will play at a party we’re holding for staff. We’re also organising a special breakfast, brunch, afternoon tea and a family and friends’ picnic and fun day.
It’s important to take the time to acknowledge the fantastic work being done at BHRUT. We want to say thank you to colleagues for all they have done and for all they continue to do.