One of the joys of being the CEO of our two hospitals is the opportunity it affords me to celebrate my many talented colleagues. I used an appearance in January on the flagship Today programme on BBC Radio 4 to highlight the innovation and learning that has come out of the pandemic.
An important part of my role is to strip out the barriers that serve as an impediment to such innovation, ensure teams have the equipment and resources they need and then step back and allow them to excel. In doing so they help countless patients such as Kevin Holmes who has spoken of how his life has been transformed after he was treated for a debilitating form of dystonia. We are one of only two trusts in the country to offer a procedure known as selective peripheral denervation (SPD).
The pride I feel when I read Kevin’s account is also there when I reflect on how we responded to the (now abandoned) legal requirement for NHS staff to be vaccinated against Covid-19. Throughout a difficult few weeks, we avoided the issue becoming a source of conflict and we ensured everyone was treated with compassion and respect.
Despite it no longer being mandatory, we are encouraging staff to be jabbed – nine out of every ten frontline colleagues have been vaccinated – as it is safe, saves lives and protects staff and patients.
Like everyone else we are adjusting to the ending of all Covid restrictions in England and assessing what this will mean for how we operate, especially as our number of Covid -19 patients is reducing. At the time of writing my report, we are asking people to wear masks at our sites and we continue to limit the number of people who can visit the wards.
I am very conscious of the fact that for those who are still suffering from the impact of the illness or who have been bereaved by the virus, ‘moving on’ is a challenging concept. I was pleased to take part in a tree planting ceremony at Queen’s Hospital in honour of those who have died during the past two years.
One of the striking features of the pandemic has been the support we have received from many quarters and the willingness of staff to go the extra mile. This was highlighted recently by the help we were given by the army and by Ramandeep Kaur’s decision to do shifts at the vaccine hub at King George Hospital (KGH). For our, at times, ‘Covid weary’ staff, tales of recovery, like that of 16-year-old Areeb Khan, have helped to sustain them.
Closer collaboration with Barts Health
I have been very grateful, during my seven months working in north east London (NEL), for the support and wise advice I have received from Dame Alwen Williams. She is a fantastic leader who has made a huge contribution to the health service. Alwen’s decision to step down as Group Chief Executive of Barts Health after an NHS career of more than 40 years, has provided the Boards of the two organisations with an opportunity to reflect on how best to replace her.
Jacqui Smith, our Chair in common, announced last month that she will be recruiting a Group CEO of Barts Health and BHRUT. The successful candidate will provide overall leadership to the two organisations as Accountable Officer and will focus on system leadership, strategic and organisational development and partnership working. They will also help deepen our collaboration for the benefit of residents.
I will lead the Trust’s Executive team, be responsible for the running of Queen’s and KGH and work with partners in the Integrated Care System (ICS). I will be accountable to the Board and to the Group CEO for all aspects of the Trust’s performance.
Urgent and emergency care
One of the benefits of our partnership with Barts Health is that we can draw on their expertise as we tackle the longstanding and deep-rooted problem of people waiting too long for treatment in our Emergency Departments (ED). Councillor Neil Zammett chairs Redbridge’s Health Scrutiny Committee and is one of our crucial ‘critical friends’. When he was damning about our ED performance at a recent public meeting it was painful to hear, but hard to disagree with. We continue to hold ‘flow weeks’ where we examine what the blockages are to patients moving smoothly and speedily from our EDs, to a ward and back to where they live.
The opening of the new £7.5m Jubilee ITU at Queen’s will help with our critical care demand and it means we can open 30 inpatient acute medical beds in a phased approach as staff become available. They will be in addition to the extra capacity we have secured with the return of the NELFT run stroke rehabilitation beds that will relieve the pressure on the stroke pathway at Queen’s. We also have the nurse-led 15 bedded discharge ward at KGH which is for those who are medically fit and waiting to go to a care home. As always, all additional beds are reliant on having the necessary workforce.
Our Ambulance Receiving Centre (ARC) is releasing valuable paramedic time and allowing patients to be taken off a trolley and into a better clinical environment. The ARC is seen as a model of good practice that should be replicated nationally. Whipps Cross Hospital has opened one and other trusts have been in touch to learn from us.
The demand for our EDs and for the GP run urgent treatment centres (UTC) at Queen’s and KGH is considerable, and it results too often in a poor experience for patients and staff. To better understand why individuals access these services, the Care Quality Commission (CQC) asked Ipsos MORI to conduct a survey of those attending. They interviewed 420 people at both sites last December.
What has struck me about their findings is that a lot of people have spoken to another service before coming through our front doors. They often want urgent access to medical attention rather than necessarily needing the specific expertise on offer at an ED or a UTC.
When I joined the February Board meeting of the CQC (1 hour 45’ in) with my ED colleagues Dr Karim Ahmad and James Avery, I gave the example of a resident on a zero hours contract for whom it makes more economic sense to spend several hours one evening at a UTC being treated, rather than face the prospect of having to attend several appointments, during working hours, arranged via a GP.
We need to approach this from a system perspective and use the data intelligently as we think about next winter. We are working collaboratively with those who run the UTCs at Queen’s and KGH to improve the experience of people when they first arrive and to get them treated in the right place as quickly as possible.
Reducing our waiting lists
We are leading the way nationally with our many and varied initiatives to cut our backlog. The way our different teams are working together – with our admin colleagues recognised as an integral part of the endeavour – has created momentum, drive and enthusiasm. The inclusion of our innovative projects in the NHS’s plan to cut waiting lists, on the BBC’s main television news bulletins and in an NHS Providers blog written by Thangadorai Amalesh, our Divisional Director for Surgery, has been a welcome antidote to the sometimes prejudiced way in which BHRUT has been viewed previously. Around 3,000 Barts Health patients have been treated more quickly this winter because they had their diagnostic scans and procedures at our hospitals.
Our Covid secure ‘green zone’ at KGH – a hospital within a hospital – has been one of our greatest assets. The importance of our focus on maintaining surgery in our green zone is borne out by the fact three out of every five of our surgical admissions (via ED) were on a waiting list of some kind. It’s where we are focusing on the six specialties that make up 50 per cent of our waiting lists - general surgery, ENT (ear, nose and throat) trauma and orthopaedics, ophthalmology, urology, and gynaecology.
It has enabled us to keep surgical beds free for patients waiting for their planned care, instead of being used for emergency cases which has often been the case in the past. This winter was the first time in four years that our full list of cancer operations has taken place.
We have succeeded in reducing the number of patients waiting more than a year from 2,430 at the end of March 2021 to 959 by the end of last year. During the Christmas and new year period the ongoing reduction slowed down because of staff leave and sickness. We have also significantly reduced the number of people waiting more than six weeks for either a CT scan or an MRI.
Inevitably, as quickly as we discharge patients others are added to our lists. The number of people on them increased by 2,000 in an eight-week period at the start of the year. Behind the statistics are real people whose lives are being blighted to varying degrees as they wait for treatment. Their confidence in the NHS relies on us maintaining our focus on cutting waiting lists and we have a moral imperative to get them the care they need.
The coming months
As the money that was once available to help tackle Covid-19 disappears, we will have to redouble our efforts to reduce our expenditure and our deficit. The most obvious and most difficult saving to deliver is a reduction in the number of high-cost agency and bank shifts we pay for. It is something we are trying to address through our partnership with Barts Health so that we can achieve standardised rates across NEL and move on from a situation where we have agency employees receiving up to three times the amount earnt by the permanent member of staff they are working alongside.
I am continuing to build my senior leadership team and recruitment is underway for a Chief Medical Officer and a Chief People Officer. I’m delighted Ann Hepworth has joined us as our Director of Strategy and Partnerships. Her breadth of experience and knowledge of the NHS will prove invaluable as we drive forward our work with partners in health and social care. I relish the chances I get to visit other healthcare providers. For example, Jacqui Smith and I went to a medical centre in Romford to learn how we can work better with primary care.
Beyond the here and now, we have exciting plans to invest in services that will benefit our population in the future. We are playing an active part in a national programme to develop community diagnostic centres that will improve access to such treatments; we’ve taken the first of many, complicated steps along the path to introducing electronic patient records over the next five years; and we want to build additional operating theatres at KGH.
They would enhance the planned care work taking place there and reinforce the reality that King George Hospital has a bright future and is here to stay.