It is heartening how the pandemic is no longer dominating our lives as it once did. The number of patients we are treating with Covid-19 is reducing and we’ve eased the visitor restrictions that were in place. A significant factor in these changes is the success of the vaccine programme and we are offering the jab to five to 11-year-olds at the King George Hospital (KGH) Vaccination Hub.
As we embrace again the freedoms we lost during the lockdowns, we remain mindful of the lasting impact of the virus. We held a virtual memorial service on the second anniversary of the World Health Organisation declaring Covid a pandemic and I spent time with our respiratory team who have cared for more than 3,000 people in the last two years. Like all services, they experienced significant upheaval to the way they worked, including the introduction of virtual wards.
The £7.5m Jubilee Intensive Therapy Unit (ITU) at Queen’s Hospital is now fully open; the new £4m, 12 bedded critical care unit at KGH has started treating patients, ten months after the first design drawings were created; and many of the innovations introduced at the height of Covid will remain in place. Before she left to join Barts Health, Magda Smith spoke to the Romford Recorder about how Covid-19 has changed us. Anjum Misbahuddin, Clinical Lead for Neurology, has found her evening telephone clinics are good for her patients and for the planet.
After a lull imposed by Covid, we’ve been recognising those who’ve worked at the Trust for a long time. They could choose to receive their award at work or offsite and last month I joined Jacqui Smith, our Chair, for afternoon tea with 25 members of staff who’ve been with us for more than 20 years. The recipients included Marissa Lickfold and Milagros Inandan who moved here from the Philippines in 2001. Those celebrating worked through Covid and I’m very aware of how the pandemic has taken its toll on all colleagues. We will continue to pay close attention to their wellbeing, especially considering the impact the cost of living crisis will have on the less well-paid.
The staff survey results are a sobering read for the leaders running our Trust. The positive feedback for the way we’ve changed the appraisal process so that it addresses wellbeing, sits alongside people’s concerns about bullying, harassment and racism. My colleagues want action, not just words. We’ve launched a ‘Better Together’ campaign to celebrate diversity; I wrote on International Women’s Day about the need to tackle sexism in the organisation; and we’ve chosen five areas we’ll address straightaway as we strive to make our Trust a better place to work. These include responding robustly to those who bully or harass their colleagues; improving the training available to managers; and ensuring every post we advertise is open to flexible working and that all recruitment is fair.
I acknowledged on social media that our leadership still isn’t diverse enough and we need to deliver change so that the Board better represents the population we serve. This work is underway and will take time. Dr Mamta Shetty Vaidya is joining us as Chief Medical Officer; Marta Phillips has started work as one of our non-executive directors; and it’s great Mehboob Khan has been appointed our Vice Chair.
Urgent and emergency care
One of the staff survey findings we’ve sought to better understand is the fact that fewer employees said they would be happy with the standard of care for a friend or relative compared with the year before. When I’ve chatted to people, it’s clear they’re very proud of the quality of care being provided in their service. What troubles them, especially if they’re based at Queen’s, is the length of the queue every day for the Urgent Treatment Centre (UTC) run by GPs. It’s a visible sign of a hospital not functioning properly and it’s understandable why Beverley Brewer, a Redbridge councillor, described the urgent and emergency care performance as a “dire situation” at a council meeting two months ago.
Those who are unwell, but not chronically ill, are waiting longer than they should be and such delays were addressed in a recent CQC report that looked at our Emergency Department (ED) at Queen’s in the context of the whole urgent care system. There has been a decline in A&E performance throughout England. We are focused on securing incremental changes – there has been a slight improvement in Type 1 performance at Queen’s (those who are most seriously ill) – as well as working with partners in north east London (NEL) around the vexed issues of access to primary care and securing timely discharges.
One obvious step to reduce the queues at our two UTCs is to improve how patients are dealt with when they first arrive. We are close to reaching agreement with PELC (who run the UTCs) to enable their GPs and our staff to work side by side rather than separately – this will streamline the process and reduce the number of times someone is asked the same question by a different medical practitioner.
The Ambulance Receiving Centre is being copied by other hospitals and continues to free up valuable paramedic time, while allowing patients to be taken off a trolley and into a better clinical environment. In five months, it has seen nearly 1,500 patients and returned more than 10,000 hours to paramedics so they can be back on the road, responding to emergency calls. On one day in April, and for the first time in several years, all handovers of patients were completed within the required 60 minutes.
Another incremental change yielding results is the special area we’ve created at the Queen’s ED to provide care on the day and reduce the number of people needing to be admitted. It has looked after an average of 30 patients a day since March and its creation has resulted in close to a 13 per cent reduction in the average waiting time.
Our efforts to improve ‘flow’ through both hospitals – a patient moving smoothly and speedily from ED to a ward and back to where they live – are being helped by the opening of a stroke rehabilitation unit on the Goodmayes site and the success of a short stay medical ward at Queen’s that is treating and discharging patients in a timely fashion.
We are being supported with this work to transform our services. We must improve joint working between doctors and nurses; refine therapy decision making; and ensure a senior doctor reviews every patient, in every bed, every day.
Achieving what’s needed will be hard yet rewarding. I told a workshop attended by the staff who will deliver the solutions, that the improvements will have a material impact on residents and staff, and it’ll be something they will be proud of for the rest of their careers.
Reducing our waiting lists
The other area where we continue to improve lives is the sustained work we’re doing to cut the backlog created by the pandemic and we were pleased to share our progress with ITV News. Recently, we were the best performing trust in London for what is known as high volume, low complexity surgery and I am the lead CEO for the capital.
The Cancer Alliance in NEL - that we’re a part of - is the top performing one in England when it comes to achieving the Faster Diagnostic Standard for cancer patients. The target is for 75% of patients to be diagnosed or have cancer ruled out within 28 days of being referred by their GP. The NEL Cancer Alliance exceeded this standard in January for the second month running and we’ve been compliant for four consecutive months. We’ve also reduced the number of people waiting for cancer treatment for more than 62 days from 546 in January – when we were dealing with the impact of the Omicron variant, patient cancellations and staff sickness - to 214 at the end of March.
My colleagues continue to find innovative ways of tackling waiting lists. The Ophthalmology department has run two ‘super weeks’ this year where extra clinics have been laid on and around 900 patients were seen each time. Patients needing a cataract operation are being treated within six weeks of being assessed.
Our 4th BONES Week saw 71 surgeries undertaken in five days. Once again, its success relied on the team working of individuals in administration, pre-assessment, therapies, community orthopaedics, clinicians, radiologists and pharmacists.
In other developments, we were delighted to show Sajid Javid, the Health Secretary, the diagnostic procedures that are being carried out at Barking Community Hospital; we triaged 3,000 orthopaedic, urology and general surgical patients over a two week period in March; and we celebrated our women surgeons who are making inroads into a very male dominated area of medicine.
As we’ve been working through the waiting lists, we’ve discovered a problem with one of them that was used to deal with the backlog created by the pandemic. It contained routine referrals from GPs who wanted their patients to be seen by a specialist, but for whom there were no appointments available. Unfortunately, these patients were removed automatically from this list before they had been seen.
We have fixed the error and contacted all those affected, either by phone or letter. The patients have been waiting to see our specialists in routine clinics in gynaecology, neurology, neurosurgery and ophthalmology. We are undertaking clinical harm reviews to find out the impact of these delays. We are setting up a formal group, reporting to the Board, to oversee the response which will be chaired by Sue Lees, one of our non-executive directors.
As a result, our waiting lists have increased by around 1,800, from 61,400 to 63,200. Of these, around 600 people have been waiting for more than a year. This figure includes approximately 200 patients who have been waiting for more than two years (104+ weeks). The NHS target for clearing the 104+ weeks backlog is the end of June, and we are confident we can meet this deadline, except for a small number of cases where patient choice may be a factor.
It is stressful being on a waiting list and I am sorry this has happened. We are putting on extra clinics to reduce the backlog. When mistakes happen in healthcare, I believe it’s important to be open and transparent about what went wrong and be clear about what’s being done to put it right.
The coming months
I continue to build my senior leadership team and I’ll be interviewing shortly for a Chief People Officer. We have our annual goals in place, and widely publicised, to guide us in the months ahead. The need to be financially fit, our fourth goal, is especially important given we spend £25 every second of every day (£2m each day) and the additional funding we received to navigate Covid-19 is no longer available. We have seen a significant investment in our workforce and in infrastructure, including £5m spent on improving the ED at KGH. We’ll be supported in achieving our main goal, delivering high quality patient centred care, by our volunteers and Patient Partners. We have led the way in having Patient Partners at the heart of any changes to services and we have vacancies for these voluntary roles.
We are seeing the tangible benefits for patients of our closer collaboration with Barts Health and we’re exploring ways of working together on issues as diverse as neurosciences, sustainability and digital.
Two weeks ago, there was a rare occurrence in my working life. We had a no meetings day. It allowed me to spend even more quality time out and about talking to teams and it reminded me that we need to avoid becoming a slave to diaries and virtual meetings. I’m determined no meetings day will become a regular occurrence, though the Board meetings will remain sacrosanct!