2020 has been a really tough year for all of us and I would like to acknowledge the pressures our staff are under and express my gratitude for all they are doing to keep our patients safe and well cared for. Their resilience is being tested as they deal with a second Covid-19 wave, a second lockdown and the onset of winter. Their ability to unwind has been affected by the lockdown restrictions. I am very conscious of the fact many have approached the second wave with a level of trepidation.
While it will be a long winter, we can draw solace from the significant increase in Covid home testing now available for our staff; the prospect of a vaccine; and the warm words of praise we receive when patients like Anil Patel are discharged. His recovery from Covid, after 149 days in our hospitals, attracted considerable interest, as it is thought to be one of the UK’s longest hospital stays for someone with the virus.
Paediatric Emergency Department at King George Hospital
Managing the pandemic in recent months has meant we have had to make difficult decisions. I have mentioned before that we have a number of staff vacancies in our paediatric department and several of our paediatricians are shielding. In order to keep our patients safe, we must use our resources wisely, and so we have temporarily closed our paediatric Emergency Department at King George Hospital (KGH) overnight, between 9pm and 9am.
I am disappointed we have had to do this, and our Board is focused on re-opening it as soon as possible. The report it considered at a recent meeting is in the public domain and was shared with Redbridge’s Health Scrutiny Committee. I thought it would be helpful to include here the relevant draft minute where the Board signed off on the temporary closure to support the management of Covid during winter:
“It was noted that the Trust was absolutely committed to reopening the paediatric Emergency Department at King George Hospital (KGH) during the night as soon as it was safe to do so. The Trust wanted to do this by April 2021, subject to the on-going impact of the pandemic. The Trust would continue to monitor the situation on a daily basis”.
Visiting our hospitals during a pandemic
Another one of the many impacts of the virus has been the restrictions we have had to impose on visiting to protect our patients and staff. Patients who have been with us for more than one week can now receive a visit from a family member and in September I was able to report a relaxation of some of the visiting rules in our maternity department. One of our learnings from when the restrictions were tightest on our postnatal ward was that breastfeeding rates increased.
Following on from the changes on the maternity wards, partners can now attend 20-week anomaly scans and any repeat 20-week scans. We cannot yet extend this to partners wanting to attend 12-week scans because of the sheer number of pregnant women we care for and the fact there is very limited space in this department, particularly in the waiting areas. Our priority is to keep our staff and expectant mothers safe and to comply with robust infection prevention and control (IPC) rules.
Four-hour emergency access standard
I wrote extensively about this in my last Board report. It is a standard we have not delivered reliably during the past ten years and it remains a very stubborn and thorny problem. We have a route map to fix it which is our Whole Hospital Improvement Plan. It has eight workstreams that are focusing, among other things, on primary care and ambulance service protocols; on a patient’s journey through our hospitals until discharge and beyond; and on our workforce, including a refreshed recruitment focus and a review of medical rotas. It will, of course, also address the critical issue of improving flow.
We also have a shortfall of beds that we need to address with all our partners in north east London. It goes without saying that extra beds would be utterly pointless if we did not secure the necessary workforce. The development of the Barking and Dagenham, Havering and Redbridge Health and Social Care Academy will be vital in this regard. Working with BHR partners, the goal is to help those involved offer productive and interesting careers for people living in the communities we serve and to recruit and retain staff.
Developing integrated frailty services
The work being done on this excites me because it shows partnership working in action – which I am very grateful for – and it will help to keep the elderly away from our Emergency Departments (ED). With colleagues from other organisations, we have developed a very good care of the elderly unit at KGH. Patients can be brought direct to the ward (without spending time in ED), treated and go home as quickly as possible. When they are with us, they are kept mobile and looked after in a calm environment.
On the subject of integrated working, I am impressed by the stroke rehabilitation service we offer in collaboration with the North East London Foundation Trust (NELFT). This month our stroke team was highly commended in the HSJ Patient Safety Awards for the work they have done to improve the service. Their co-clinical lead, Devesh Sinha, will be familiar to you as I have shared, in the past, the very personal blogs he has written about his experiences of racism in the NHS. It was a topic he also tackled when he broadcast his reflections on Talk Radio. I was pleased that this national radio station wanted to expose its audience to issues that are not discussed routinely on its airwaves.
Along with the four-hour emergency access standard, our finances – and more precisely our deficit – are another challenge that have bedevilled us in recent years. Our underlying run rate for last month is estimated at around £6m, which is £1m more than our target. We believe that the difference between what we receive and what we spend will remain closer to £6m than £5m in the coming months and will deliver us an underlying forecast deficit for the year of £64m, rather than £59m. Looking ahead to the next financial year our target is a net deficit of £59m. Our cost reduction measures will include reducing our spend on agency staff; improving efficiency in our planned (elective) work; and reducing corporate expenditure.
The drivers of our deficit, and the assumptions and ambitions that underpinned our Financial Recovery Plan (FRP), need to be tested in the light of Covid-19. We will present a refresh of our FRP to the Board before the end of the financial year.
The picture, when it comes to our capital expenditure, is a more promising one. We are interpreting the much-needed money we are receiving as a vote of confidence and we are determined to ensure that the projects we undertake transform our services and remove waste. The capital funding we are receiving from central government will be spent on redeveloping the ED at KGH; improving the ED at Queen’s Hospital; and developing a permanent Paediatric Assessment Unit at Queen’s to compliment the new one planned for KGH. These permanent emergency assessment units for children and young people will aim, where possible, to assess, treat and discharge home in a short space of time.
It is our declared aim to run two of the happiest and healthiest hospitals in the UK. Choosing this as a goal is one thing – and who would not want to work in such an environment – delivering it, is something else. To succeed we need to tackle another of our longstanding issues – our culture. It needs to become one of compassion, inclusion, respect and safety. We have listened to staff about their experiences during the first wave of Covid and this learning will inform the changes we will introduce.
On a practical level we have been focusing on staff wellbeing by continuing the team reflective sessions; providing support from psychologists; and we are looking to establish permanent wellbeing hubs where colleagues can relax and unwind.
To achieve cultural improvement, we need to address ongoing inequalities. We are recruiting inclusion champions who will support staff to speak up; we are actively monitoring the inclusivity of all senior appointments; and we are supporting the continuing development of our staff networks. I am delighted Rosemary Idiaghe, Consultant Midwife for Midwife-led Care, has agreed to be the new co-chair of our BAME network. She wrote in July about the work she has been doing around cultural awareness.
IPC and the second wave of Covid-19
Unlike during the first wave, we are determined to both respond to the pandemic and maintain, as best we can, our other services. What we are finding is that the prevalence of the virus in our three boroughs is translating into outbreaks in our hospitals. An outbreak is defined as when two or more people are infected, and their cases can be linked.
Those attending our hospitals do not necessarily know they are infected. We test every patient when they are admitted. If they are not showing symptoms, we care for them in shared ward areas until the results come through. When outbreaks happen, it can result in the temporary loss of beds, while cleaning takes place, and this has an impact on the movement of patients out of ED and onto the wards.
One of our responses to such outbreaks is the introduction of see-through plastic curtains between beds to reduce the risk of transmission. We are also redoubling our efforts to ensure there is rigorous adherence by our staff to the rules around using the correct PPE; hand hygiene; wearing masks where necessary; and observing all social distancing requirements.
Other changes that will help us are the roll out of testing to staff to capture those with Covid who are asymptomatic (we are part of a pilot); the introduction of more rapid testing for patients; and the help we are receiving from NHS England’s IPC intensive support team who have visited our sites and who will work with us in the months ahead as we constantly review our cleaning and testing regimes.
Planned (elective) care
KGH is our high volume, elective services site. It is also one of four dedicated surgical hubs in north east London. It will offer a range of surgeries such as cataracts, hysterectomies, tonsillectomies and hip and knee replacements.
We are making progress addressing the backlog that was created during the first wave. We saw nearly 600 more day case patients and inpatients in October compared with September; last month, with outpatient appointments, we reached more than 80 per cent of the level we were at when compared with the same time last year; and we expect to meet the 2 week wait cancer standard (time from GP appointment to first clinical contact) for a third month in a row. The number of people waiting longer than 52 weeks reduced considerably in October; it went down by 250 from the start of the month to the end.
Endoscopy optimal week
We have had less success recovering our 62-day cancer performance target (time from referral to treatment). This is, in part, because endoscopy (an aerosol generating procedure) ceased completely earlier in the year. Now the service is back up and running and we had a dedicated week in October where we focused on maximising the service. More than 400 patients had endoscopic procedures across seven days, and this represented a 47 per cent improvement on our performance in the previous month.
Perfect orthopaedic week
Dedicated weeks are a useful means of clearing backlogs and improving the ways in which we care for our patients. Last month, we ran an ambitious project, in collaboration with the Practice Plus Group (an independent provider) to treat as many orthopaedic patients as possible on the waiting list in a seven-day period. Together, we exceeded expectations and delivered 135 joint replacements, 88 day case surgeries and 27 spinal procedures.
Behind the statistics, are the lives that have been improved. Natasha Mercer had a total hip replacement, and she has spoken of how she felt reassured throughout about her safety while undergoing her treatment. Such positive feedback is very helpful as we are still encountering significant numbers of patients who are unwilling to come into hospital during these Covid times.
Queen’s Birthday Honours
The hard work of two of our members of staff has been recognised in this year’s honours. Michele Elliot has been awarded a MBE in recognition of her work during the pandemic; and the same honour has been awarded to Parminder Kaur Kondral, our honorary Sikh chaplain.
Giving back to those more in need
During the first wave we were inundated with generous gifts (including more than 100,000 hot meals, snacks and drinks) that we were both pleased and humbled to receive. This time, we are encouraging people and businesses who would like to donate to offer their gifts to those more in need than our staff and to contact, for example, their local food banks and homeless shelters.
Farewell to Joe Fielder
I would like to end my report by paying tribute to Joe, our Chair, who will be attending his last Board meeting at our Trust this month. Quite simply, I could not have asked for a better Chair when I joined the organisation at the start of the year and had to navigate not only the challenges of a new job, but also the enduring impact of a global pandemic. I am sure you would want to join me in wishing Joe all the very best for the future.