Chief Executive's Board report: November 2021 | Chief Executive's Board Reports

Chief Executive's Board report: November 2021 | Chief Executive's Board Reports

Chief Executive's Board report: November 2021

I’m sure I’m not alone in believing that now, more than at any other time, we must treasure the NHS and those who work for it. I am very conscious of the fact that any support needs to be earnt and we are determined to learn and to improve when we get things wrong. It is, of course, heartening when the feedback we receive is positive. One of our patients told us recently that we had restored their faith in the health service. 

They were part of the ‘Scalpel Project’ - the first of its kind – that treated 1,000 people at six special Saturday clinics. Those benefiting from this work included a 103-year-old woman whose treatment had been delayed by Covid-19. 

Reducing our waiting lists

This initiative isn’t an isolated example, and the skills of our medical teams extend to an ability to conjure up inventive names! We’ve had ENT Kidz, where children were seen at weekend clinics; our Gastronaught project focused on the needs of those facing long waits; and our Ophthalmology department (where waiting times have been six weeks for the past 12 months) held a prEYEority week, with clinics in the evening and at the weekend.

Despite the different names, these projects are bound by a common purpose – to exploit the very best of multidisciplinary working to deliver good patient care and reduce our waiting lists. They’ve generated a buzz and raised people’s spirits. Others in the NHS have been in touch to learn from us, and we are one of the best performing trusts in London when it comes to the delivery of high volume, low complexity surgery. Our drive to tackle our backlog is being helped by the improvements that have taken place in our radiology department at King George Hospital (KGH). The enhanced ultrasound rooms will allow us to complete up to 150 additional scans each week. 

By the middle of next year, we expect to have reduced to zero the number of people waiting 52 weeks or more; we intend to deliver above the levels we saw two years ago for outpatient appointments and theatre cases; and we will do more to tackle the number of people waiting for more than 62 days to start their cancer treatment.

The coming months

I am proud of what has been achieved and I am determined that we will continue to reduce our waiting lists, especially as the overall total now stands at in excess of 50,000 and our referrals are returning to the rates we were used to before the pandemic. We have to balance this with the fact we will also be responding to winter, Covid-19 and the anticipated rise in respiratory illnesses among children. One of our senior doctors, Ayo Ahonkhai, has become our Winter Director and his expertise as a geriatrician will help us as we enter a difficult few months. Our absolute priority will be on keeping our patients and our staff safe. I believe that if my colleagues are looked after properly, they will deliver even better care.

As part of our response to winter we are increasing and improving our critical care capacity at both hospitals. When this work is completed at Queen’s Hospital it will free up a 30 bedded short stay ward that will help with the anticipated additional demand on our services. We are also seeing wards at KGH return to general use, post the height of the pandemic. 

We continue to treat Covid-19 patients and, in common with all other trusts in north east London (NEL), the overwhelming majority of Covid patients in intensive care are not fully vaccinated. I would urge you, if you’re eligible, to get the Covid booster and the flu vaccine. Protected residents reduce the pressure on all health services

Urgent and emergency care

The experience our patients have when they come to one of our Emergency Departments (ED) remains our Achilles’ heel. The solution lies with everyone in our Trust and not just with those at the sharp end who are witnessing ever greater demand – on one evening last month, the staff at the KGH ED treated 111 walk-in patients. The major improvement work taking place at KGH is coming to an end and it will result in the ED being one of the best designed in London. The department - and the whole hospital - have a very bright future, especially if we succeed in building extra theatres and expanding diagnostic capacity.

The politicians in Barking and Dagenham, Havering and Redbridge (BHR) are, justifiably, very concerned about our performance against the four-hour emergency access standard. The performance in an ED reflects how well a whole hospital and a whole system are working together. The overall performance of the Trust is overshadowed by this, and we won’t enhance our reputation and achieve the standing we deserve until we have improved. 

In all my meetings with our BHR politicians I have made clear that I will be transparent and that I welcome constructive challenge. I have also stressed that there is no quick fix, and it will take many months to deliver sustainable improvements to the flow of patients through our hospitals. I cannot defend the status quo and it is my responsibility, with the support of others, to fix it. 

We are being helped in this challenging endeavour by Dr Karim Ahmad who’s joined us on secondment from Barts Health as our Improvement Director for Emergency Care, Medical. Karim is working alongside James Avery (Improvement Director for Emergency Care, Nursing) and other colleagues in the Trust and across the system to improve our pathways. The Evening Standard focused recently on the pilot work we’re doing with the London Ambulance Service to reduce the time patients spend waiting to be handed over when they arrive in an ambulance. 

Urgent and emergency care at our hospitals is a multifaceted problem that demands many solutions. Last month, we held a ‘flow recovery week’ to trial new ways of reducing delays in patient care; a pilot of a Rapid Assessment and First Treatment (RAFT) area at KGH was well received by patients; and we continue to support our primary care colleagues who run the urgent treatment centres at both sites. 

The experience of our younger patients has been helped by the fact we’ve been able to reopen a children’s ward at KGH and our elderly patients continue to benefit from our frailty units where the over 75s can bypass our EDs. The evidence shows that those attending are less likely to be admitted than if they’d gone through an ED and if they do end up on a ward, the time they spend there is reduced. 

When Lord Adebowale visited the unit at Queen’s recently, the Chair of the NHS Confederation was impressed with our close working relationship with social services. The London Ambulance Service has been supporting us with this work and they referenced the benefits of such frailty units at their annual general meeting.

Improving our culture

Three months into this role and I continue to be excited by the prospect of what can be achieved, especially once I have secured a stable senior leadership team. We are currently recruiting a Chief Operating Officer, a Chief People Officer and a Director of Strategy and Partnerships. The recruitment to these roles will use Recruiting for Difference where shortlisting will be based on the responses of candidates to the scenarios set and questions asked as part of the application process. Our Trust will never be an easy place to work, given the demands, but our staff are united by a desire to make it the best it can be, and they are proud of what they are doing in the areas where they work.

In the short term, our focus will be on navigating our way through winter while keeping our patients safe and looking after the wellbeing of our staff; continuing to reduce our waiting lists; and tackling our monthly £6m overspend and balancing our books, by delivering the necessary £40m savings over the next fifteen months. 

In the longer term, we have to improve our organisation’s culture, not least because of the impact a poor culture has on operational performance. People don’t tend to mind working hard if they are well supported and respected by their colleagues and by their employer; they’re treated well and have access to the basics such as lockers and rest rooms; and they’re not victims of discrimination or bullying.

Rather like the changes we must make to improve our performance against the four-hour emergency access standard, getting to grips with our culture will take time as we make clear what are acceptable ways of behaving and we make people accountable for when this doesn’t happen. One definition of an organisation’s culture is the way people conduct themselves when they think no one is watching them. 

I believe we have a window of opportunity in which to ensure our Trust is an organisation that is a good place to work; where our staff feel looked after consistently; and we are an attractive employer for BHR residents. I am optimistic about the future, and I have the full support of the Board to deliver the changes necessary to make this a reality. 

Closer collaboration with Barts Health

This support comes from the very top - from our Chair, Jacqui Smith who is also Chair of Barts Health. One of her key roles is to oversee our collaboration – in September our two trusts produced a document that captured what we have achieved so far and our direction of travel

The crucial test of all that we do together will be that it delivers better, quicker and more effective access to services for NEL residents. The benefits of our closer working are already evident. As I mentioned earlier, we have a senior Barts consultant helping us resolve our longstanding urgent and emergency care problems and patients from Barts Health are having their endoscopy procedures carried out at KGH.

Partnership working

It would be understandable, given the challenges I’ve highlighted, for an organisation like ours to hunker down and develop a siege mentality. In fact, our Trust needs to always look up and look outwards. The BHR Health and Care Academy is a concrete example of how, by working across organisational boundaries, we will deliver improved opportunities for residents. 

I have devoted as much time as I can to meeting, either in person or virtually, representatives from our many partner organisations. One such individual is Oliver Shanley, the Chief Executive of the North East London NHS Foundation Trust who will be leaving NELFT at the end of December. I’d like to wish Oliver all the best for the future, and I look forward to working with Jacqui Van Rossum who will take over as acting CEO in the new year. 

Clinical strategy

Our partnership working will be critical as we continue to refresh our clinical strategy. It has to meet the needs of our patients and we have to rectify the fact our two hospitals lack a clear sense of what the future holds for them. We must also address the inequalities that were so cruelly exposed by Covid-19. The long-term solution to NHS pressures isn’t to just grow the size of an acute hospital – they are not, for example, always good places in which to care for the frail elderly. 

We will look at what services we can move into the community and at how they properly address the distinct and different needs of the three BHR boroughs. This work will continue into the first half of next year as we seek to provide clarity around what our purpose is and what our Trust will look like in five years time.

We are not doing this on our own. I spent a rewarding and illuminating few evenings in the company of our residents when we asked them for their thoughts on what we should do to improve healthcare. They spoke about reducing waiting lists; primary care; the provision of mental health services; and their experience overnight at our sites. The strongest plea was for us to improve our communications with patients in all its many forms. I was challenged as to whether the virtual events were just ‘talking shops’. I believe we will be able to demonstrate that we have listened to the concerns articulated by those we serve and acted upon them. 

A greener BHRUT

In the wake of this month’s COP26 climate change conference it is everyone’s responsibility to examine what more can be done. We are reducing the harmful gases we release into the atmosphere, given the direct link there is between the health of the planet and the health of its people. Over a six-year period - before the pandemic struck - we reduced by 25 per cent our measured carbon emissions. The initiatives we’ve put in place have saved enough carbon to heat 2,500 homes for a year. We’re encouraging our staff to play their part – not least by ensuring we all waste less – and we’re working on our own Green Plan that will map out a path towards achieving net zero carbon.

Matthew Trainer
Chief Executive
November 2021

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