The independent report into maternity services in East Kent is a profoundly depressing and sobering read. The failings it identifies serve as a reminder to this Board of our responsibility to listen to the women and families who use our service; to ensure the care we provide expectant mothers is safe; and to be fully aware of the culture in the department.
We’ve been helped in this critical endeavour by an inspection of our maternity services that was organised by NHS London in September. Their findings (which you can read here on page 17 [pdf] 378KB) are an encouraging read. Whilst acknowledging what still needs to be done in a department that is experiencing considerable pressure, the inspectors were impressed with the progress that has been made in providing a good safety culture; the commitment of the new senior leadership to deliver change; and the ongoing efforts to listen to those using the service.
Care Quality Commission
The maternity service will be examined again soon by the Care Quality Commission (CQC). We expect the CQC will also inspect our Emergency Departments (ED) and some other services; conduct a review of our resources; and pass judgement on how well led we are. When I am interviewed by them, it will be an opportunity for me to acknowledge the challenges, highlight our achievements and reinforce the point that delivering many of the required improvements will take time.
One obvious area of immediate focus is improving our results in the next CQC Adult Inpatient Survey. The most recent one - conducted with 320 patients in November last year while we were still responding to the impact of the Omicron variant on our hospitals – is very disappointing.
At a meeting last month of the Joint Health Overview and Scrutiny Committee, Beverley Brewer, a Redbridge councillor, rightly voiced her concern. We have been striving to improve the experience of all patients and recent audits are promising. We are also setting up patient panels where those who’ve been treated can feedback directly to the staff involved and return later to learn about the changes that have been introduced as a result.
Urgent and emergency care
The dissatisfaction of patients can begin when they wait too long in our EDs and Urgent Treatment Centres (UTC). The UTCs are run by PELC (a GP partnership) and their service will be looked at by the CQC at the same time as our EDs, so that the inspectors get a full picture of the quality and safety of the urgent and emergency care provision. We work closely with PELC and we’re currently looking at moving some of our doctors and nurses into their centres to try and reduce the length of the queues.
Another development that will benefit our residents is the appointment of three GPs – Dr Jagan John, Dr Anil Mehta and Dr Atul Aggarwal – as Associate Medical Directors. They are with us one day a week to strengthen the relationship between those providing healthcare in the community and those in the hospitals.
When the CQC visit our EDs they will see the departments are among the busiest in London for the number of ambulances arriving, with Queen’s Hospital often receiving up to 100 a day. All of those who arrive by ambulance are seen by a senior clinician straightaway and aren’t left waiting inside the vehicle. Despite having our Ambulance Receiving Centre, we still have too many delays in the handover of patients to our care and we are working with the London Ambulance Service to reduce them.
Our collaboration with Barts Health is at its best when it delivers concrete benefits for our patients. One of these will be a reduction in the number of ambulances queuing at our sites once REACH (Remote Emergency Access Coordination Hub) has been extended to cover the Trust. It was launched at the Royal London Hospital at the start of the pandemic and now also takes in Whipps Cross and Newham hospitals. The REACH call centre is staffed by clinicians and has significantly reduced the number of people who have to be taken into a hospital by ambulance.
We’re determined to cut the ED queues and our focus continues to be at Queen’s. The work here has, so far this year, delivered a nine per cent increase in the number of those most seriously ill (Type 1) being admitted, transferred or discharged within four hours.
Operation Snowball, as the new initiative is called, is focused on proactively moving patients each hour out of ED and onto the relevant ward. We started with the Frailty Unit and are now doing the same with other departments.
The results are encouraging. In September, we saw an additional 75 patients move through the Frailty Unit at Queen’s; more patients were transferred earlier in the morning when the ED is most congested; and the average length of stay in the unit decreased by four hours. While not a perfect solution, it has ensured the elderly person is on a ward - away from a busy A&E – where they can be seen and assessed by a frailty specialist.
Those with mental health needs are still waiting too long in our hospitals to be transferred to the right service that can care for them properly. Two months ago we had 28 patients (up from 15 in August) who each waited in excess of 36 hours. On one Friday morning last month we had 15 people in our two EDs, aged between 13 and 62, waiting to be seen by mental health specialists. Five of them had been with us for more than two days and it took ten days to find the correct bed for one of these patients.
Reducing our waiting lists
The demand for care is growing, even as we cut our waiting lists. We are working hard to increase capacity to treat patients and reduce waiting times for everyone who is referred to us. The total number of people on the waiting lists in September was 63,511. The vast majority need to be seen in outpatients. 4,700 are patients who are waiting to be admitted to one of our hospitals or for a day case procedure. 2,064 patients have been waiting for more than a year and we are prioritising 208 of them as they require treatment.
We have had considerable success in reducing the number of those waiting 18 months or more from 474 in July to 59 at the beginning of last month – the largest reduction of any trust in London.
We are monitoring the impact of the current shortage of blood supplies on non-urgent operations. At the time of writing, we have had to postpone seven procedures.
Our teams continue to maximise the ways in which they tackle the waiting lists. The Ophthalmology department held its seventh PrEYEority super week, with clinics in the evenings and at the weekend, so that 1,153 patients could be seen; over a 12 week period, our ENT colleagues reduced the number of children and young people waiting for their first face to face appointment from 1,500 to zero; and a special Endoscopy week, GutFeeling2, saw 312 patients.
Other initiatives have included a digital surgery clinic for people waiting for an operation; we’re part of a national trial of a new treatment for haemorrhoids; and we’ve opened a special clinic for those suffering with overactive bladders.
The North East London Cancer Alliance (NELCA) remains one of the best performing ones in London. Three out of every four of our 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; and against 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, our performance in August of 83.4% was above the London (65.9%) and national (66.1%) averages for this metric.
We have fallen behind on meeting the target of 93% of patients being seen by a specialist within two weeks of a referral. Our performance of 80.6% was due to a lack of capacity when dealing with breast and skin cancers and we are seeking additional funding from NELCA to address this.
Residents are benefitting from faster diagnosis thanks to an additional 30,000 tests and scans being available at Barking Community Hospital (BCH) and we were delighted to show Dame Margaret Hodge, the MP for Barking, around the facility. One of the proposals to increase diagnostic capacity across Barking and Dagenham, Havering and Redbridge (BHR) is to build a dedicated Community Diagnostic Centre (CDC) at BCH that will offer CT, MRI scans, ultrasound and blood tests.
We asked residents and stakeholders what was important to them when using such services and more than 820 people completed our survey. We also held public and virtual drop-in sessions to ensure those who live closest to BCH had access to the plans for the site and were able to provide feedback.
One indication of the confidence senior NHS officials have in the progress we’re making is the fact we’ve been able to spend significant sums of money on improving services. Our capital expenditure for the past two years was £90m and saw us invest in, among other things, the ED at KGH and new critical care facilities at both hospitals.
Future plans include a belated, but totally transformative move away from paper records to digital ones; the proposed CDC at BCH; and expanding the KGH surgical hub with the addition of two extra theatres, more recovery beds and improved staff facilities.
At the halfway point in the financial year we were on track to deliver a deficit of £20m on an income of £780m. We continue to make reasonable progress cutting our spend on high-cost agency workers and we have 500 more substantive staff compared with a year ago. We’re also examining how much we spend on the items we use. We’ve saved £9,000 switching our supplier of bed socks. When we did the same exercise with our blood gas syringes, we saved £300,000.
The hike in mortgage repayments has been added to the list of things colleagues are concerned about as they deal with the cost-of-living crisis. Later this month the S.M.I.L.E. charity will run stalls where the items being offered to staff (for a £2 charity donation) will include new and used toys, food and clothes. This builds on what we’ve been doing to provide free period products (we’ve distributed nearly 600 items across our sites) and help with the cost of school uniforms.
Another development that addresses staff wellbeing is the provision, on a trial basis, of subsidised Brompton bikes at Queen’s. The benefits of cycling for one’s health and for the environment are obvious. We’re looking at extending the scheme to KGH and at introducing electric bikes.
Given the gap between this year’s NHS pay rises and the rate of inflation, there is talk of industrial action being taken in the near future by nurses, junior doctors and other health workers. If this happens, it will inevitably have an impact on our services.
The coming months
I’m delighted Janine La Rosa, our new Chief People Officer, joins us this month and Louise Dark will start next year as our KGH Managing Director. Louise will bring her considerable NHS experience (she’s currently programme director for elective care at NHS London) to this new role as we strengthen the site leadership of the two hospitals.
The way our new hospital leaders communicate with their teams will be aided by the fact we’ve introduced Workplace. It helps people collaborate and connect with colleagues (via a mobile app or a desktop computer) far more easily than before. We are the first acute trust in London to introduce it and in just three weeks more than half of our substantive staff had signed up.
I am excited by the opportunities Workplace offers to make the organisation a more enjoyable place to work which, in turn, will have a positive impact on the care being provided to those we serve.