The cost of living crisis and a looming recession are on everyone’s mind as we deal with the impact of rising prices. The need to spend money wisely is also, quite rightly, a Trust priority. For some years, we’ve spent more than we’ve received and this is currently to the tune of £100,000 a day. One of the advantages of our closer collaboration is that we are benefiting from the support of colleagues at Barts Health and others in the NHS as we work to cut our deficit and have more money to spend on patients.
One area of focus is dramatically reducing the use of high-cost agencies to fill gaps in our rotas. A significant part of the cost goes to the companies involved, not the employee, and it leads to the unjust situation where two people can be performing the same roles, working alongside each other, but be paid significantly different amounts. To help us achieve this, we will be joined throughout this month by more than 500 new, substantive staff and we’ll soon be in a position where nine out of every ten colleagues will be employed directly by the Trust, with bank shifts meeting seasonal demands.
Our staff come from more than 50 countries. The diverse nature of the workforce was showcased last month on the BBC TV News at Ten and captured beautifully, during South Asian Heritage Month, in a series of reflective articles written by Tahira Rasool, Sadaf Solangi and Rajoo Miah.
We are constantly looking for ways to retain permanent staff and took action with an issue that has been proving difficult for some employees, particularly senior doctors. Where they have opted out of the NHS Pension Scheme to avoid incurring a tax charge under the regulations governing the lifetime allowance, we will pay them any unused employer pension contributions as additional salary. This is known as recycling contributions.
Cost of living crisis
I am very conscious of the detrimental impact the economy is having on some of our staff and we continue to look for practical ways in which we can support them. We have increased the mileage allowance for people who use their car as part of their role and extended the hours of the staff shuttle bus that runs between the two hospitals. Staff can now access a proportion of their salary in advance of payday if they need to (to save them paying high interest rates on payday loans) and we’ve distributed school uniforms.
We have supported more than 450 employees with donated clothes or £30 vouchers that can be exchanged at school uniform shops. Our cost-of living project team continue to explore new ways of helping. We will shortly be providing staff with free period products, on a trial basis.
Thank You weekend
After a gruelling two years, it was only right we acknowledged the contribution of colleagues at a series of events in July that demonstrated staff wellbeing in action. More than 3,500 people (staff and relatives) attended a breakfast, lunch, afternoon tea, evening party and family fun day. There were many smiles on many faces and the feedback has been fantastic with people expressing their delight at getting together socially and being part of an organisation that values them. Such an investment in staff morale means people are in a better place to care for patients.
I had great fun playing in a band that performed at the lunch and the party in the evening. Other members from our Trust included a still youthful 80s Scottish rocker and a member of the London Welsh female choir. Pfizer Chiefs - other good vaccines are available is confident Glastonbury will come calling …
Urgent and emergency care
The weekly ‘Clap for Carers’ is becoming a distant memory and has been replaced by an understandable and growing concern among the public about waiting times for operations and the delays they experience when they visit an Emergency Department (ED). They often raise such issues with their MPs who then bring them to my attention as Julia Lopez has done recently.
There are external constraints on just how successful hospitals can be – the size and complexity of the populations they serve, the number of GPs, the provision of social care – but there is also a lot that is in the gift of a trust to improve. This was the message I was keen to share when I spoke to the Health Service Journal and when BBC Radio 4’s PM programme spent time in our ED at Queen’s Hospital, one of the busiest in the capital. I told Evan Davis, the presenter, that we have a ‘moral responsibility to ensure people get the best possible care they can’ when they visit us.
We are focusing initially on Queen’s and will then implement our learnings at King George Hospital (KGH). Even though we are the only London trust to have improved performance this year, it is from a low base that casts a shadow over all of the good work we do and damages our reputation.
These are deep seated problems that have been years in the making. While it will take time to deliver sustainable change, it is reassuring that the compassionate care our staff provide was recognised during the most recent CQC inspection.
We continue to struggle with moving patients out of ambulances in a timely fashion because of the limited physical capacity in the department (it deals with three times the number of people it was designed to cater for) and individuals with mental ill health still spend far too long in ED.
In July, 24 patients each spent in excess of a day and a half waiting to be referred to mental health services. In one twelve-month period (April 21 – May 22), we had 84 patients attending ED more than five times for a mental health reason; one person attended 38 times; and the longest stay, on one single occasion, was seven days.
This is clearly not good for the patients involved, for our staff, or for our attempts to reduce overcrowding. We are in a constant dialogue with partners who provide mental health services to improve this unacceptable situation.
A positive sign emerging from our work is that we are starting to see an increase in the number of patients who are discharged from wards before midday. This needs to happen consistently to free up space for those arriving in ED.
When the mercury was regularly touching 30 degrees in the summer, some ingenious minds christened the next phase of our improvement work, Project Snowball. It is designed to ensure patients are being treated in the most suitable location. Our initial focus is on the over 75s and we will proactively, and without delay, begin to move them from ED to our frailty unit where they’ll be looked after by medical staff who specialise in geriatrics.
The ‘snowball’ effect will be delivered as we adopt the same approach with other groups of patients and start to automatically move them to areas of Queen’s where they’ll receive better care.
Reducing our waiting lists
The government has made clear that surgical hubs are one of the ways the NHS will address another of the public’s growing concern – the size of the post pandemic waiting list. Our surgical hub at KGH featured in a report by the Royal College of Surgeons and ministers have highlighted the work we’ve been doing in the Evening Standard.
The total number of people on our list at the end of last month was 64,989. The overwhelming majority need to be seen in outpatients. 4,646 people are waiting for procedures - more than 2,100 have been waiting over a year and 73 of them have waited for more than 78 weeks.
Those who’ve waited a long time are one of the priorities of our recovery programme. We are holding weekly meetings to check on progress; we are increasing the number of appointments that are available and striving to improve the productivity of our theatres; and we’re contacting the patients to make sure they receive an appointment to attend for treatment or review.
We continue to develop fresh initiatives to reduce our waiting lists. We saw 200 hernia patients in just one day, with those needing surgery being treated a few weeks later; 24 operations were carried out during an Endometriosis Awareness Week; and we’ve opened a new unit for treating kidney stones. We are also part of a trial of a new surgical treatment for haemorrhoids.
We’re proud to be an active member of the North East London Cancer Alliance which is ensuring north east London (NEL) residents are being diagnosed with cancer sooner and receiving quicker access to treatment. Reflecting on this joint working across trusts and healthcare organisations, Uche Igbokwe, our clinical lead for histopathology, put it like this: ‘synchronised swimming is not enough, it’s important all teams work together’.
This teamwork has meant that in June we once again met the target of 93% of patients being seen by a specialist within two weeks of a referral; three out of every four 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 of 69% is above the London (64%) and national (64.6%) averages for this metric.
More than 800 people (at time of writing) have completed a survey with their thoughts about a plan to build a community diagnostic centre at Barking Community Hospital. The forecast population growth means there will be an increasing need for better access to CT scans, ultrasounds and blood tests across the boroughs we serve. A consultation has also been underway on proposals to develop more of these centres for NEL residents.
The coming months
While winter is likely to be difficult – it’s a season that is rarely not challenging in the NHS – I remain confident about our ability to respond and about what lies ahead. We are up for awards with the Health Service Journal, at the Nursing Times Workforce Awards and at the Patient Experience Network National Awards. Ambalika Das, a consultant neonatologist, has already won an award for her work helping children learn from an early age how to live more healthily.
I have finished the recruitment to my senior leadership team with the addition of Janine La Rosa (Chief People Officer), Caroline Van Luttmer (Urgent and Emergency Care Improvement Advisor) and Fiona Wheeler (Programme Director, Planned Care).
We also intend to introduce permanent leadership teams at both hospitals to better manage the sites and offer clear accountability. To provide a fresh perspective for all these leaders we will recruit to a shadow executive – an initiative I introduced at my last trust to great effect.