Reflecting on 2023

Just before Christmas, I welcomed 97 new colleagues to our Trust. It’s something we now do every two weeks to ensure that on their first day they feel at home and receive a comprehensive introduction to the organisation. I told them I loved working somewhere that made a difference to people’s lives and I was pleased they wanted be part of our drive to make it an even better place.

We’ve made tangible progress in our priority areas and we’ve strengthened our senior leadership with 23 new appointments. We have five clinical groups, two site teams and much clearer lines of accountability. Fewer people are facing lengthy waits in our A&Es, we’re getting more patients home on time and more people are getting planned care at the right time.

There were 759,663 outpatient appointments, 302,979 people visited our A&Es and 6,959 babies were born – we celebrated those who arrived on Christmas Day and on New Year’s Day.

I am conscious, as I write about our achievements, that we still need to do better. It’s brought home to me when I receive a letter from a resident complaining that their relative has waited too long for treatment and each time I see someone being cared for in a corridor when I walk through our A&E at Queen’s Hospital.

When Queen’s was opened in 2006, it was designed to accommodate around 300 patients a day who were seeking urgent and emergency care. Now, at peak times, more than double that number come through its doors. We need to redesign and improve the facility as we’ve done at King George Hospital (KGH).

The space required to do so will become available later this year when the renal service moves to the new St George’s Health and Wellbeing Hub. We’re talking to NHS England about funding this rebuilding work that will transform the department for patients and staff and make corridor care a thing of the past.

The year ahead

In the coming months, as we strive to make 2024 a year of improvement, we will continue our work to join all the acute trusts in London that have an electronic patient record; we will open a new, expanded Same Day Emergency Care department (SDEC) at KGH that’ll have 16 additional spaces to improve the A&E; and we should exit special measures for finance and emergency care.

When I reflect again, in a year’s time, I’ll be able to write about two new theatres at KGH that allowed us to undertake 100 additional operations each week. We’ll also have reduced the time people waited for treatment with the opening of Community Diagnostic Centres (CDC) at Barking Community Hospital and at St George’s Health and Wellbeing Hub. The CDCs will have enabled tens of thousands of extra scans to be carried out. 

Our finances

We are in touching distance of hitting our deficit target for this financial year and reducing the regulatory oversight we are subjected to when it comes to how we spend our money. Moving out of financial special measures will enhance the way we are viewed by senior NHS leaders and increase our chances of receiving the extra funds we need to upgrade Queen’s A&E and other capital projects.

Over the past few years, we’ve saved around £30m by cutting what we spend on expensive agency staff. To put that in context, £30m is the cost of the new theatres at King George Hospital and the CDC at Barking Community Hospital.

We’re making the deployment of high cost temporary workers a matter of last resort, rather than business as usual. This will be the case in nursing by the end of the financial year and by then we will also have 45 additional, permanent consultants to help reduce our reliance on more expensive, temporary senior doctors.

Urgent and emergency care

It’s a tribute to many of our teams that we ended 2023 as the trust that had improved its emergency care the most in England. Last month, nearly 5,000 more patients were treated within four hours in our A&Es and Urgent Treatment Centres (UTC) compared with the previous December. This is despite the fact that in recent months, Queen’s has seen the largest increase in ambulances (from the London Ambulance Service) of any hospital in the capital – up from 1,636 in December 2022 to more than 2,109 last month.

The national standard is for at least 95 per cent of all patients attending A&E to be admitted, transferred or discharged within four hours. A recovery target of 76 per cent of all patients has been set, with the expectation it will be hit by March.

We are on track to achieve this, having moved from being the worst performing trust in London – we were at 54.41% in December 2022 - to 6^th out of 18, with a performance of 72.1%. We are 97^th out of 190 nationally.

We will hit the 76% target with the help of PELC, a GP cooperative, that run the UTCs where the less seriously ill (Type 3) patients are seen. They’ve benefitted from additional investment from the north east London Integrated Care Board (ICB); they’ve increased the number of doctors at both sites; and Queen’s atrium no longer plays host to long queues of sick patients since we moved the hospital’s UTC entrance. 

These improvements led the Care Quality Commission (CQC) to increase our A&E ratings. Their feedback, following an inspection, was positive. The CQC commented on how senior leaders were visible and approachable; staff felt respected, supported and valued; and they treated patients with compassion and kindness.

Reducing ambulance waiting times

Another contributory factor is the work we’ve done to reduce the time it takes for the handover of patients arriving by ambulance. The results are particularly striking at KGH where the amount of time lost to crews while waiting was halved last year. We’ve eradicated delays of more than an hour and, at this month’s meeting of the Joint Health Overview and Scrutiny Committee (JHOSC), Daniel Elkeles, Chief Executive of the London Ambulance Service, spoke of how delays at our Trust had “massively plummeted”.

Improving services

Even with this progress, I know too many people still wait too long and we’re constantly looking for ways to improve services. The development of a frailty unit, run by our doctors, at the St George’s Health and Wellbeing Hub in Hornchurch will allow elderly residents to be seen there by a geriatrician or a therapist, have tests and then return home, rather than visit one of our crowded A&Es.

While we wait for St George’s to open, frail and elderly patients are benefitting right now from our virtual ward. Under this ‘hospital at home’  scheme, a multi-disciplinary team, made up of senior doctors, nurses, therapists, social workers and support staff, is delivering care in the community.

We’re also tackling delays with the opening of a new £3m Surgical Assessment Unit that’s helped more than 80 patients in its first two weeks; our Infusion Suite is game changing as it moves care to the best environment and helps patients avoid an overnight hospital stay; and our SDECs, where patients are moved out of A&E to be assessed and have their treatment (including diagnostics) start on that same day, are seeing roughly 130 people each day.

Patients with mental health needs

For the past 18 months, I’ve been highlighting my concerns about the long periods of time too many individuals with mental health needs spend in our A&Es. Since the Metropolitan Police introduced what’s known as Right Care, Right Person we’ve seen a reduction in the number of people being brought to us who’ve been detained under the Mental Health Act and an increase in those being taken to healthcare providers better equipped to respond to their needs.

Cutting our waiting lists

Our efforts to cut waiting lists have been affected by the ongoing strikes by junior doctors. The 34 days of industrial action – an average of three every month since the dispute began - have meant we’ve had to re-schedule 16,024 outpatient appointments and 1,174 non-urgent surgeries. We’ve spent significantly more on covering for the walkouts than the doctors are asking for as a pay increase.

The juniors, a term that doesn’t do justice to their level of training and often years of experience, are the future of the NHS. They believe they are not being treated with respect. The lack of a resolution is damaging morale and our work to reduce the time people wait for their treatment.

We are in the top three in London for our elective (planned care) performance and colleagues continue to find fresh ways of tackling the backlog. The Radiography team were recognised for their push to reduce to zero a backlog of 60,000 people waiting for their x-ray results; the KGH Elective Surgical Hub was highly commended at the HSJ awards for its focus on getting people the care they need more quickly; and we’ll be using artificial intelligence (AI) to speed up the diagnosis and treatment of lung cancer.

We’re the first trust to use robotic surgery in urogynaecology (it’s safer for patients and more efficient); we’ve improved our treatment for suspected bladder cancer; and residents can now access ophthalmology services at Barking Community Hospital.

Our staff

No one should have to suffer being shouted at, hit or subjected to racist abuse while doing their job. Sadly, this is increasingly the case for many of my colleagues who are being abused and harmed by patients and visitors. They shouldn’t have to tolerate it and we are taking steps to address it.

We’re making it more straightforward for a staff member to ‘red card’/ban an abusive patient from our hospitals, when it is clinically safe to do so. Under the existing, more complicated rules, this has only happened once in the past five years.

We’ve ordered 60 new body-worn video cameras and are extending their use in our A&Es and frailty units. We’re also improving our training; increasing the visibility of our security officers to provide support; and launching a hard hitting, public facing campaign about the impact such behaviour has on colleagues.

Our message couldn’t be simpler: no violence, no excuse.

Matthew Trainer

Chief Executive

January 2024