Annual report summary 2019/20

Reporting back

This page provides a summary of key headlines from our annual report 2019/2020.

Much of this year's annual report, on which this summary is based, was prepared in the weeks before the impact of the coronavirus (COVID-19) pandemic became known. However, in preparing this information, we have sought to provide some early reflections on the Trust's response to the pandemic.

The year 2020 will be remembered as a traumatic one for much of the world. Certainly, in its 72 years, the NHS has never known anything like it. We have been tested as never before, as a National Health Service, as a Trust and as individuals.

Many families, including among our own staff caring for the sickest patients, will have been deeply affected by the tragic loss of life.

Faced with this devastating pandemic, staff across the Trust demonstrated their ingenuity, their courage, and their commitment to our patients and to each other.

Putting patients first

Our status as one of the four national centres for High Consequence Infectious Diseases (HCID) meant some of the country's first COVID-19 patients were admitted to St Thomas' and we were in the global spotlight when caring for the Prime Minister after he was taken seriously ill with the virus in April.

We quickly and safely reorganised the way we provided many of our services in the face of this new threat. This included reducing the number of patients attending our sites, with appointments instead held remotely by video or telephone where possible.

In just two weeks, the children's intensive care unit was moved to a new floor to create extra space for adult critical care patients. We also doubled the number of patients we could treat with extracorporeal membrane oxygenation (ECMO), a highly specialised technique to provide oxygen into the bloodstream when a patient's lungs cannot cope.

The most clinically urgent surgeries, including some cancer operations, were able to continue using HCA Healthcare facilities at London Bridge.

During the national lockdown period, in common with the rest of the NHS, we witnessed a sharp reduction in the number of patients accessing services such as A&E and rapid diagnostics for possible cancer. We therefore took steps to publicise to our community the importance of patients continuing to seek help when they needed it.

Supporting our staff

Looking after our 18,000 staff was also an important focus of our response.

We introduced a range of innovations to help, including free emergency supplies stores for groceries, health and wellbeing hubs and access to psychological support. We were also overwhelmed with offers of support and generous gifts from within our local communities.

Planning for better times

While we remain vigilant, we appear to have passed the peak of the first phase of the pandemic and are gradually increasing the number of consultations, tests and procedures we carry out for patients with other conditions.

While our values remain the same, the Trust will emerge from this pandemic a changed organisation, providing services in ways that are more innovative than before.

At the start of the year we agreed a control total with NHS England and NHS Improvement which required us to deliver an underlying deficit of £8.4 million. 

Due to the additional cost pressures of the COVID-19 outbreak our control total was adjusted by £4.6 million, creating a new control total of £13 million deficit. However, when accounting for the planned levels of Provider Sustainability Funding (PSF), this equated to a planned surplus of £3.5 million.

We are pleased to report that despite the difficult financial climate across the NHS, we ended the year £1.1 million ahead of our control total, including PSF, delivering a surplus of £4.6 million.

This includes £67.4 million of savings through our Cost Improvement Programme (CIP), achieved through a combination of increased income, savings and efficiencies. 

After accounting for technical capital items, our final reported position is a deficit of £63.6 million.

We have worked hard to maintain our operational performance against key standards despite an extremely challenging external environment.

Following the completion of our emergency floor transformation in 2018/19, we have continued work to improve our emergency services.

We have increased the number of senior clinicians across the emergency floor at evenings and weekends and added an evening rota for senior operational managers to support the emergency floor during weekday evenings. These changes have enabled us to have sufficient beds for all patients who needed to be admitted to our hospitals and to provide mutual aid to neighbouring hospitals during the winter months.

The number of patients attending A&E continued to grow and on our busiest days we are now seeing 600 patients, up from 400 only two years ago. This has meant we have not always been able to meet the maximum four-hour A&E waiting time target despite the tireless work of our staff.

We have implemented project 600, an initiative to support our emergency floor and emergency services across the wider hospital when high numbers of patients attend A&E. The aim is to make sure we are able to operate effectively and safely when under exceptional pressure.

We have continued to see a high number of cancer two-week wait referrals. On average, 2,300 patients have attended our two-week wait clinics each month, an increase of 100 per month compared with last year.

A number of changes to how we deliver cancer services have been introduced to help us prepare for the new 'faster diagnosis standard'.

We work closely with our neighbouring hospitals, local commissioners and the South East London Alliance Cancer Network to improve shared services and are investing further in dedicated senior operational management support and extra diagnostic and theatre capacity.

The demand for our services has made it difficult to consistently treat patients within the national standard of 18 weeks and we still have patients waiting longer than 52 weeks for their treatment in a number of specialties.

Addressing the complex issues causing these long waits remains of the highest importance. We have reprioritised theatre space and moved some procedures to alternative providers where patients are willing to accept this option.

However, the difficult decision in early March 2020 to stop all non-essential activity in response to the COVID-19 pandemic included treatment for many of these patients. Urgent elective activity, such as cancer surgery, was able to continue by using London Bridge Hospital and the HCA facilities in the Cancer Centre at Guy's.

As a local and specialist provider, we must maintain an appropriate balance between meeting the needs of patients in south east London and those needing complex treatments that only a few hospitals can provide. Local commissioners and the Trust's Board reluctantly supported temporary restrictions to out-of-area referrals for some specialties.

This year, we have also struggled to consistently achieve the standard of 99% of patients receiving their diagnostic test within six weeks. This was primarily due to an increase in demand for our endoscopy and imaging services and, although we have increased capacity, it has taken some time for these changes to have a positive impact and reduce waiting times.

Infection control remains a priority and we believe the vigilance of staff has contributed to our strong performance against a very challenging C.difficile target, and contributed to our ability to avoid bed closures and maintain capacity during the winter. More than 12,000 of our staff received the flu vaccination, including 77.6% of frontline staff, slightly up on last year.

Evelina London Children's Hospital held a series of events throughout the year to mark its 150th anniversary.

Among many highlights Evelina London Patron, The Duchess of Cambridge, visited patients at Sunshine House, one of our community centres for children and families in Southwark.

Further expansion of children's services is planned over the next few years, including investment in new buildings to support our ambition to make Evelina London a regional specialist centre.

Our new Integrated Care strategic business unit (SBU) launched in April 2019, bringing together adult community, acute medicine and therapy services.

The Integrated Care SBU provides opportunities to focus on new ways of working in order to meet existing and future patient needs in Lambeth and Southwark.

Our adult community services were rated outstanding by the Care Quality Commission (CQC) last year and our new community nursing model, known as 'neighbourhood nursing', is being rolled out after a successful pilot scheme.

We are also targeting extra support at patients who have been in hospital for more than 21 days and who are medically fit to leave but have been unable to do so for non-clinical reasons.

The Lambeth reablement team has been held up as a model of best practice for the integration of health and social care. Lambeth Council has shown that the team contributed to a significant reduction – from 11% to 4% – in the annual growth in spending on social care services in the borough, and over 90% of people remain at home 90 days after leaving hospital.

Our results in the NHS Staff Survey improved in nine of the 11 categories compared to last year.

The majority of our scores were above comparable trusts and we're proud that 88% of our staff are happy with the standard of care we provide and would recommend us to their friends and family.

We scored below average in two themes – equality, diversity and inclusion, and bullying and harassment.

These two areas remain a concern and, as part of our equality, diversity and inclusion strategy, we have introduced a range of measures centred on our Trust value of 'respect others', to drive improvements, including:

  • 'respect hackathons' to generate new ideas to address disrespectful behaviours
  • 'inclusion agents' in each directorate to help support staff and share good practice on inclusion
  • expansion of our reverse mentoring programme and diverse recruitment panels
  • development workshops to support career progression for our black, Asian and minority ethnic staff.

The reaccreditation of King's Health Partners (KHP) as an academic health sciences centre will help make sure that we continue to align world-class academic research with world-class clinical practice to deliver improvements in the health of our local communities.

KHP is a partnership with our colleagues at King's College Hospital and South London and Maudsley NHS Foundation Trusts and King's College London, with a shared ambition to be a world-leading health organisation through the integration of research, education and patient care. 

In 2019, our partnership once again led the way in involving patients in research, with more than 57,000 patients taking part in clinical studies.

Research highlights include the development of unique ways to see images of the fetal heart through 3D reconstructions, while our alcohol care team is helping reduce pressure on busy emergency departments and improve support offered to patients.

Guy's Tower is a major centre for research and includes a wide range of specialist research facilities which continue to strengthen our position as a leader in advanced therapies, genomics and regenerative medicine. St Thomas' is a 'medtech hub' and includes the new London Medical Imaging and Artificial Intelligence Centre for Value-based Healthcare funded by Innovate UK in partnership with King's College London.

We refreshed our equality, diversity and inclusion priorities last year and have been working to embed these into day-to-day business.

The objectives aim to drive improvements in patient care and staff experience, reducing inequalities for our diverse workforce and population.

As part of our response to the COVID-19 pandemic we carried out regular risk assessments to protect those who are most vulnerable, and this included staff from black, Asian and minority ethnic groups.

Working with colleagues across King’s Health Partners (KHP) we have put in place plans to improve care and outcomes for people with cardiovascular and respiratory disease, including our proposals for an agreed merger with Royal Brompton and Harefield NHS Foundation Trust.

We are reducing our environmental impact through our sustainability programme and aim to be one of the most sustainable healthcare organisations in the country.

Our SAVE programme (Sustainable Actions delivering Valuable Efficiencies) is already active in 70% of our directorates and contributed savings in excess of £200,000 last year.

Our sterile services team, working with Guy's Dental Institute, managed to eliminate unnecessary plastic from procedure trays to achieve an annual saving of £21,000.

Our energy performance contract delivers £1.25 million in savings and includes an ambitious LED lighting programme, which consumes on average 55% less energy, and has reduced lighting maintenance costs by 80%.

We scored above the national average in all six categories for our Patient-Led Assessments of the Care Environment (PLACE), including 99.6% for cleanliness.

Results showed improvement in five out of six scores compared with the last assessment, once again demonstrating our commitment to providing good food, high standards of cleanliness and facility maintenance, and support for patients with dementia or a disability.

Last updated: March 2022

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