Sir Hugh Taylor: Welcome to all my colleagues. We're meeting under rather extraordinary circumstances. But welcome anyway, and I hope you can hear me. And in some cases, see and hear me. Forgive us if we get any technical issues. This is a bit of an experiment. But we'll do our very, very best to make it work for you.
Because of the number of participants, we aren't able to make this session interactive, but particularly for my Council of Governor colleagues, can I just emphasise that there is the opportunity to raise questions with us. And I know some of you have already done that. And if you want to raise questions as a result of observing the board as we go through, then you can do that either on the team's app, or by emailing us at CorporateAffairs@gstt.nhs.uk and I'll say a bit more about how we're going to respond to all the questions when we get to the Council of Governors meeting.
And this is being filmed, and the film will go on the website after the event. And so I'm going to whistle through the board agenda. The substantive item is going to be Ian's report, and he's going to bring in a number of colleagues. He has with him Jon Findlay, our Chief Operating Officer, Dame Eileen Sills, Chief Nurse, Julie Screaton, Chief People Officer, and Simon Steddon, our Medical Director, and I know Ian will bring them in as he does his report. We have no apologies for absence recorded from any of our board colleagues, and no declarations of interest.
I'm going to take the minutes of the last meeting as agreed, since we've had no comments on them, and I think all the matters arising are covered in the Chief Executive's report.
I haven't tabled the chairman's report. And in a sense, I don't want to add too much to Ian's report, which we'll hear about in a moment. But obviously, recent weeks at the Trust have been dominated by the COVID crisis. Lockdown has meant different ways of working for the board as well as for the whole Trust and we'll be hearing a bit more about the impact on the Trust shortly. And both I and my colleagues have been working remotely for the most part during this period. I receive daily briefings from our Chief Executive and I and the non-executives have been given weekly updates on events at the Trust from the Chief Executive and his executive colleagues and we've been able to hold a number of committee meetings of the board virtually over this period. And the minutes are recorded with these papers of those meetings. Now, meeting in this way obviously has its limitations. But I think in all circumstances, I'm satisfied that we've managed to maintain an appropriate level of board governance during this unprecedented period.
The eyes of the country have been on the NHS in an unprecedented way, I think, during this crisis, and this Trust has been in the spotlight for some of that period. The NHS has responded magnificently and the public appreciation of that has been evident in so many different ways.
Together We Care is our touchstone. It's the touchstone for all we seek to do here at the Trust and it's a commitment we've seen in action every minute, every hour, every day, both here and I would say in the whole of the NHS over recent weeks. It's difficult, of course to look past the human tragedy and suffering that this pandemic has brought in its wake. Our hearts go out to the individuals and families whose lives have been disrupted by COVID-19, and of course, above all, to families who've suffered bereavement during this period. But every day, patients are leaving our hospitals and responding to care in the community services that we provide and are on their way to restored health and strength and we rejoice with them and their families. I just want to take this opportunity, personally and on behalf of the board, to thank all our staff, in our hospitals and in the community, for the extraordinary way they've responded to this challenge, often in ways which pass unnoticed by the general public. And the story, half of which will never be told really. We see a limited amount of the picture even at board level in the organisation.
So to all our staff a huge vote of thanks. We're very, very proud of you. You're all stars. So I'm now going to hand over to Ian to take us through the highlights of his report with his colleagues. Over to you Ian.
Dr Ian Abbs: Thank you Hugh. My report to the board this time is necessarily focused on the COVID-19 pandemic. And I and my colleagues will address some of the issues which I'm sure the board wants to hear more of. This has been a focus for the Trust, as it has been for the NHS and for the country as a whole. I'm really going to try and summarise some of the incredible responses here at Guy's and Thomas' through my report today. We continue with some of our major strategic work, but today's report focuses on COVID-19. I'd like to echo Hugh's opening remarks. This has been a time when we've seen quite extraordinary courage and determination demonstrated by all of our staff at Guy's and St Thomas', clinical and non-clinical, across the range of services, from the most specialised into our important community setting. The response to this international emergency has at Guy's and St Thomas' been amongst the best. I've seen first-hand just how our staff has responded to this pandemic, and had the chance to meet them and witness the brilliant work that they do, and also the transformed ways that they've changed their working patterns to meet the crisis challenge. And I feel incredibly proud and privileged to lead this great organisation at a time of global challenge.
And I'm truly humbled by the commitment and care that our staff have given with compassion to our patients at this time. As the board knows, we've been at the forefront of the national response, having been an HCID, a high consequence infectious diseases centre, receiving patients right at the very beginning of this pandemic. At the time of this report, on the 16th of this month, the Trust has treated well over one thousand admitted patients. And many of those patients have returned home to their family and to their friends. Sadly, however, we have seen over one hundred COVID-19 related deaths, and I'd like to send my personal condolences to the families and loved ones for that loss, that's been felt incredibly by them, but also by our staff at Guy's and St Thomas'. As you would expect, the operational challenges in responding to this national and global action has required a large number of operational changes. I'm going to hand over to my colleague Jon Findlay, our Chief Operating Officer, so that Jon can give you a little bit of more detail on those operational challenges, some of which are summarised in my report. So, Jon, over to you.
Jon Findlay: Thank you Ian. So I think probably first of all, to be clear, we've been managing this whole process under sort of a critical site incident and had to make some very significant changes to both our hospital and community services in order to respond to what has been an unprecedented challenge of extreme proportions, both for this part of London and clearly across the country.
What the major focus of this work was really to create sufficient additional critical care capacity in order to be able to provide the right response to some of the sickest patients that we've had to deal with, and in volumes that we have never dealt with previously. So we've had to more than double our critical care capacity across both sites, on both St Thomas' and on the Guy's site. And what this has meant is that we've had to make some very significant physical changes to our infrastructure. And I would like to just acknowledge the support we've had from our engineering team and our estate team to make very, very rapid changes in order to cope with that increased volume of patients.
We've also had to retrain and redeploy very large numbers of staff in order to be able to provide that additional critical care capacity. And that has involved that enormous input from all parts of the hospital community in terms of the support from our training team, our workforce team, and I think some really big challenges and people taking on some very, very different roles.
To enable us to do this, we have had to stop much of our elective activity, we've significantly reduced the number of outpatient appointments. And we've had to stop most of our elective surgery to free up the capacity to be able to redeploy the staff to be able to look after those other patients. This has clearly had other consequences.
And what we have been doing is we've set up an elective care hub that is working to support patients from across southeast London. So our most urgent, critical elective patients and cancer patients that we're treating on behalf of southeast London have been managed through this hub using facilities on the Guy's site, but also in the independent sector. So this has resulted in some very significant changes to the way that people have had to work and in terms of being able to deliver those services for those patients that are the non-COVID patient, so it's still those patients who require our services that aren't affected by COVID and to be able to protect that environment and to keep those patients safe during this whole incident. Thank you. Ian.
Dr Ian Abbs: Jon, thank you very much. I think importantly, as you have referenced, the hospital very much has changed its way of working. Our community services have been transformed as well. And large numbers of patients now able to be discharged from our hospital are being cared for by our brilliant staff in the community. As well as changing our inpatient activities, we had to make some major changes to our ambulatory and outpatient services, often those changes being enabled by technology. I'm now going to ask our medical director, Dr Simon Steddon, to outline some of those changes in new ways of working to help our patients during the pandemic. So, Simon, over to you.
Dr Simon Steddon: Ian, thank you. Yes, as you say, a large number of our patients have needed safe ongoing clinical review throughout this period. And where possible, we've endeavoured to keep our patients away from hospital by bringing in across many, many services virtual outpatient appointments both on the phone, but importantly using video techniques. And I'm very, very grateful to all of our clinical services for engineering that change in the best interests of patients and also to colleagues and IT for facilitating these new technologies and ways of communicating which have also allowed us as a team to communicate across different campuses and sites of the organisation and to enable remote working, which has meant that all staff members can support the frontline response. Thank you.
Dr Ian Abbs: Simon, thank you very much. And I know you and colleagues were working on learning some of the lessons of the COVID-19 pandemic, particularly in these new ways of working, that we can bring to bear when we do, as we will, get through this pandemic, to enable our patients to receive care in ways that are truly patient-centred. I want just now to talk for a moment about a topic which has been very broadly rehearsed in the media, it's a political question of some notes around personal protective equipment or PPE. To ensure the safety of our staff and the safety of patients, it's been vitally important that we both source the appropriate protective equipment, that we train our staff to use that, and that we have been agile in our responses to a number of changes in personal protective equipment recommendations over the course of the pandemic.
I would like to thank our corporate departments, our procurement and finance departments, David Lawson in procurement, Steven Davies in finance, and also our new deputy chief executive Lawrence Tallon, for the amazing work they've done with their colleagues in sourcing this equipment from across the world. Such that I can reassure the board, to date, we've been able to provide our staff with the appropriate level of equipment for the tasks that they're doing to keep them and our patients safe. This has been a subject of national interest.
But at present, I'm reassured that the personal protective equipment has both been supplied in adequate amounts and is appropriate to the task that we're asking our staff to do. The other national question has been about testing. And I'm going now to hand over to Julie Screaton, our chief people officer, to update the board on some aspects of testing, and I'll also ask Julie to talk about some of the incredible wellbeing opportunities, the wellbeing of our staff being absolutely central to all that we do at Guy's and St Thomas', to care for our patients well, their wellbeing is very important. I'll ask Julie to comment on that as well. So, Julie, over to you on testing and wellbeing.
Julie Screaton: Thank you Ian. I'm pleased to say we've been able to offer our staff access to testing for a number of weeks now, initially through the O2 arena at Greenwich, which is a national program, and more recently at St Thomas', on site here.
Many of our staff, though, do not have access to a car, so I'm pleased to say that recently, in the past few days, we've been able to offer a mobile service, where our dental nurses who have been at the backbone of this service are going out to people in their homes to swab them and their family members to test for presence of the virus and we now have sufficient capacity for that service such that we have no backlog or waiting lists and people are getting tests within 24 hours of request. Now, because of this situation, we're very closely monitoring the welfare of our staff.
The absence associated with COVID really falls into three main categories. One group of the people who are symptomatic, secondly, those who are remaining at home for two weeks because a family member or a household member is symptomatic, or those who are shielding under the 12 week arrangements that were announced nationally at the beginning of the pandemic.
We've seen their levels of absence drop significantly over recent weeks. Currently, around 600 of our stuff are away from work due to COVID related symptoms or shielding. To give you a sense of that break, the majority of people away from work are those in the 12 week group. Those who have long term conditions that require them to stay at home. Around 250 people are self-isolating - the 14 day rule - and around 200 people are symptomatic with COVID. Obviously the symptomatic group and those household isolation groups are being supported with the testing program so we can get people back to work when it is right and safe to do so. Ian referred to the importance of wellbeing, and we have been inundated by amazing offers of support for many people, for the wellbeing of our own teams, as Ian said retraining to support the wellbeing effort, we've had donations from all around London, items of food and hand creams and all sorts of products to support our staff to feel safe and well at work.
And we've been running two supermarkets over our two main sites and providing support out into the community, as it's been difficult to get hold of basic foodstuffs. The work that our staff are doing is truly incredible. And as Ian has said, people are working in different ways in different roles. And we've been truly amazed by their flexibility and willingness to put themselves forward to do that. But we're fully aware that that risks a psychological pressure or difficulty for people working in different ways and different roles. So we have a full-time consultant psychologist on the team here dedicated to working with staff, who along with all the psychologists we employ with the Trust is looking now at that ongoing support to our staff as the pandemic continues and that intensity of work, although is dropping, still maintains quite busy in many areas. And we're also focusing on providing support and relaxation spaces to staff so they can just recharge and rewind after a busy shift. Thank you Ian.
Dr Ian Abbs: Thank you, Julie. I'd just like to echo your thanks to the thousands of generous donors who have helped us support our staff. And in particular for the board I'd like to thank the Guy's and Thomas' Charity, who have through their generosity allowed us to support staff in a number of ways including to ensure that no staff feel a particular hardship during the COVID pandemic. I think the summary of this part of my report to the board, I think exemplifies Guy's and St Thomas' at its best. And I would summarise the organisation at the moment in the care of patients particularly with COVID-19, as compassionate, controlled and caring. The two or three other items beyond COVID.
Just to note that we've now, in addition to Lawrence Tallon joining us as our deputy chief executive, been joined by Jessica Dahlstrom, our new chief of staff with functions across the corporate affairs department. Lovely to welcome Lawrence and Jessica, but also to note with some sadness that we say goodbye to Hannah Coffey, our Director of Improvement, who's moved on to new opportunities. A number of other highlights has been the reaccreditation of King's Health Partners as an Academic Health Sciences Centre, a brilliant achievement for all involved and a pleasing outcome to the recent information commission audit where the Trust processes were found to be satisfactory in quite a testing audit. So, on that note, Hugh, I'm going to end my report. But finally again to say thank you to all colleagues that Guy's and St Thomas' and for the support of the board at this challenging moment.
Sir Hugh Taylor: Thank you very much Ian. Just before we move on to Eileen's report, I'm conscious that our non-executive directors aren't able to participate in this meeting interactively. So I just asked them, whether there are one or two things they just like to pick up on for the purposes of this meeting. And a couple of points, that I just wonder if you could comment on. One is just a question about how, obviously sadly, your report notes that we have a number of deaths, we've had a number of deaths, and I think people would just be grateful to know how we're measuring our mortality.
Is it above or below expectations and how it's benchmarking. So just a word or two about how we're assessing our outcomes if you like, from managing the COVID-19 crisis. And then perhaps if you could just elaborate a little bit on the work which we discussed in the Quality and Performance Committee, which is in progress in relation to assessing risk in relation to non COVID, non COVID diseases. And there's been a lot of attention given in the media to the fact that attendances at emergency departments are low. And so I just wondered if you could just say a little bit more about how we're keeping an eye on our patient lists and assessing risk in relation to the patients that we're aware of who we need to keep supporting over this period. Just those two questions.
Dr Ian Abbs: Certainly, Hugh, thank you. I think I will summarise the current position on the data position on outcomes during COVID-19. And then I'm going to ask Jon, I think, to summarise some of the work that's going on, to comment on our tactical response to the pandemic, around how we are tracking those patients, and how we're going to assure ourselves that we can measure harm. But if I first take, Hugh, the question on some of the outcome data. I'm going to if I may update the board with our latest information. We've treated approximately 1,300 patients to date, and the number of deaths in those group reported into the public domain is 148 in line with the NHS England reporting requirements.
Patient outcome data is constantly evolving, and it's difficult to determine overall mortality rates at present. However, I can comment on the mortality outcome data of our critical care cohort. These are on smaller numbers. But the current outcome data suggests a mortality rate of 32%. So therefore, survival rate from critical care of 68%, which is significantly better than maybe a number of factors that we'll need to look out for the causation of the somewhat better outcome data that we are seeing compared to the national registry data, where the mortality rate is about 50% compared to roughly 68% here. So we are seeing somewhat better survival in our critical care patients.
One area that is of concern to me, of concern to the board, however, is again, a subject of national concern, which is we are seeing trending numbers to poorer outcomes in black, Asian and minority ethnic patients. That is of concern. And we are looking into those data to look for some of the demographic or health risk factors that might be driving that trend. Clearly, there are a number of health issues that have been identified with poorer outcomes in COVID-19 disease, such as diabetes, hypertension, that may be risk factors, but it's very important that we assure ourselves around those causes, we understand the outcome data by ethnicity, and we look hard at the causes and see what we can do, if anything, to change that outcome.
Another risk, as you highlight Hugh, is the risk of those patients who are not coming to see us at the moment, I'm going to turn to Jon Findlay, our Chief Operating Officer, just for a brief comment on the processes in place to assure that that risk is mitigated. Over to Jon.
Jon Findlay: Thanks Ian. So, I think like other organisations, we have seen a very significant reduction in both referrals into our services and patients attending A&E, which are the two main routes that patient access to services in normal circumstances. So what we've done is we've got a number of tactical groups that are really focusing on these areas and we've really split them into those patients we know about, so those patients that are already on our waiting list or already on our outpatient follow-up list and all of those patients have been reviewed by the clinical teams and they have been prioritised and their needs identified and contact has been made with those patients, or a decision has been made that their appointments can be delayed. And their subsequent appointments have been cancelled and they will be reappointed in time. And all of that has been done with an individual patient clinical review by a multidisciplinary team and for the elective patients multidisciplinary teams have been as involved, clinicians from across the organisations within southeast London looking at that waiting list and coming up with a clinical priority for all of those patients to make sure the most urgent patients are still being seen in a timely fashion.
For those patients that we don't know about, so those patients who aren't accessing the service in the way that we would normally expect them to, what we've been doing is working with GPs locally, to make sure that their people are fully aware that all of our services are open for referrals, that the normal route of referrals are still there. We put in place new arrangements to provide advice and guidance to GPs and other referrers who want to access services. And we've been using all our communication channels to encourage patients to access their GP, to phone 111, to come to the hospital should they need to, and that the hospital is fully open and open for all services, and that we are encouraging people should they need to, to not delay in accessing healthcare.
And so we've been promoting that through all the possible communication channels that we use, and will continue to develop ways of talking to those patients and trying to make contact with those. And we've been working also with colleagues in social care to identify patients potentially at risk, with our community team, and also then encouraging those patients to seek help, should they need it.
Dr Ian Abbs: Thank you very much, Jon. And there, Hugh, I'm going to end my report and hand back to you for the continuation of today's agenda.
Sir Hugh Taylor: Thank you very much, Ian. So I'm now going to hand over to Eileen to introduce briefly, her annual nursing and midwifery report. And this is an excellent document, very, very comprehensive. And I fear we're not going to be able to do it justice in the time available to us today, but we're very, very grateful to have it and it is an important annual assurance document for the board. Eileen, would you just like to say a few words about it, and any particular points that you want to highlight in the report?
Eileen Sills: Thank you Hugh. I think, can I just first echo what everybody has said in terms of thanking staff, but in particular I'd like to thank all the nurses and midwives at Guy's and Thomas', many of whom are working now in different teams in different environments. And have had to upskill themselves, for example to work in critical care. It's been absolutely astounding, and very moving. So this is the annual workforce report that we have to do for the board on an annual basis and then there will be a follow-up one in November, which is just a stocktake. This demonstrates a pretty robust picture from a nursing midwifery perspective, we've 7,100 funded posts across our acute and community services. And it has grown somewhat in the previous 12 months by 500 posts. Turnover is slightly down as well. And in relation to reviewing the safe staffing numbers, we've identified a need for an additional 40 whole time equivalent staff, we're just waiting for verification, they've been funded through Steve Davies and I will be able to follow up in a future board meeting to confirm whether they've been funded.
But we've also asked for some further investment to be able to take forward the nursing associate program from an apprenticeship perspective for 50 posts within the trust to continue our program. We've already got 123 trainees, but what we want to do is to make sure that our own nursing assistants are not disadvantaged through the new route that we're developing, which is the direct student entry route. At this present time, this sets out a framework for our nurse establishment for nurse to patient ratios, which doesn't reflect COVID-19. At the end of the emergency situation that we're currently in, and when we do a stocktake about whether we will be working differently, it may very well require us to review this document and the nurse to patient ratio going forwards. And that may very well be adjusted. But I think this document should act as a benchmark, and say that actually we are safely staffed in the organisation from a funding perspective.
And from the establishments that we have set. There were some questions that were raised by one of our governors, I will respond to those directly in relation to some specific points within the report. Otherwise, probably there is nothing I would want to cover in this meeting, but we can come back to it in future meetings. Thank you Hugh.
Sir Hugh Taylor: So we know your report, as well as the chief executive's report. And there are a number of other reports for noting which are reports from board committees. And I don't think I have any other recorded business. So that would bring us forward to the end of this board meeting.