Annual Report summary 2021/22

The COVID-19 pandemic has continued to present us with great challenges, as well as new opportunities, over the past year. It has affected us all, both in our professional and personal lives.

Once again, our heartfelt condolences go out to those who have lost family, friends or colleagues. We also appreciate the impact that the pandemic continues to have in many other ways, including long waits for diagnosis or treatment and the pressure it has placed on staff.

The way our staff have continued to respond and step up remains a source of huge inspiration.

It is very positive to see that our survival rates for those admitted to critical care with COVID-19 have remained among the best in the UK. We continue to share our experiences of treating these patients with others.

Ongoing peaks in the pandemic during the past year, particularly as a result of the rapid spread of the Omicron variant in December 2021, placed health services including at Guy's and St Thomas' under immense pressure. More patients required unplanned hospital treatment, at exactly the same time as we experienced unparalleled levels of staff sickness and absence.

Staff again redeployed to the areas and services needing them most, enabling us to meet the increased demand for medical treatment both on the wards and in critical care.

Regrettably some patients experienced unavoidable late cancellation of their planned treatment or surgery at this time.

Throughout the year, we have worked extremely hard, with partners in south east London and beyond, to develop comprehensive plans to recover and restore services for patients whose primary health need is not COVID-19 related. Many of these patients are waiting for complex or life-saving treatment, and we continue to place their needs at the forefront of our minds.

Across the NHS there have been phenomenal efforts to restore planned care and diagnostic services to pre-pandemic levels, increasing face to face services for many, while retaining virtual consultations where appropriate. New ways of working, in both our hospital and community services, have developed rapidly over the past two years and will help us to increase the number of patients that we are able to treat in future.

Many patients have welcomed these changes, although we are very conscious of the need to listen to their experiences and to ensure that we retain a range of ways to access care so that this is equitable and does not disadvantage anyone, particularly our most vulnerable patients.

As we celebrated the first anniversary of our merger with Royal Brompton & Harefield NHS Foundation Trust in February 2021 we were able to reflect on the ways our clinical teams have worked together to improve care for patients.

Not only are we now the UK’s largest provider of specialist respiratory care, including extracorporeal membrane oxygenation (ECMO) therapy for the very sickest patients, but our surgical teams have benefited from being able to access additional theatre and bed capacity at our new sites when this has been constrained at Guy's and St Thomas' hospitals. The warm welcome extended to colleagues has paved the way for further integration, including through management changes from April 2022.

We know the national emphasis on restoration and recovery will be a huge focus for the NHS over the next few years, and we are very aware of the sustained effort that will be required to bring our own waiting times back to acceptable levels in many specialties. We are also conscious of the considerable distress and anxiety that long waits for diagnosis and treatment place on patients, and their families and friends, often through personal experience.

Looking ahead, we welcome the opportunity to work collaboratively with our colleagues in the new Integrated Care Systems as we seek to tackle these challenges together and to improve care for the communities we serve.

Our focus has remained on treating as many patients as we safely can, both those with COVID and also those requiring diagnosis or care for other conditions.

Our emergency department had to make significant changes to ensure patients were kept safe and treated as quickly as possible in the most appropriate areas, with infection prevention measures maintained at all times.

Despite some exceptionally busy periods, we have managed to sustain 4-hour performance at above 80% throughout the year. Staff have worked tirelessly in often difficult and stressful conditions to meet the needs of patients. This has included redeployment to those services under the greatest pressure at various stages during the pandemic.

Omicron impact

Prior to the Omicron variant, progress against recovery plans was promising and in October and November 2021 we delivered 83% of outpatient activity, 82% of elective admissions and 103% of diagnostic activity, when compared to 2019/20 levels.

The delivery of this activity also had a positive impact on some of the Trust's key waiting time targets. In November, the Trust reported 87% of patients had received their diagnostic test within 6 weeks. This is a significant improvement compared to our May 2020 position, when just 35% patients received their diagnostic test within 6 weeks following the first wave of the pandemic. In addition, the number of patients waiting over 52 weeks for treatment had also reduced by 68% compared to March 2021.

However, our progress with elective recovery – to reduce waiting times for diagnosis and treatment – was set back by the Omicron wave in December 2021. The Trust and other partners in the South East London Acute Provider Collaborative, had to reduce routine outpatient appointments and non-urgent surgery to ensure sufficient capacity for urgent and emergency care, including patients with COVID-19.

As COVID-19 infections again reduced, the Trust set 3 clear priorities:

• to maintain safe care pathways for patients requiring urgent or emergency care
• to ensure sufficient capacity to diagnose and treat high priority patients quickly
• to ensure our COVID vaccination and treatment service could meet demand from all eligible patients

Waiting times

There has been a steady reduction in the number of patients waiting over 52 weeks. At 31 March 2022, there were 1,628 patients in this category, of which 56 patients had been waiting more than 104 weeks.

As cancer referrals increased in the early part of the year, performance against the 62 day waiting time standard deteriorated, although referrals have stabilised since October and we are working hard to improve the timeliness of both diagnosis and treatment. At 31 March, 9% of cancer patients were waiting more than 62 days.

Throughout the year we have carefully prioritised theatre capacity within the Trust, and also moved work to alternative providers where patients have agreed to this. We recognise the need to increase capacity for the longer term given the very significant number of patients waiting for care across the NHS.

During this year we were able to open additional operating theatre capacity at Queen Mary's Hospital, Sidcup, where surgical teams from Guy's and St Thomas' work with our neighbouring trusts to carry out high volume, low complexity procedures. Working through the South East London Acute Provider Collaborative, this new facility is enabling us to increase operating capacity for patients across south east London.

Our performance against the national diagnostic standard, where 99% of patients should wait no longer than 6 weeks for a diagnostic test, unfortunately deteriorated during the Omicron wave of the pandemic in December and January.

However in recent months we have worked hard to provide additional capacity, including through the provision of mobile scanners and by using the private sector and in early 2022 we opened a new Diagnostic Centre at Royal Brompton Hospital.

In addition, we are working with our south east London partners to open diagnostic hubs and we have seen a sustained improvement in diagnostic performance since. At 31 March, 11% of patients were waiting more than 6 weeks from referral for a diagnostic test.

Wide ranging national recovery targets were published in December and we are working hard to achieve – and where possible exceed – pre-pandemic levels of activity as quickly as we safely can.

The Trust has remained subject to the emergency financial regime introduced to support the national response to the pandemic.

Our plan was for a surplus of £5.5 million, before technical adjustments such as capital donations, depreciation on donated assets and valuations. It was also assumed that we would continue to access the same COVID-19 and 'top up' payments that were available in the previous financial year.

The Trust's financial plan assumed receipt of £21.2 million from the Elective Recovery Fund, with an increase in expenditure of £15.7 million, to deliver the necessary volume of activity.

Including all technical adjustments, not taken into account as part of the control total calculation, the Trust results show a deficit of £1.2 million. The total adjustments for donations, depreciation on donated assets and valuations were a deduction of £15.1 million, £1.6 million greater than plan.

Capital donations of £12.9 million were £6.8 million above plan. Technical adjustments for impairments were as follows: annual revaluation of land and buildings £8.4 million; donated inventory £6 million; other technical adjustments £1.6 million.

Following these adjustments, the Trust reported a surplus of £0.2 million.

We continue to invest in improving our estate, digital technology and medical devices to support the needs and expectation of our patients.

Electronic health record

Our ambitious plans for a new electronic health record system through the 'Apollo programme' will transform every aspect of how we work. We are now in the implementation phase and due to go live in April 2023.

The new system will span Guy's and St Thomas', including Royal Brompton and Harefield hospitals, and also King's College Hospital. In addition, our digital infrastructure programme is focused on key investments such as network replacement and our integration engine, ahead of this programme.

Building for the future

Our new Diagnostic Centre at Royal Brompton was completed during 2021, and allows us to provide state-of-the-art imaging services to help diagnose heart and lung disease.

Investment in leading edge imaging technology also continues on the St Thomas' site and will create further capacity to meet growing demand and strengthen our research capabilities.

Our longer term plans to increase orthopaedic theatre capacity at Guy's and to expand Evelina London Children's Hospital also continue to make good progress.

In the community we are planning a new ophthalmology outpatient facility to serve patients from across south east London.

Innovation

In the past year we have brought together our wide-ranging innovation, improvement and transformation capabilities (including computing, engineering, AI, digital, data analytics, private patients and international business development) to form a new Centre for Innovation, Transformation and Improvement (CITI).

In collaboration with King's Health Partners, CITI will support our ambition to be internationally recognised for delivering better, faster and fairer healthcare.

The past year has also been characterised by ongoing medical breakthroughs and new knowledge about the best ways to treat and prevent the most severe disease arising from COVID-19.

Our clinical and research teams have continued to play a central role in this work, and we are proud that we continue to enrol so many patients into clinical studies and research as these offer the best hope for the future as we prepare for the possibility of new variants and coronaviruses worldwide.

We were proud to be asked to rapidly establish a new COVID Medicines Delivery Unit to provide the very latest treatments for COVID-19 to the most vulnerable people in south east London. Our team assessed over 3,000 patients in the first 6 weeks, preventing the need for hospital admission for those most at risk of serious illness from COVID-19.

Our role in the ongoing delivery of COVID-19 vaccinations and boosters to staff, patients and our local communities has continued to be a key priority. We’ve delivered almost 900,000 vaccines, and more than 20,000 of our staff took up the offer of vaccination.

As the lead provider for the Our Healthier South East London vaccination programme, the Trust was responsible for the training and management of staff at a number of vaccine centres across south east London in addition to running up to six centres at any one time on our hospital sites. Our focus on meeting demand for vaccines, including through a range of outreach programmes, ensured that everyone who was eligible had access to a vaccine or booster.

The Trust serves some of the most diverse communities of in the UK, as well as caring for patients from further afield. This diversity is also reflected in our staff and brings many benefits to our organisation that we are incredibly proud of. 

The disproportionate impact of the pandemic on Black, Asian and other minority ethnic communities remains with us and has shone a spotlight on wider societal inequalities too. In response we have renewed our focus on equality, diversity and inclusion and we are determined that this extends to every aspect of how we support, engage and meet the needs of our patients, staff and the communities we serve.

As part of our response to the COVID-19 pandemic we have carried out regular risk assessments to ensure we protect those who are most vulnerable, which has included staff from Black, Asian and other minority ethnic communities and those with long-term health conditions and disabilities.

We recognise that we have more to do in all these areas, including to improve opportunities for career progression, remove discrimination and to build management capability and confidence.

Since the Trust refreshed its equality, diversity and inclusion priorities in 2018/19 we have been working to embed these into day-to-day business. Our focus is to provide equitable access to service provision and delivery of care by driving improvements in patient care and staff experience and reducing inequalities and disparities for our diverse workforce and population. 

We launched a new 10 year sustainability strategy in June 2021  which recognises the Trust’s environmental impact and our responsibility to address this in the long term.

As part of the Trust's carbon-zero ambitions, our target of reducing the use of desflurane anaesthetic gas in clinical practices by 80% (compared to 2018-19 levels) has been met ahead of the target date of May 2023.

We’ve completed a full review of our fleet of approximately 400 vehicles, enabling us to focus on tackling our biggest polluters. We’ve already met our target of having 85 electric or hybrid vehicles by May 2023, and have developed an electric vehicle charging infrastructure strategy. From June 2022 only ultra-low emissions vehicles will be on offer to staff through our Trust vehicle salary sacrifice scheme.

As part of our transition to a 'greener' fleet, we have provided e-cargo bike training and safety equipment to neighbourhood nurses taking part in a pilot at one of our community sites. The pilot is enabling nurses to reduce their journey times by cycling to patient visits, while also bringing about environmental and health and wellbeing benefits.

We continue to support active and sustainable travel amongst our staff and have opened a new staff bicycle storage unit at Guy’s.

We hold 'bike marking' and bike maintenance sessions, bicycle auctions and provide a range of information to keep cyclists safe and promote enjoyable commutes.

We are committed to reducing the amount of food waste in our hospitals and, following a successful pilot at Guy's, we are working with south east London Integrated Care System to track food waste over a 24 month period in the St Thomas’ and Royal Brompton central production kitchens and several wards. We hope the programme will lead to improvements at scale which can be shared more widely.

We continue to focus on reducing single-use plastic across our sites and have partnered with Brunel University London to assess sustainable alternatives to the more than 2,500 single-use plastic cubicle curtains used in the Trust each year.

The single-use plastics and sharps working groups are seeking to prevent 80,000 plastic sharps bins a year from being incinerated by switching to a reusable model.

The NHS Staff Survey is the largest annual workforce survey in the world and has been conducted every year since 2003. 

As in previous years, our staff reported a positive experience of working for the Trust, and the results show there is much to be proud of at Guy's and St Thomas', particularly given the pressures presented by the COVID-19 pandemic.

The Trust achieved above the national average in all 7 People Promise elements and in the staff engagement and morale theme scores, compared to comparable trusts.

We continue to achieve high engagement scores and ranked fifth in the country on the overall staff engagement theme, including:

•73% of staff would recommend the Trust as a place to work, compared to a national average of 58%

•87% of staff would recommend the Trust to a friend or relative as a place to receive care or treatment, compared to the national average of 76%. This is the highest score in London.

As part of our local questions, 94% of our staff said that they were proud to work at the Trust.

Results also indicate that best practice exists within our clinical groups and corporate directorates, with some scores at this level exceeding the best score nationally, including in our Essentia and workforce directorates.

There were also a number of areas where the Trust scored less well and which we need to improve. We scored below the national average for diversity, equality and inclusion as well as for bullying and harassment. These findings are consistent with those from previous surveys and remain a priority for us.

Last updated: July 2022

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