Annual General Meeting 2020

COVID-19

• Staff were treating an unprecedented number of patients: many needed to be looked after by our critical care teams
• The peak of the pandemic saw our staff working around the clock in what can only be described as a heroic response to the virus

2019/20

• Inspectors recognised the improvement we’ve made across our services
• Both our emergency departments rated good for providing safe, caring, and well-led care
• We continue to be rated as requires improvement

Cutting-edge technology

• Robotic knee replacement at Central Middlesex reaches 250 completed surgeries milestone
• St. Mark’s Hospital is one of the largest centers for complex cancer in Europe
• The Caryl Thomas Centre sexual health clinic in Harrow was refurbished
• West London Vascular and Interventional Centre officially opened thanks to a grant from our charity

Embracing technology

• ePortering app developed in partnership by Infinity Health, Digital Services, and ED won a prestigious HSJ award
• Formed a network to improve imaging services in north west London with five other trusts
• Started procurement process for a new Digital Care Record (DCR) system
• Upgrades to our digital network and security

Transformation

• 63 Improvement Fellow graduates each completed an improvement project
• Work to digitise and streamline outpatient services started
• Text reminders and digital letters help patients to easily accept or decline their appointment, all from their phone

Quality and patient experience

• Data showed lower than expected mortality rates
• We worked to identify patients at risk of deteriorating more quickly, improving their care
• A&E continues to be a focus: with nearly 350,000 attendances, one of the busiest in the country

Let’s celebrate

• ACAD at Central Middlesex Hospital turned 20
• Ealing Hospital and the Brent Sickle Cell and Thalassemia Centre both turned 40

Our amazing people

• Our staff and volunteers make all our improvements and progress to date possible
• We celebrated their success at our annual Staff Excellence Awards, proudly supported by our charity and sponsored by partner businesses
• We’re proud that 64% of our staff come from BAME backgrounds

Looking to the future

Our way forward delivery programme plan outlines how we’re going to restart our services safely and rebuild to better than normal after COVID-19.

In 2019/20 we…

• Delivered a significant proportion of our Cost Improvement Programmes and started to build our Transformation Plans
• Met our cash and capital statutory targets
• Made significant investments into equipment, estates, and our digital infrastructure
• Reported a financial deficit of £107.5m

Read more about our finances in our latest annual report

What our auditors said

• Noted our teams’ hard work to improve efficiency and productivity
• Confirmed the accuracy of our reports and accounts with qualifications regarding the challenges we face in 2019/20 and future years
• We’re using the auditor’s report to plan for our long-term future
• Read more in our latest annual report

Going into 2020/21

• A new financial framework
• A new start
• Work towards financial balance
• Better partnership working with the NHS in north west London
• Invest in our future

Setting the context

• Receiving for Heathrow
• Rapidly designated as the sixth HCID
• One of the largest ID units in the country
• Busiest A&Es in London
• Plus what turned out to be a very significantly affected population in Brent, Ealing, Harrow

Preparation and the early days

• Simulation training
• Learning from first case
• ITU move – setting up a Respiratory Assessment Centre
• Rapidly remodelled A&E to stream patients
• Community testing  and drive through testing

Outbreak

• First in UK to use mobile dialysis units in critical care setting
• Virtual visiting and Healthy Vibes
• A&E absorbed impact
• Huge move to digital working – new technology, new hardware
• Virtual outpatients

Research

• Second highest national recruiter for 5773 trial
• Third highest national recruiter for severe emerging infection study
• The national CMO’s priority list: prioritising research for the fight against COVID-19

Our outstanding teams

• Clinical teams
• Support staff, from estates, to Medirest
• Redeployed staff, and other teams who just helped out like finance
• Volunteers
• Our charity
• Our communities

Keeping our people safe

• Infection control has been one of the major priorities throughout the outbreak
• All our entrances are controlled with temperature scanning and hand gels
• Staff and their immediate family can get tested for COVID-19
• Daily tracking shows PPE supplies are healthy

Keeping our wards safe

• No cases of COVID-19 on the low risk elective pathway since it was introduced in June
• Every area had to have infection control approval before recommencing work
• The CQC has undertaken a remote assessment of our infection control processes which we passed

Keeping our pathways safe

High risk

• Symptoms unknown
• Confirmed positive
• Symptomatic or suspected

Medium risk

• Asymptomatic and waiting for test results

Low risk

• Clinically assessed prior to treatment with no symptoms and negative test
• Recovered from COVID-19

Our recovery

• April: agreed arrangements with Independent Sector for urgent and cancer treatments
• May: waiting list prioritisation
• June: routine referrals restarted, restarted elective and day case theatres across sites
• September: preparing for wave 2, restarted started staff testing, further expansion of theatre lists
• August: started weekend surgical lists, supported sector trusts in sharing theatre capacity
• July: theatre recovery, winter planning, expanded cancer surgery theatre lists, increased diagnostic capacity, first wave lessons learnt

Recovering outpatients

• By October, we will deliver 80% of our pre-COVID outpatients through a combination of face to face and virtual
• We expect virtual (telephone and on-line) appointments to increase by 374% compared to pre-COVID activity
• We will always give face-to-face appointments to patients who need them for clinical reasons or if they cannot use virtual appointments

Recovering inpatients and surgery

• Total admissions are forecast to  recover to 83% of pre-Covid by October with day cases and elective up to 80% and non-elective up to 90%
• Continued use of joint pathways agreed with Independent Sector delivering over 700 operations to date
• Further work across north west London NHS to develop joint clinical pathways and share surgical capacity

Recovering A&E

• In August, A&E attendances had returned to 74% of pre-Covid levels
• By October, we expect this to rise to 90%
• We have in place clear clinical protocols to identify potential Covid cases and isolate these patients from non-Covid patients​

Preparing for winter and wave 2

• Developed robust Trust plans for use of A&E, ambulatory care, beds, theatres, outpatients and supply of equipment to maintain as many services as possible with robust infection control pathways
• Adopting sector wide principles;
  • mutual aid arrangements for sharing staff and equipment
  • transfer critical care and elective patients to hubs
  • redirect ambulances early to manage demand
• Invested in new intensive care facilities
• Continuing use of the independent sector
• Joint winter plan signed off with our key health and social care partners

Winter is coming

• Get you flu jab: you may be offered a free jab by your GP
• Stay safe: wear a mask, wash your hands, and leave space
• Get tested if you have symptoms
• Download the Test and Trace app
• The NHS is open: speak to your GP or call NHS 111 for advice. Always call 999 in an emergency

The NHS’s broader objectives

• NHS commitment to housing
  • ‘Surplus land costs money to maintain which is better used to directly provide healthcare services’
• NHS commitment to carbon reduction and the environment
  • ‘The NHS will be taking immediate action in 2020, with a proposed new NHS Standard Contract calling on hospitals to reduce carbon from buildings and estates’
• The Trust, Brent Council, the University of Westminster and Network Homes formed a committed partnership to promote the redevelopment of the land at Northwick Park to deliver new homes and jobs as part of the ‘One Public Estate’ initiative

Northwick Park redevelopment

• Public consultation during 2019
• Redevelopment starts 2021
• As part of the OPE collaboration we have received a grant from Homes England (£10m) to improve the road infrastructure to improve the flow on the Watford Road an to make it safer for pedestrians and cyclists
• We're building a new multi-storey car park and energy centre:
  • Reduces direct costs by c£1m/year to the NHS
  • Facilitates an investment of £10.4m in replacing old, dirty, inefficient infrastructure
  • >£70m benefit over 15 years
  • District heating opportunities

The benefits

• Air pollution is linked to killer conditions like heart disease, stroke and lung cancer, contributing to around 36,000 deaths annually
  • Reduction in carbon generation of 1700 tonnes per year
  • Planting over 450 new trees to protect wildlife habitats and to improve air quality
  • Improving the safety and security of the park, especially at night and when walking
• Reinvestment in services for patients
  • Initial receipts for the land sale are being invested back into specialist patient services including a new facility to manufacture critical cancer medicines
  • Further substantial receipts c£15-20m to follow in 2021 for reinvestment directly back into improving healthcare facilities

Ealing Hospital redevelopment

• Having secured the future we can start to pursue a similar strategy to the Northwick Park site.
• Develop a high density, multi-story car parking solution to vacate valuable land at the front of the hospital that could be reutilised for residential development including support for our staff
• Improve assess to outpatients and frequent visitors area
• Raise capital for reinvestment in clinical services

Central Middlesex redevelopment

• Central Middlesex Hospital represents the Trust’s best condition real estate….. however it has been poorly utilised historically
• Exciting new plans and opportunities are emerging across the sector that give us the opportunity to establish CMH as a centre of excellence both locally and for patients across North West London, particularly in respect to orthopaedic and specialist surgery
• This of course complements the existing specialist excellence, such as the sickle cell clinical services that directly support our local population demographic and ethnic mix.