Agenda item

UPDATE FROM KING'S COLLEGE HOSPITAL NHS FOUNDATION TRUST

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Minutes:

Jonathan Lofthouse, Site Chief Executive – PRUH and South Sites (“Site Chief Executive”) and Debbie Hutchinson, Site Director of Nursing – PRUH and South Sites, provided an update on the King’s College Hospital NHS Foundation Trust.

 

The Site Chief Executive informed Members that in addition to the PRUH, he was also the lead for Orpington Hospital, Beckenham Beacon and the King’s College Hospital services delivered at Queen Mary’s Hospital – Sidcup.

 

Reflecting back to late January, early February 2020 the Site Chief Executive noted the harrowing scenes in countries around Europe, of the profound and substantial impact of COVID-19. The approach of King’s College Hospital NHS Foundation Trust in response to the threat of the pandemic was to organise services with a view as to how bad the pandemic could be. There had also been a requirement to be very robust in formalised command actions, which were taken at the highest level of a national incident. It was acknowledged that there had not been a huge amount of permission and communication outside of the organisation.

 

The Site Chief Executive informed Members that there were around 510 beds at the PRUH, and from the 25th February 2020 the majority of these beds had rapidly been turned over from their standard use, to be COVID-19 response bed space. COVID-19 patients that had presented at the Emergency Department, had mainly required inpatient admission into acute and general wards, but there was also a number who required higher level care in high-dependency and intensive therapy wards.

 

Areas of the organisation, and its partners, had needed to change rapidly as part of its response. To increase capacity, other buildings on the campus had been utilised and the day surgery unit, which was on the PRUH site, had been linked by a protective tunnel to allow bedded patients to be transferred across the car park with dignity. A number of services had also been moved out of the PRUH site, to create additional capacity and protect vulnerable patient groups. This had included moving the ophthalmology outpatient’s department to Queen Mary’s Hospital – Sidcup, to allow this space at the PRUH to be used as part of the COVID-19 response. The capacity of the site had also been enhanced for other provision, and additional temporary mortuary capacity had been housed on the PRUH site over the last few months. This was used by the organisation, as well as partners across Bromley.

 

The Site Chief Executive advised Members that well over 1,200 patients had presented at the PRUH and South Sites and been admitted with defined (not suspected) COVID-19. Sadly, despite all their best efforts, over 240 patients had passed away during the pandemic. King’s College Hospital NHS Foundation Trust had collectively seen more COVID-19 patients than a number of hospitals across the UK, which was largely due to the local demographics of the PRUH and Denmark Hill sites.

 

The Site Chief Executive stated that he was incredibly proud of all his staff, who had responded beyond expectations to this national crisis – the quality of care, bravery and compassion shown had been phenomenal. The support shown by Bromley, as a community, had been astonishing and had allowed staff to provide the best care to their patients. It had also allowed the Trust to look after its staff, either working remotely or as care givers, as wholesomely as possible, offering welfare support and psychological support, for events that they had not been used to witnessing.

 

As the Trust moved into a recovery phase, and a return to ‘normal’, they intended to mainstream some of the rapid solutions to enhance the receiving and urgent care capacity. These enhancements were currently delivering an improved emergency care 4-hour standard performance. Since late April 2020, the PRUH and South Sites’ 4-hour emergency access standard had been significantly higher, and on some days had been one of the best performances across London. The current rate for the month-to-date stood at around 95.5%, which reflected the continuation of robust care opportunities, as well as the changes made to respond to the pandemic.

 

In response to a question from a Co-opted Member, the Site Chief Executive said that within the organisation, sadly a small number of staff had passed away during the pandemic. It was not possible for the Trust to determine if those individuals were infected with COVID-19 in a hospital or care setting.

 

A Member asked for more details relating to the Recovery and Reset Programme for the PRUH, particularly in relation to the priority areas of cardiology and oncology diagnostics, and the availability of outpatients’ appointments. The Site Chief Executive advised that as the country entered into the first wave of the pandemic, the Trust had been issued with regular and rapid directional instructions from Public Health England (PHE) and the Department of Health and Social Care (DHSC), regarding what services should continue, and which should be paused. Those that were required to be paused included endoscopy, which was also a diagnostic for cancer patients. The issues around accessibility were therefore due to national instructions, which the Trust were required to follow. Throughout the pandemic, the PRUH had continued to provide urgent and critical care for cancer patients, either being treated on site or at the designated centre for South East London. However, a sizeable and complex backlog had developed, particularly in endoscopy, echocardiogram and CT scan services. The majority of services were now in a ‘near normalised’ state, and an outsourcing contract had also been agreed with a local partner, who had additional capacity for the three services mentioned. A range of other clinical options (video, telephone and face to face) would also continue to be provided, but there was a need to recover the position of the diagnostic pathway.

 

In response to a question regarding preparations for a second wave of the COVID-19 pandemic, the Site Chief Executive said that the Trust had taken distinct learning out of their response to the first wave. They were extremely proud of their response to the pandemic, and it was considered that they would not have done much differently. Learning had also been taken with in terms of how environments of care could be escalated; how quickly intensive therapy beds could be made available; and how many could safely be staffed. There was now also detailed modelling regarding length of stay in hospital and medical interaction with patients. There would always be a level of risk and escalation, and a second wave would be more complex if it arrived during the winter flu season. This was recognised nationally, and the Trust was already being asked to give additional capacity to stockpile the resources needed for a second wave response.

 

In response to a question regarding the support given to NHS staff, the Site Chief Executive informed Members that the Trust had been conscious of the need to provide an enhanced offer of on-site welfare and support. There was a safe space to which care givers could go, have time to reflect and receive psychological and therapeutical support. The feedback from staff had been extremely powerful, and the Trust had permanently established 'welfare sites' at Orpington Hospital, the PRUH and Denmark Hill. Work was underway to design a memorial garden, which had been gifted by the owners of the PRUH hospital building and would be a private space for staff which provided a holistic and reflective environment. The Trust’s occupational colleagues had also been working with the Oxleas NHS Foundation Trust to look at the long-term welfare offer for staff. It was felt that the Trust had responded rapidly, and that the value of the support offered had been recognised as an organisation.

 

In response to questions regarding care home testing and PPE, the Site Chief Executive advised Members that the Trust had been given distinct direction from PHE as to how they should augment their response to the pandemic. The information was received rapidly and was very extensive. At the outset of the pandemic, it was noted that UK-wide, patients had not been routinely swabbed on discharge from hospital, and this was equally the case in London. At a stage during the pandemic, the guidance changed from PHE, and all patients were required to be swabbed on discharge. The Site Chief Executive agreed that following the meeting, he would provide Members with the date that this guidance had changed.

 

With regards to PPE, the Site Chief Executive confirmed that at no point had the Trust run out of the required PPE to care for different categories of patients, during the pandemic – for example, a standard ward required staff to wear surgical facemasks, whereas on a COVID-19 ward a FFP respirator mark was worn. There had been challenges in terms of the purchasing and provision of PPE, and at the peak of the demand reserve levels of stock had been reduced. However, the Site Chief Executive highlighted that the Trust had a significant level of stock reserve, with 4.5 million facemasks available on site for its 13,000 staff.

 

A Co-opted Member noted that there was still some reluctance to access outpatient appointments and services and asked what was being done to reassure patients that there were precautions in place. The Site Chief Executive agreed that this was a challenge, but as mentioned previously, the majority of services were now available and accessible to patients. However, they were finding that a number of patients were not wishing to shield prior to elective operations, or had difficulty getting the required pre-swab, and less to do with patients having a fear of coming on to the site. The Trust was responding to this by providing an embedded information leaflet with all correspondence to patients, advising of the safety precautions being taken. The number of access points on the hospital sites had been restricted. On arrival, everyone was asked to sanitise their hands, and they were provided with a surgical facemask to wear. The corridors of the hospitals were marked out with two metre distancing, and divided into left and right flow. The number of seats in waiting areas and general footfall had also been reduced substantially, and a range of telephone and video consultation options were available to patients if they were still reluctant to come to the site.

 

The Portfolio Holder for Adult Care and Health thanked the Site Chief Executive and all his staff for their amazing work, on behalf of the residents of Bromley. The Portfolio Holder for Adult Care and Health noted that there had been a requirement for the Local Authority to increase expenditure during the pandemic to ensure residents were supported, and enquired if the Trust felt they had received the support needed from central government; and for an update on the current financial position of the PRUH. The Site Chief Executive stated that at no point had there been any restrictions on the ability to spend money to provide the necessary response to the pandemic. The DHSC had eased financial restrictions to ensure that it was possible to provide the care needed to every patient. However, there were now some challenges with all NHS organisations moved on to a block financial position. Currently there were no concerns regarding the financial position of the PRUH and South Sites, however there was a shortfall of expenditure due to complex accounting. There was no financial hardship being experienced as a result of their response to the pandemic, and no evident financial challenge as they moved into the recovery phase.

 

The Chairman extended her thanks to Jonathan Lofthouse and Debbie Hutchinson for attending the virtual meeting of the Health Scrutiny Sub-Committee and providing full and honest answers in response to the questions from Members. The Chairman asked that the Site Chief Executive relay the thanks of the Sub-Committee to all his staff.

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