Agenda item

The Chairman welcomed Julie Lowe, Site Chief Executive Officer, King’s College Hospital (“Site Chief Executive Officer”) to the meeting to provide an update on the King’s College Hospital NHS Foundation Trust.

The Site Chief Executive Officer introduced Angela Helleur to the Sub-Committee, and advised Members that she would be taking up the role of Site Chief Executive – PRUH and South Sites from 18^th September 2023.

The Site Chief Executive Officer advised that all performance had been significantly affected by industrial action. With regards to elective recovery, the NHS was focussing on reducing the number of the longest waiters. There were no patients at the PRUH, or across the Trust, who had been waiting over 100 weeks – there was a small number of patients around the 78-week mark, but these generally tended to be patients that needed operations undertaken by a specialist consultant/team. The total waiting list continued to grow which was mainly due to industrial action reducing capacity. Diagnostics waiting times had increased slightly and there was a particular issue related to ultrasounds (not maternity), but they were reasonably confident that this could be resolved. Overall they were doing well in terms of elective recovery, but it would take a long time to address.

With regards to cancer diagnostics, the PRUH’s response to the 2-week wait referral had always been around the 90% target – it had dipped significantly but they were starting to recover this position. It was noted that the PRUH had always struggled with the 62-day referral to treatment time, but this was recovering slightly. It was complicated as patients were often treated in multiple hospitals. In response to a question, the Site Chief Executive Officer said that cancer targets were changing, with the attention being on the 28-days to diagnosis target, which the rapid diagnostics centres focussed on. Patients would be moved to other locations if it was the best way to get them seen quicker. There had been an increase in potential cancer referrals across Trust over the last year or so – the reasons for this were not fully known, but it was not just due to delays caused by the pandemic.

The Site Chief Executive Officer informed Members that emergency performance had been less affected by industrial action. Attendance at the PRUH had fluctuated, with a dip in January and February 2023 being an unusual occurrence. It was noted that the national standard was now 76% and reflected the fact that lots of patients were treated in the Emergency Department (ED), receiving same day care and going back home. The PRUH continued to struggle with some longer lengths of stay and long waits for beds. With regards to mental health patients, the average wait times had slightly reduced, but some patients were waiting a very long time in ED (1 in 20 waited more than 2 days) – this was a difficult situation for the patients, their families and other patients in the ED. A Co-opted Member enquired if there was any data available relating to how many people were discharged into community mental health services and how many were referred to secondary care. The Site Chief Executive Officer said that there were patients brought to the ED as mental health patients; patients that self-presented at the Urgent Care Centre; and patients who were admitted with a combination of physical and mental health needs. The vast majority of patients presenting at the ED were in crisis and a number went on to be admitted into the hospital or mental health services. It was agreed that a copy of the South East London Carnall Farrar report could be circulated to Members following the meeting.

Members were advised that in terms of PRUH ambulance handovers performance had improved, particularly on weekdays, but they needed to continue to work to get the flow right. With regards to the impact of the strikes, there had been 29 days in total for the year to date, and more had been announced for junior doctors and consultants. They had been impacted by lost activity on each day – nearly 16,000 outpatient appointments had been cancelled, and the cost to the Trust had been £10.5m. Members were advised that work was underway to convert an outpatient space to house 16 new beds, which would include high dependency beds. This work would be completed by December 2023 and would also allow more flexibility to refurbish other wards when needed.

Work on the PRUH endoscopy unit was proceeding, and they were just waiting on decisions around plans to meet four of the eight planning conditions. Building work was anticipated to be completed by quarter 4 of 2024/25. In response to a question, the Site Chief Executive Officer said she would be happy to provide Members with a timeline of what was happening during the build. With regards to rumours concerning the weight that the new car deck could hold, the Site Chief Executive Officer said that these were unfounded, and it met the current planning standards. They were unsure where these rumours had come from but if any further information could be provided by Members she would be happy to look into this.

The Site Chief Executive Officer informed Members that Epic would go live on 5^th October 2023. This was a new electronic health record (EHR) system, which would provide more functionality and included MyChart, with optional patient portal access. In response to questions regarding MyChart, the Site Chief Executive Officer said that they did not expect every patient to use the system from 5^th October. It was slightly different to the NHS app as it enabled patients already in the system to communicate with hospital staff. Patients would be able to log in and see detailed information and the system may be used intensively whilst receiving ongoing treatment. Family members could also be given access with appropriate consent. With regards to concerns that patients may see their diagnosis before speaking with a consultant, the Site Chief Executive Officer advised that patient reps were on a number of the working groups, and conversations would be held before a patient signed up to use the system. It was noted that patient letters were already copied to them, and this had not caused an issue, but colleagues would need to be responsive to patients’ questions. It was noted that there was no maximum age limit for using MyChart – a lot of older people in other areas had nominated their son or daughter to access it on their behalf. In terms of the minimum age, this would be based on an assessment, and access would not be given automatically. If it was for a teenager they may have access alongside their parents, and for much younger children it would just be the parents that were given access.

The Site Chief Executive Officer advised that external agencies would continue to have access to a patient’s summary care records, which contained information similar to that on the NHS app. MyChart was intended to be used by patients, rather than by professionals. Information was automatically downloaded into GP records – GPs having full access to all hospital records was not something that had been used in the UK Epic roll outs, but she understood that it had been used in the United States. The Site Chief Executive Officer confirmed that the information would be available in real time. Clinicians could use a pre-filled template in clinic and free text boxes and once authorised, it would go straight to the GP. A voice recognition system could also be used.

The Chairman thanked the Site Chief Executive Officer for her update. Members requested that an update in relation to postpartum haemorrhage be included in the King's College Hospital NHS Foundation Trust presentation at the next meeting.

RESOLVED that the update be noted.