Agenda item

The Chairman welcomed Angela Helleur, Site Chief Executive – PRUH to the meeting to provide an update on the King’s College Hospital NHS Foundation Trust.

The Site Chief Executive informed Members that, with regards to emergency care performance, there had been an improvement in relation to ambulance handover delays, which had been highlighted in the update from the LAS. It was noted that the PRUH was a relatively small department and there could be challenges in offloading patients. Patients were often offloaded into the corridor, which could have a negative impact on their experience, but it did allow vehicles to get back out on the road to attend those waiting for an ambulance.

The Site Chief Executive informed Members that the 4-hour wait target for A&E had previously been 95%, however the national target was now 76%. In December 2023, the PRUH was at 61.33% but they aimed to get as close to the target of 76% as possible by the end of March 2024. It was noted that January 2024 had been particularly challenging – in addition to the usual winter pressure there had been nine days of junior doctor strikes. There had been a fantastic response from teams and no patient safety issues had arisen as a result of the strikes.

With regards to elective care, Members were advised that the target for referral to treatment was 18 weeks, however this was no longer being achieved. Across the NHS, waits of up to 104 weeks were being monitored. The Trust had generally been very good at managing waiting lists and only two patients had been waiting over 104 weeks for treatment – both were on non-emergency pathways and had been provided with appointment dates. It was noted that prioritisation was based on clinical need. The Site Chief Executive informed Members that the Trust’s waiting list had grown significantly to around 109,000 patients. On cancer, the  PRUH currently stood at 55%, against a 75% standard, for the cancer target of 28 days for the  faster diagnostic standard. There was also a 31-day standard for diagnosis to first treatment – the Trust currently stood at 78% against the target of 96%: there were action plans in place to address. The Site Chief Executive noted that the implementation of Epic, an electronic patient record system, had impacted the Trust’s performance. This related to their ability to report, as well as it taking longer for clinicians to use the newly implemented system. There had been a bigger drop off in October 2023, however a month on month improvement was being seen – a comprehensive recovery plan was in place, and they planned to be back on track by the end of April 2024. In response to questions, the Site Chief Executive said that the Trust was doing well in terms of vacancies – vacant roles across the whole Trust stood at around 8%, compared to 15% a year ago. In terms of additional capacity, if there was not a clinician in post it could be covered by bank/agency staff where appropriate. The focus was on reducing the backlog of elective activity, which was halted during the pandemic, and a recovery plan was in place.

A Member noted that there were pressures on ophthalmology services and asked about the retention of glaucoma specialists. The Site Chief Executive said she would look into this and provide information following the meeting.

With regards to the Apollo programme (Epic and MyChart), the Site Chief Executive advised that progress was being made month on month, and the problems experienced by patients, GPs and staff were generally reducing. Over 85% of frontline staff had been trained and over 150,000 patients were using the MyChart function within the app. A Member asked what this represented as a percentage of eligible patients. The Site Chief Executive said this information could be provided following the meeting.

In response to questions, the Site Chief Executive said that ongoing training was being provided. Masterclasses for staff would also be introduced for those that wanted to take their use of the system further. The view and usage of the system could be personalised, which helped with productivity. It was noted that they had a detailed breakdown of where the system was, and was not, being used, and could provide support to individual clinicians. In terms of continued use, the Site Chief Executive said that the legacy systems had now been switched off and therefore the numbers using Epic were increasing month on month.

In response to questions regarding MyChart, the Site Chief said they recognised that not everybody had access to the technology or ability to get online, and the usual systems for getting results remained in place. For those that wanted to access MyChart, staff were able to provide help and show them how to use it when they attended clinics. It was noted that they were in the process of producing an easy guide on how to use the system. It was understood that the guide would be created in paper form and translated into various languages – an update could be provided at the next meeting. The Operations Co-ordinator, Healthwatch Bromley said they would be happy to help support the distribution of the guide.

The Site Chief Executive advised Members that the new ward would be in use from the first week of March 2024. Work on the endoscopy unit build was ongoing, and was expected to be complete by March 2025 – this was a South East London resource which would increase capacity for screening and diagnostics. It was noted that the new MRI and mortuary at the PRUH were both open. In response to a question regarding the cost increase of the endoscopy unit, the Site Chief Executive said that the project had been a few years in the making and construction costs had increased following the pandemic. Initially no tenders had been received, and when it went out again the bids received had been higher than expected.

The Site Chief Executive advised Members that the Trust’s financial position was challenging, and a financial recovery plan was being worked through with oversight from NHS England. In response to questions, the Site Chief Executive emphasised that patient care was paramount, and any cost reductions would be risk assessed. The Trust would be looking at what efficiencies could be made through productivity approaches. It was noted that once the Epic system was fully rolled out it would provide some significant productivity benefits, and “root and branch” reviews of services would be undertaken. The Site Chief Executive advised that a number of NHS Trusts had an underlying deficit position. The ‘control total’ was agreed upfront with the regulators on an annual basis. There was now an approach in place to manage finances across the system. The Trust was reporting a £52.4 million deficit at the end of November 2023. The measures to reduce costs included avoiding any unnecessary spend on bank/agency staff – this was reviewed on an hourly basis with patient safety in mind. Other measures included buying in products in bulk and looking at income in terms of maximising efficiencies in elective services.

In response to a further question, the Site Chief Executive advised that there had been a Joint Chairman role at Guy's and St Thomas' and King's College Hospital NHS Foundation Trusts. As both organisations faced significant challenges it had been decided that each trust needed a separate Chairman, and the stepping down from the role of Chairman of King's had been related to capacity. The Trust was working with NHS England on its financial position and working on efficiencies to “get back on track”. It was emphasised that the future of King’s, and the PRUH, were not at risk.

The Chairman thanked the Site Chief Executive for the update to the Sub-Committee.

RESOLVED that the update be noted.