Agenda item

The Committee received a presentation from Simon Knight, Director of Planning and Performance, and Liz O’Hara, Director of Workforce, UCLH NHS Foundation Trust, on performance against key targets. The Committee had also requested an update on staff morale, which would also be covered in the presentation.

On the quality of care provided:

·       Infections – all hospitals were required to monitor infections carefully. Numbers of MRSA cases had been kept low for the past few years. UCLH had more cases of clostridium difficile than other hospitals and it was thought that this was principally driven by the fact that UCLH looked after a number of cancer patients.  However, these numbers remained below the target set for UCLH, which was somewhat reassuring.

·       A good indicator of nursing care was the low number of patients with pressure ulcers, with numbers remaining no higher than seven or eight each month. As a result of following best practice, UCLH was proud of the low number  of these cases.

·       Another good indicator of the quality of care was demonstrated by the comments by patients about services. UCLH compared well to other London Trusts in this respect and appeared top in a table of comparison with peers.

·       On the matter of the amount of time patients waited for care, there had been approximately 30,000 patients awaiting treatment in 2010, with the figure rising to 70,000 by 2023.  This trend was similar across the country during that timeframe.  However, numbers had increased significantly for UCLH in 2019 when a new electronic health system was taken on and which had proved a difficult time for the Hospital, attempting to keep on top of the figures and to work out what was happening in the system.  This had also coincided with the Covid pandemic.  One of the challenges now was for the Hospital to address the very long waits some patients were experiencing. UCLH was now focusing on patients waiting the longest for treatment

·       UCLH was tracked around the longest waits.  A couple of years ago, the aim was to ensure that no patient was waiting more than two years, but the focus was now on getting the numbers down to 78 weeks, or a year and a half and 65 weeks, which was 15 months. UCLH had attained the 78 week target by March of last year, although there had been particular spikes in dermatology services, affecting cancer care especially.  However, this had now improved.

·       On the number of patients waiting for over a year for treatment, current guidance was that no patient should be waiting longer than a year for treatment by the end of March 2025.  It was anticipated that this would be a very hard target for UCLH to meet, so time was being spent predicting which specialties were likely to face the most challenge, through mathematical modelling and looking at referral rates and opportunities for maximising outpatient space.

·       There had also been a significant reduction in the number of patients seen in time for diagnostic checks, which were meant to happen within six weeks of a referral.  The numbers had been affected due to the issues associated with the introduction of the health records system and the Covid19 pandemic, The new standard was that 95% of patients should be seen within six weeks of a referral for a test and UCLH was currently at about 90%. Further improvements were being made to the MRI, which would hopefully assist the Hospital in moving closer to the 95% target in the next couple of months.  UCLH performed well on endoscopy.

·       Cancer care – UCLH performance had recovered faster, following the pandemic. The target for patients being given a diagnosis from time of referral was 28 days and UCLH had achieved this consistently for the last year and a half, together with the target of patients being treated within 31 days of a decision to treat them.  The target of 96% was largely met, apart from a tail off in the past couple of months in the urology service.

·       On the 62-day service target for cancer patients, from referral time to treatment for patients, performance had tailed off in the past year. Diagnosis and treatment were performed well at UCLH, but there were challenges with pathways from other Hospitals, where referrals were sometimes late. UCLH managed to turn around treatment quite swiftly, but not enough to achieve the standard. This was a challenge to the sector as a whole, to try and make those pathways much clearer, along with the accountability for that pathway much clearer. There was room for improvement on this issue.

·       A & E – where the main target was for patients to be seen and discharged within four hours, performance had tailed off in the past year or two, which could be attributed to lack of bed capacity.  There were also numbers of people attending A&E who could perhaps be seen elsewhere, though UCLH worked well within the sector to ensure that patients went to alternative services.

·       On safe care in A&E and the target of ensuring that patients did not wait longer than twelve hours, considered a clinical risk, UCLH had performed well against its London peers until the last quarter.

·       Ambulance handover times – the target for which was to make sure that ambulances dropped off patients safely at the Hospital,                                                                            and then moved on to look after the next patient, UCLH had performed well, close to the 95% target and ambulance handovers at the Hospital taking no longer than half an hour.

·       Delayed transfers of care – the position had been improving over the past two or three quarters. UCLH enjoyed good relationships with Council colleagues and those providing services. Due to this, the position felt generally positive and because of the support from partners, UCLH had a relatively low number of patients waiting in Hospital who did not need to be there.

·       UCLH’s ability to meet all of its targets had been significantly affected by the number of strikes within the Hospital and across the NHS. Patients who needed to stay overnight in Hospital (elective care) were most affected. Fortunately, highest risk patients, including those with cancer, were being managed well, with any cancellations swiftly rebooked. However, the action had had an affect on those patients who had waited longest, as those patients were usually not in as serious a condition and could afford to wait longer for treatment.

·       Health, Wellbeing and Morale

First and foremost, UCLH recognised that good patient care required staff being looked after and health and wellbeing were consequently at the centre as key strategic priorities. The Hospital was fortunate in having a charity which helped to enable some of the issues which mattered most to staff.

·       A number of issues had impacted the drive on health, wellbeing and morale within the organisation, including the Covid pandemic. It was recognised that staff needed ongoing support for this.

·       Many lower paid staff were affected by the cost of living crisis and much had been done by UCHL as an employer eg providing advice and directing staff to services. Hardship funds had also been set up.  On industrial action, UCLH was an open organisation and time and effort had been put into communication with staff. Formal and informal mechanisms of communication with staff had been established. Hospital management enjoyed good relationships with trade unions which had helped with continuing work which needed to take place, with staff feeling valued and respected through these difficult times.

·       Health and Wellbeing indicators

To enable UCLH to measure and have a grip on what was happening with regard to staff morale, one of the biggest indicators was the annual staff survey, which helped to measure staff morale against peers and nationally. UCLH tended to be above the national average in terms of how staff felt about working at UCLH. Particular attention was paid to staff sickness, managing vacancy rates and staff turnover.  UCLH had noticed good signals with regard to vacancy rates and staff turnover.  There were also quarterly staff surveys, alongside a range of other informal ways of ensuring that the situation was being monitored.  Regular fortnightly briefings with the Chief Executive were held, which staff could attend remotely and pose questions, whilst remaining anonymous, allowing staff to say exactly what they thought. UCLH tried to be aware of what was important to their staff and to ensure that subject experts were available to address any points raised by staff. 

Some of the things which UCLH was proud of and had received good feedback directly from staff, all assisted by the Charity, were the launch of a long term programme which the Chief Executive started called “Be Well”. This was a range of ways to support staff, including basic hygiene factors, such as accessing hot food on an evening shift, discounted food and access to advice services, all based on what staff had asked for.  There was also a spa, based on volunteer masseuses, all to make the working space better.  All received good feedback from staff.

UCLH also recognised that staff needed to be able to let them know when things were not going well. Staff could raise issues through the “Freedom to speak up Guardian Service”, which was external to UCLH, with staff knowing that any concern raised through that Service would be acted upon. Mediation services were also available to help to address any conflict in the work place.

UCLH was particularly proud of its staff briefings and revamped staff network, which all helped to keep UCLH focused on diversity, equality and inclusion issues.  In addition, there were a number of local champions who were passionate about Health and Wellbeing and could deliver messages about the services available. A staff psychological service and occupational health service were available to support day to day activity that people might need access to as part of their working lives at the Hospital.  There were also reward and discount platforms for all staff, including bank staff, and salary sacrifice schemes. This year, UCLH was working to support working parents and carers at the Hospital, with a Strategy being launched this year. It was considered that one of the biggest things that could be done, and often the least expensive, was how staff in the NHS were thanked. How staff were rewarded was really important, and this was supported through the Charity, by long service awards and recognising the valuable work done by staff over a number of years. Recognition awards were held annually and staff enjoyed attending, with staff feeling valued and respected.

Questions/responses were supplied as follows:

Confirmation was given that the data supplied included children.

On the 31-day cancer wait to first treatment, did the wait include people waiting for radiotherapy and was that considered primary treatment? Was it considered that disproportionately affected the figures as there was often a slightly longer wait for radiotherapy than for chemo?  It was not considered that the figures were disproportionately affected and figures has turned around in the past six months.

Regarding the12- hour trolley wait in A&E at UCLH and comparing the experience of a relative in another A&E department at another hospital, the relative was told that they had to be moved to a bed, as the wait approached 12 hours, and a bed was brought down to A&E so that person was no longer on a trolley. It was confirmed that this was not the practice at UCLH, meaning the patient was actually in a hospital bed, or had gone home.

The work of UCLH with regard to its staff wellbeing was impressive and much of that work could be usefully shared with others. These were incredibly difficult times for the NHS and the days lost through industrial action were tragic. Agency staff had to be employed to cover staff on strike, which was an extra cost, and how could this be managed financially?  UCLH were congratulated on their work for staff and, although staff morale was noted to be above average compared to other hospitals, it was still relatively low at 5.9%.   A response was given that some central funding was provided for the impact of industrial action. Legislation had changed as to how the funding was used. It was UCLH’s own staff who were used in different ways during the strike days, to support their colleagues to undertake their right to strike, while essential care services were still being provided.

One of the councillors commented that she had been offered a massage while in the staff canteen, proving that those services were being offered to staff!

The Chair thanked Simon Knight and Liz O’Hara for attending and for their presentation. The Committee was pleased to hear about all of the good work being carried out at UCLH.