Agenda item

To follow

RESOLVED:

·         that the report be noted along with the request for further information on the waiting times in the hospital’s emergency department as well as other services such as ENT.

Miranda Jenkins (Chief Operating Officer, Lewisham and Greenwich NHS Trust) and Dr Neil Goulbourne (Chief Strategy, Partnerships & Transformation Officer, Lewisham and Greenwich NHS Trust) presented the update. The following key points were noted:

3.1. Officers presented some important statistics related to the performance of University Lewisham Hospital (UHL). In 2023/24, the hospital had 317,330 outpatient appointments and saw 350 to 450 patients in the emergency department per day.

3.2. Officers were currently working towards the launch of a patient portal. This portal would improve people’s access to their appointments and patient records as well as streamline communication. The patient portal project was currently in the programme delivery phase and had two main components-

·         The Doctor-Doctor portal- this would facilitate the exchange of patient letters and patient appointment details between doctors. This would also allow patients to cancel appointments electronically. Officers hoped that in the long-run this would enable patients to choose appointments electronically as well.

·         Patient Knows Best- this tool would empower patients to access their own medical records independently and grant access to specific caregivers as needed.

3.3. The hospital was reviewing its patient experience approach to explore how they could capture and use patient experience data more systematically and also to develop a programme of work around bedside care. This work was being led by the Chief Nurse and the governance team.

3.4. The front door at UHL was being redesigned and it was noted that construction on this would start later this year. Redesigning of the front door would also lead to the creation of a separate urgent treatment centre.

3.5. The hospital faced significant challenges with extended waiting times and the current focus was on reducing these long waits. These long waiting times were particularly pronounced for ENT services because the demand for ENT services exceeded the system’s capacity. The closure of ENT services at the Princess Royal University Hospital in Bromley 18 months ago had further strained resources, necessitating additional workload redistribution to UHL as well as to Guy’s and St Thomas’ NHS Trust (GSTT). While long-term plans for ENT care models were under collaborative development, immediate efforts focused on expanding operational capacity, recruiting new consultants and redesigning service delivery. Work was underway to establish a new community-based ENT service for South-East London, slated to commence operations in June 2024.

3.6. UHL’s emergency department’s performance was hovering between 65% to 70%. This was below the annual target of 76%. Officers reported that daily meetings were being held to improve performance.

3.7. UHL had received very positive feedback from CQC (Care Quality Commission) on their maternity services. CQC’s report on its inspection of maternity services and care provided at UHL and Queen Elizabeth Hospital (Woolwich), reported that both sites had maintained good ratings overall with UHL improving to an outstanding rating in the well-led domain.

3.8. Officers reported that some funding had been made available through NHS England to improve the acute access for sickle cell patients on the UHL site. This funding would be utilised to develop a hyperacute sickle cell unit so that patients in sickle cell crisis don’t have to go through the emergency department.

3.9. Lewisham and Greenwich NHS Trust was assessing the financial implications of maintaining its commitment to the London Living Wage for the upcoming year, given significant funding pressures and an anticipated overall financial deficit. Nevertheless, despite these challenges the Trust remained steadfast in its commitment and was determined to find ways of managing the situation.

3.10. Construction commenced in March 2024 for two new theatres on the UHL site, aimed at enhancing the acute care capacity across South-East London.

3.11. Officers acknowledged the challenges with the current infrastructure of the Ladywell Unit and the need to improve the facility. South London and Maudsley NHS Trust (SLaM) was currently exploring community-based models for mental health care provision, aiming to reduce reliance on facilities like the Ladywell Unit.

The Committee members were invited to ask questions. The following key points were noted:

3.12. The discussion highlighted the positive impact of the patient portal’s development but acknowledged that not everyone had access to smartphones due to various reasons including age, digital literacy, and financial constraints. A Committee member raised concerns about ensuring equitable access to information for those without technology. Mention was made of the Lewisham Healthwatch report on digital exclusion, indicating the team’s existing focus on this issue. The Doctor-Doctor portal was accessible via text message and email, accommodating users without smartphones. Prioritising patients capable of utilising technology was underscored to streamline services for those who couldn’t. Therefore, efforts were being made to transition to electronic communication where feasible. Additionally, officers briefed the Committee on an Inequalities and Population Health Management programme aimed at addressing healthcare disparities and devising strategies to mitigate them.

3.13. The team, with whom the Trust was collaborating to deliver the patient portal components- Doctor-Doctor and Patient Knows Best- had deployed these tools nationwide, thus exhibiting adeptness in addressing language access challenges.

3.14. A Committee member enquired about the frequency of patient safety discussions and the corresponding measures taken. It was reported that patient safety was addressed in daily 2-hour huddles within emergency department, however, issues could also be escalated outside of those sessions. Additionally, several meetings were held throughout the day with senior officers to discuss emergency department operations.

3.15. A significant focus area was reducing prolonged length of stay throughout the Trust, which contributed to congestion in the emergency department. Although there were no patients in corridors on wards, the Hospital experienced double boarding and extra patients occupying ward spaces where beds would not typically be. This situation had persisted through winter, but the Trust was actively striving to rectify it.

3.16. A Committee member asked about the average waiting time for patients in the A&E. Currently, performance stood at about 68%, indicating that 68% of individuals visiting A&E were seen within 4 hours. Triage efforts aimed to direct individuals to the appropriate queue. Ongoing efforts were being made to enhance this process, with a system-wide initiative involving the Lewisham UEC Board.

3.17. It was noted that GSTT’s MyChart and Swiftqueue patient platforms had proven to be highly effective. However, upon their initial implementation, there were some issues, such as patients accessing biopsy results before clinicians. It was suggested that the Lewisham and Greenwich NHS Trust team should learn from these mistakes. Officers recognised that it was imperative to ensure patients accessing their records did not encounter unfamiliar results. The Trust was not deploying MyChart as it didn’t have the same EPR (Electronic Patient Record) system as GSTT but it eventually aimed to integrate into the same system for optimal patient care. However, financial constraints and the need for a fair procurement process were important factors to consider in choosing the right system.

3.18. A Committee member emphasised the importance of including numbers and data from the previous year alongside the statistics for 2023-24 in the presentation, stating that it would aid the Committee in identifying trends or activity pattern.

3.19. During discussions, it was suggested that the Committee would appreciate additional data on patient experience at a later data, potentially at the next update from UHL. Officers agreed to incorporate this into their future presentation.

3.20. An enquiry was made regarding the impact of changes made by Lewisham Council to their care offering, particularly focusing on the enablement service. The query aimed to ascertain if these changes were facilitating smoother discharges, especially for those needing care upon returning home.

3.21. The Committee requested further information on the waiting times in the hospital’s emergency department as well as other services such as ENT.

3.22. It was acknowledged that it was important to retain internationally trained nurses, and that they were supported in the Trust by dedicated resources. Detailed numbers of internationally trained nurses would be provided by officers post-meeting.

3.23. The junior doctor strike was noted to be affecting A&E waiting times and patient appointments, necessitating consultants to handle additional workload. The Cabinet Member for Health and Adult Social Care enquired about the recovery plan, particularly concerning lost appointments for cancer care. Officers reported that efforts were made to minimise cancellations, especially for cancer patients, and to mitigate waits. However, the impact was more significant on routine appointments, with some areas managing to increase capacity while others experiencing longer wait times.

3.24. The Committee expressed that the replacement/ rebuilding of the Ladywell Unit was a high priority for Lewisham Council. It was important that the Ladywell Unit remain on Lewisham Hospital site to maintain the integration of physical and mental health services on the same site. The Committee was pleased with Lewisham being chosen as the pilot site for SLaM’s community mental health model but emphasised that even with that model, the need for secure beds would remain.

RESOLVED:

·         that the report be noted along with the request for further information on the waiting times in the hospital’s emergency department as well as other services such as ENT.