Supporting patients who have waited too long

As I promised in my last blog, I will be taking some time over the next few weeks to bring everyone up-to-date about the work we are doing, the plans we are developing, and the progress we are making as we look to the future.

Over the last fortnight we have seen further steps being taken towards a strategy of living alongside COVID-19 as the prime minister announced his ‘living with covid’ plan in Parliament on 21 February. We’ve also seen a raft of policies being published which look to the future including the Levelling up white paper and the Integrated Care white paper.

Locally we continue to turn our attention as a health system, across the region and in the city, to transitioning out of covid ways of working and concentrating on tackling the unintended health consequences of the pandemic. We need to be able to work together at pace to make sure that patients across the North East are able to access care quickly.

Today I want to focus on the challenge of improving waiting times to surgery, diagnostics and other procedures and how we are approaching this.

Two years ago – in March 2020, we were very worried that we had 20 patients who were waiting over 52 weeks for their surgery, and we had good plans in place to ensure that they were seen and treated quickly.

Today after two years of coronavirus, we now have 3829 patients in that position.

We have heard a lot on the news about the scale of the challenge we face, and how overwhelming it is for the NHS. Today I want to encourage us to focus on the solutions we are putting in place so that we can take control and take the right steps to achieve the biggest impact for our patients.

Last time, I wrote about the importance of supporting our people – knowing that everyone has been through so much in the last two years. I’ve been struck by the many team members who have told me how focussed they are on the future, and I’d ask that you read this message alongside the sentiment of the last one.

Our operational activity builds upon the work to support staff, and specifically remembers the need for us to avoid building the recovery in a way which is damaging for staff. I know that the progress we are making in reducing long waiting lists is due to the hard work and incredible flexibility of people across our trust, and it goes without saying that our patients are very grateful.

Our first priority must be with those who have waited 104 weeks or more for their treatment. I didn’t think I would ever see such long waiting again in my NHS career and although the reasons for these delays are understandable, I know they make every one of us uncomfortable.

I want to acknowledge the huge amounts of effort going into supporting these patients, and we have seen great progress from that hard work. We now have 251 patients in this group – most of them needing either complex ophthalmology care, spinal deformity surgery or neurosurgery. We have been asked to make sure that we eliminate all of our 104 week wait patients by July 2022.

While this seems reasonable, and is something that we all want to see, there are real challenges to achieving this milestone.

As an example, you may have seen surgeons Andy Bowey and John Andrews undertaking complex spinal surgery during episode 5 of Geordie Hospital. This showed a four-hour operation which needed two very experienced surgeons and a large support team, and even with that level of expertise it is a highly risky procedure.

It was a real privilege to witness the care and attention given to our patient, Amelia, and it gave a unique view of the complexity of this life-changing procedure. The importance of these operations for our children and adult patients is unmistakable.

Each of the directorates with long waiting patients are looking at each patient individually and doing everything they can to get them listed for surgery, avoiding cancellations and making sure that their procedures take place as planned.

We are also having individual conversations with patients who have chosen not to have procedures at the moment, but who remain on our waiting lists.

Alongside this, all of our clinical directorates are focussing on those who have waited over 78 and 52 weeks – and it’s important to remember that given the length of the covid disruption, more people are reaching these milestones each day.

Our EPOD directorate (ear, nose and throat, plastics, ophthalmology and dermatology) has among the highest throughput of patients with 270,000 contacts in a usual year and this week I asked them how they are tackling the huge numbers of patients that they need to see.

They described a whole team effort involving the clinical teams, operational managers, waiting list teams, the central ’18 week’ team and the ABC team for outpatient appointments. They work closely together on a daily and weekly basis, ensuring that they are making the maximum use of capacity and seeing the right patients, in the right place, first time – minimising delays as much as they can.

Two factors have made a difference for them, firstly they developed a directorate level dashboard which allows them to track and monitor their lists effectively. The other game changer was validating their waiting lists.

This led to up to 30% of general dermatology patients saying that they no longer required the appointment that they were waiting for. There were a few reasons for this and the nature of dermatology conditions for example is that they can sometimes flare up and then improve meaning that an acute episode has passed before the appointment took place.

The team are looking at introducing patient-initiated follow-ups for this group of patients so that they can seek help directly when they need it, without requiring a new referral from primary care.

They found that other patients had already been seen in other pathways and specialties who had managed their condition well. There were a number of patients who felt that they didn’t need to be seen for other reasons.

It was interesting that they piloted an approach of sending texts to a cohort of long waiting patients to see if they still required their appointment, followed up with personalised phone calls, so that they could be absolutely sure that waiting lists were accurate and up-to-date.

This has meant that as much as possible they can maximise the very precious clinical appointments they have and see as many people as possible.

I’m looking forward to visiting both the ophthalmology teams, and the plastics team in the next couple of weeks to see their hard work for themselves, and I know that in every part of the trust we have exceptional levels of similar work underway.

I would strongly encourage everyone to be curious and find out what colleagues are doing so that we can learn from each other and share our best practice. One great way of doing this is through the monthly quality improvement learning and sharing events which always include inspirational examples of real-life improvements, led by clinical and directorate teams. To request joining details, please email nuth.newcastleimprovement@nhs.net

What I’m seeing across the whole trust is a new determination to tackle our waiting lists so that our patients are seen as soon as we possibly can.

To do this we have invested significantly to support clinical services – in a new Day Treatment Centre at the Freeman, in our Westgate Cataract Centre, and in many other directorate level projects. We’re also working closely in partnership with private sector providers and prioritising quality improvement work to use theatres and outpatients most efficiently and effectively. This will all make a difference now and in the long term.

In future blogs I will highlight our emergency care pathways, our cancer services, our corporate teams and our community services to name but a few, but needless to say, I am incredibly proud of the efforts of every one of our teams, across our hospitals, and those working in our communities.

Quality Improvement case study

The vascular team at the Freeman Hospital has transformed care for patients with diabetic foot disease across Northumbria, North Tyneside, Newcastle, and Gateshead, through collaborative working to reduce hospital admissions and amputations in diabetic patients. You can read more about their quality improvement work here.

 

Ukraine

Every one of us will have watched the news and seen the devastating impact of Russia’s invasion of Ukraine.

Within our own community, we know there will be staff, colleagues and friends with links to Ukraine and Russia, as well as Belarus, Lithuania and other bordering nations that are being impacted by this conflict.

We will continue to reach out to anyone affected by the events in Eastern Europe and offer practical and wellbeing support at this worrying time – details of which can be found here.

People are asking what they, as individuals, can do to help at this time of deep crisis and for those wishing to donate, humanitarian aid agencies such as the British Red Cross Ukraine Appeal, CARE International UK, International Rescue Committee, World Vision and Save the Children UK International Children’s Charity are all doing excellent work.

A group of North-East doctors are also currently spearheading efforts to procure vital medical aid from trusts across the North East and North Cumbria by co-founding Ukraine Medical Aid North East (which can be found on Facebook).

By way of support, we’re holding a medical aid amnesty and have asked wards and departments to check their cupboards for products that may have recently expired – or are about to expire and would be discarded – and drop them off at designated collection areas at the RVI and the Freeman.

Director of Finance

Angela Dragone, our director of finance has announced that she will be retiring in July 2022, and I would like to thank Angela for her many years of service.

This week we’ve launched a recruitment campaign to attract her successor –and I will provide further information in due course.

Awards and Achievements

  • The National Institute for Health Research (NIHR) Newcastle Clinical Research Facility (CRF) has received over £5.47m to continue its research into a range of health conditions. The NIHR Newcastle CRF, a partnership between the trust and Newcastle University, is one of 28 in the country to receive funding which will support research into new treatments and early phase clinical trials which test treatments for the first time. You can find out more information here and a huge well done to all involved in the successful funding application.
  • A much-loved midwife from Newcastle, Jennifer McDermott, was posthumously awarded the Chief Midwifery Officer for England’s Gold Medal in February in recognition of her exceptional 55 plus year contribution to her profession.
  • Congratulations to our VAD nursing team who have been shortlisted as ‘Best cardiac team of the year’ in The Society for Cardiothoracic Surgery in Great Britain and Ireland Awards. The winners will be announced in May.
  • Our research teams have been recognised for recruiting to time and target (RTT) in two studies, ‘BronchUK’ and ‘Pharmacokinetic variation and toxicity in Ewing’s sarcoma’.
  • This is a significant achievement and testament to our team’s ability to effectively deliver research opportunities for NHS patients, despite the on-going challenges and additional difficulties that covid has imposed.

Ageing at the heart of Newcastle’s future

A cutting-edge £500m development – led by Newcastle University – which supports the understanding, care and innovation of products and services for an ageing population was given the go-ahead in Newcastle this month on the former General Hospital site. We are delighted to be a partner of this ambitious project and you can find out more here.