PERFORMANCE: Barking, Havering and Redbridge University Hospitals Trust recorded the worst performance in London for A&E based on the latest figures and minutes of the January meeting.

The documents identified delayed transfers of care (DTOCs) and “capacity issues” among the problems.

Since then chief operating officer Mark Ogden-Meade has left the trust, less than six months after joining in October.

The minutes submitted to the latest board showed “the highest number of reported DTOCs in November for over two years, with the average monthly figure exceeding over 70 patients (in excess of two wards), although some additional capacity had been put in place”.

“Mr Ogden-Meade reported that the trust had achieved an overall figure [for A&E four-hour wait] of 84.25 per cent in November, with King George performing at 91.11 per cent and Queen’s at 80.81 per cent,” a board report said.

“Two key areas were responsible for the disappointing performance; poor flow and the lack of permanent emergency department medical staff.

“He also reported that December’s performance had been slightly worse and signalled that the trust had been under extreme pressure during the last few weeks. A recovery plan was in place and the board had already discussed various actions and challenges that the plan had aimed to resolve.

“Focus was now on the number of patient delays in the system. Two snapshot audits had been undertaken on all patients in the trust to understand the impact of delays where patients were medically fit to leave, but their discharges were being delayed. The audits had demonstrated that there were approximately 200 patients in this category.”

The report also blamed bed capacity at the trust, following a “mapping exercise”.

“In overall terms with the length of stay the trust operated at the moment and the bed occupancy at any given point in time, the trust would always be 60-200 beds short of the number required to sustain 95 per cent performance, so there was a fundamental capacity issue,” it said.

The report added: “The chief executive had written to all the directors of social services inviting them to a meeting later this month to discuss DTOCs. The trust had addressed the delays in the internal systems, although it still had issues with medical reviews, and it was now important to agree processes with external partners to improve the rate of discharges.

“Some of the onerous paperwork undertaken by nurses, e.g. Section 2’s and 5’s needed to be moved away from nursing staff.”