Essential insight into England’s biggest health economy, by Ben Clover

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London and A&E

I’ve written before about London’s A&E performance relative to the rest of the country (it’s worse, apart from south west London).

That analysis was based on data for the first quarter of 2016-17. July is the first month where trust performance can be checked against the (usually relaxed) performance targets set for trusts in the “reset”.

Nationally the picture was grim: the 95 per cent target was missed for the first July ever. Less than a third of trusts even managed to hit their reset targets.

But some big London trusts did hit the July targets, including Barts and Imperial, which have quite a large impact on national performance.

It is significant also that North Middlesex University Hospital and Barking hit the reset targets, although it is worth bearing in mind how low these were (86 per cent for North Mid, 84 per cent for Barking).

The Homerton, and Chelsea and Westminster hospitals deserve special recognition for being two of only 16 trusts in the country to achieve the 95 per cent target – you know, the way everyone did three years ago.

But it was also heartening to see most of south west London’s trusts miss 95 per cent only very narrowly.

On Tuesday the King’s Fund hosted a conference on A&E performance that highlighted some interesting differences across the capital.

Dr Katherine Henderson, clinical lead for emergency medicine at St Thomas’ Hospital, spoke and noted that even with an “outstanding” rating from the Care Quality Commission and an understanding chief executive, the pressure was unrelenting.

In common with many departments, Dr Henderson said her trust’s analysis was that outflow from the department was what sends breaches soaring.

She was also clear that hers was a trust which “doesn’t do ambulance queueing” – something that is a big problem in other parts of the capital – and “we don’t do 12-hour breaches”.

Again, Dr Henderson cited support from the chief executive in making resources available and allowing planned care to be disrupted if necessary.

Guy’s and St Thomas’ runs the community services in its two main boroughs, Lambeth and Southwark, so has a greater measure of control there than some trusts. The foundation trust also runs the urgent care centre there.

The consultant told delegates that since she had been in charge three patients had waited more than 12 hours after a decision to admit was made. She said they had all had a mental health dimension – “a shameful thing for our mental health system”, rather than GSTT.

King’s College Hospital FT had six 12-hour breaches in July, Imperial College Healthcare Trust had two and Barking, North Middlesex and the Whittington had one each.

London Eye is told that ambulance attendance at north west London trusts is up by a quarter year-on-year. Does anyone know why this might be?

Reputational damage

Some of London’s better regarded mental health trusts have seen reputational damage from CQC inspections this month.

Oxleas FT was given a “requires improvement” rating from the inspectors earlier this month, while a report released this week gave the same score to North East London FT.

The Essex-facing trust had been forced to close the Brookside inpatient unit for children and young people in April after a CQC inspection found it to be dangerously understaffed. The CQC had issued the trust with a warning notice about the unit.

Minutes of NELFT’s July board meeting say there has been an increase in staff turnover at the trust (15.6 per cent against a 10 per cent target on most recent figures) but a reduction in staff sickness.

Vacancies are still above 20 per cent against a target of 10 per cent.

The trust was also taken to task on a failure to assure itself about the removal of ligature points.

(I’ve been covering health issues for a while and ligature points seem to be a predictable issue that fails to go away. I understand that the mental health estate is often worse than the acute sector but that can’t explain all of it. If someone wants to enlighten me, anonymously is fine,

London Eye features a look at what’s going on in England’s biggest health economy. London has the best and worst regarded hospital trusts in the country. It has excellence and dysfunction in commissioning and primary care. I will cover all of this.

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