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

Could have been worse

The picture for London in the quarter two performance release could have been bleaker.

Although only one acute trust – Chelsea & Westminster Hospital Foundation Trust – had hit the 95 per cent accident and emergency target, another couple were just below the threshold.

Homerton University Hospital Foundation Trust – a perennial high performer on this measure – just missed a green rating, while Epsom and St Helier University Hospitals Trust also came very close.

The continued achievement at Chelwest and the Homerton are notable for different reasons. The Homerton serves a deprived area and has maintained its performance over an eight year period where other providers have struggled.

Chelwest is rare in the small number of hospital trusts achieving the 95 per cent target in that it is running two A&Es.

Normally trusts with two A&E hospitals, which they can’t centralise, and thus can’t staff properly, suffer poor numbers and outcomes.

While Chelwest always performed strongly under Heather Lawrence earlier this decade, the same could not be said of West Middlesex University Hospital Trust, which it acquired in 2015.

Keeping performance above 95 per cent is a significant achievement for a multisite trust.

Which makes Epsom & St Helier University Hospitals Trust’s score of 94.92 per cent for quarter two similarly impressive. Like West Middlesex, this was a trust usually found nearer the bottom of performance league tables at the other end of this decade.

In spite of receiving ministerial approval to do so, Barking, Havering and Redbridge University Hospitals Trust could never really make a case to close one of its A&E units because performance was usually so poor there.

Perhaps consistently hitting the target in south west London/Surrey will allow the Epsom & St Helier team to make the case for reconfiguration a little more easily.

And, although scores in the low to middle 80s are nothing to crow about, the worst performers in London on these measures have at least moved out of the 50s and 60s range.

Hillingdon Hospitals Foundation Trust has recently been the worst performing trust in the country on A&E, with performance threatening to go below 50 per cent on the more challenging type-one target. North Middlesex University Hospital Trust, which had a well-publicised care disaster in A&E, also recovered to 86 per cent.

Embarrassingly, performance at North Mid beat that at University College London Hospitals Foundation Trust – something systems leaders find perplexing.

The worst performing trust in London for A&E in quarter two was King’s College Hospital Foundation Trust, which also runs two A&Es.

It is also the largest net contributor to the national 52-week-plus elective waiter total and a financial blackhole.

Of course, quarter two includes the milder months of the year – July to September – and the Q3 figures are likely to be far starker, and on Tuesday the capital saw the first mass cancellation of elective work at a trust in the face of bed pressures.

The Royal Free declared an internal incident and cancelled non-cancer operations as it worked to free-up space.

Whoever takes up the regional director role for London in the next few weeks may well find a similar picture across the capital.