Managing the pandemic

In the fifteen months since the pandemic first reached the UK, the Barts Health group of hospitals has successfully treated and discharged 15,000 Covid-19 patients.

This latest milestone was recorded on July 1 as London’s biggest NHS trust set out its plans to restore as much routine surgery and regular outpatient care as possible over the next few months while preparing for the prospect of a third wave.

The four acute hospitals in the group are already running as many planned operations and outpatient appointments as last autumn before the second wave hit and aim to reach 90% of pre-pandemic activity by September.

This is already making inroads into the backlog of long waits that built up as elective work was suspended so that staff could focus on Covid patients.

More than 90,000 patients on the waiting list are being prioritised according to clinical need and the length of time they have waited and we have already reduced the numbers forced to wait over 12 months by one third in three months. 

In addition, over 55,000 doses of the Pfizer vaccine have been successfully delivered to health and care workers at Barts Health.

The temporary vaccination hubs were set up at Whipps Cross Hospital, The Royal London Hospital, St Bartholomew’s Hospital and Newham Hospital respectively.

The temporary vaccination centre, the NHS Covid-19 vaccination centre, Newham – based at the ExCeL London has delivered over 130,000 doses of the vaccine to staff and members of the public alike in just six months.

This number included 10,000 doses through outreach clinics in the community, with mosques, synagogues, churches and temples stepping up to provide clinics for people to get their vaccine and assuage concerns from the religious communities they serve.

The achievements and ambitions of the group’s 17,000 staff are set out in Looking ahead - Our plans for the next year [pdf] 5MB.

Our plan reflects on what Barts Health has achieved in one of the most difficult years for the Trust and the NHS since it began and sets out our objectives for the year ahead.

Dame Alwen Williams DBE, Group Chief Executive at Barts Health NHS Trust said: “The challenges of Covid brought out the very best in team Barts Health. Together we responded magnificently in the face of adversity and brought our vision and WeCare values to life in ways we never imagined. Our staff remain our greatest asset and their well-being is at the heart of our plans for the future. We are determined to build on the scale and pace of transformational change we have achieved so far and this plan sets out how we will do exactly that.”

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Managing the pandemic

This winter our hospitals treated more than double the number of Covid-19 patients than we did during the first wave.

A Winter Like No Other [pdf] 10MB sets out the inspiring story of how our staff rose to the challenge posed by the second wave, and is also the tale of how our diverse east London communities continue to be disproportionately affected by Covid-19. Understanding this impact, and using the insight we obtain, will be key part of our planning for the next phase.

Like its predecessors, this brochure is dedicated to the memory of those members of the Barts Health family who lost their lives from the coronavirus.

Yet we hope it also serves as a fitting tribute to the care, compassion and kindness shown by our staff and supporters, who have safely treated almost 13,000 people for Covid-19, the overwhelming majority of whom recovered. 

Our task now is to balance maintaining our Covid-19, emergency and vaccination services; introducing a breathing space for staff to rest and recuperate; and planning a phased restoration of those services put on hold. With hope for the future inspired by our experience of the last few months, we move forward in the spirit of our ongoing #WeBelong campaign to become a truly inclusive healthcare organisation.

• We have marked another significant milestone in our recovery to a new pattern of hospital business as usual.
• Cancer operations are restarting as theatre capacity comes back on stream.

This week marks another significant milestone in our recovery to a new pattern of hospital business as usual with the return in-house of cancer surgery that was taken off-site earlier in the pandemic.

Operations for gynaecological cancers are restarting first, followed by procedures for liver and pancreatic cancers, then brain and colorectal cancers too as theatre capacity comes back on stream.

We are proud to have continued to provide urgent cancer treatment throughout the first phase of the pandemic, including chemotherapy, radiotherapy and interventional radiology.

In particular, as part of London-wide arrangements to ensure the highest risk patients were treated, St Bartholomew’s continued to perform thoracic, breast, lung and eye surgery. 

However as a temporary measure, many other operations (including all elective surgery) were performed in private hospitals. This was paid for by the NHS and used our own doctors and anaesthetists as part of a national agreement with the independent sector. Over 300 of our patients were treated this way last week, taking the total to more than 2,000 since the start of the pandemic.

Restarting the postponed elective operations in-house is more complex than it was to put them on hold, and is being done in stages as our hospitals make progress with setting up Covid-free (‘green’) zones.

Patients awaiting surgery are prioritised according to how soon clinically they need it. The first elective restarts at Whipps Cross were on 8 June, with over 50 day cases done since. The first inpatient was admitted on Monday and by next week the hospital will be averaging a dozen operations a day. The Royal London’s new ‘green’ theatres on the 3^rd floor also opened on Monday, with 88 patients booked this week.

The Barts Health Orthopaedic Centre at Newham restarted at the same time and over 80 patients had endoscopies or minor procedures. Meanwhile St Bartholomew’s is doing about 30 cardiac cases a week, compared to around 40 pre-Covid.

One issue all hospitals are facing is patients cancelling their operations, either because they are worried about catching Covid-19 or they cannot meet the requirement to self-isolate for up to a fortnight before and after the procedure.

We are working hard to reassure patients and the public that are hospitals are safe.  All staff are urged to share with their friends and families the short videos we are making with clinicians and nurses to show how staff and patients are protected.

Alistair Chesser, Chief Medical Officer, said: “The commitment of all our staff to getting our elective services up and running again has been incredible. Each hospital has had to redesign its theatre schedules and set up sophisticated zoning systems which will ensure our patients will stay safe when under our care.​ This is a fantastic achievement.”

Resources

Our Response to Covid-19 [pdf] 5MB

Videos to reassure and inform patients about what to expect when coming into hospital

Animation on Covid-safe hospitals from Explain My Procedure

We have published our Peak operating plan summary for the Covid-19 pandemic[pdf] 4MB to treat and care for a potentially huge increase in Covid-19 patients at the peak of the pandemic in a few weeks’ time.

The plan involves a major reorganisation of both clinical and support services across our group of hospitals to manage a large influx of infectious patients with this new respiratory illness.

By mid-April, we will be looking after more Covid-19 inpatients, in more beds than we currently in our five hospitals, and moving them more promptly back into the community when they are better. The plan sets out how we intend to:

• Achieve a ten-fold increase in intensive care beds (with ventilators), including using the 14^th and 15^th floors of The Royal London and supporting the new temporary NHS Nightingale Hospital at the Excel Centre in Newham
• Allocate as many general beds as possible to recovering Covid-19 patients at The Royal London, Newham and Whipps Cross, and work with local partners (including private hospitals) to create extra general beds (eg at Mile End)
• Retrain and redeploy large numbers of clinical staff to care for Covid-19 patients in line with expert advice on clinical management and safe staffing
• Reorganise clinical and support services (including estates, transport, informatics and procurement) to enable a timely transformation to take place 
• Maintain critical services like emergency care; plus trauma and stroke at The Royal London; heart attack response at St Bartholomew’s; and paediatric and maternity services at Whipps Cross, Newham and The Royal London. 

We have already switched the majority of our outpatient services to be virtual clinics via video or on the telephone, suspended most elective surgery, and redesigned care for vulnerable groups like cancer and renal patients. Teams are also working closely with GPs and community services to support more recovering patients closer to home.

Alwen Williams, group chief executive, said: “I know all of us feel a deep motivation to do everything we can to ensure the NHS does its utmost to respond to these challenges. We have already shown at Barts Health over the last five years that we can achieve great things. These steady and important achievements have left us in a strong position to meet the challenges we now face.

“In times of crisis, our values and our pride in the services we deliver to the public come to the fore and shine through. And in times of crisis, it is even more important that we have a clear plan of action so that all of our efforts can be directed to a common goal. This document summarises the plans we are making at Barts Health, plans we know will need to adapt and change, but plans which I hope will allow us all to succeed in the weeks ahead.”