The Sub-Committee received a report that provided an update on progress towards recovering elective care and outpatient services at the Royal London Hospital and Barts Health NHS Trust. It also covered the urgent response to dental provision in the London Borough of Tower Hamlets.  A summary of the questions and feedback provided to Members is outlined below:

The Sub-Committee:

v  Recognises that the impact of coronavirus has been unprecedented. And the Royal London Hospital and Barts Health NHS Trust now face another unique challenge with a resurgence of Covid-19 cases - just as the Trust are restoring planned care to previous levels, and as the usual seasonal pressures begin to bite. The Royal London Hospital and Barts Health NHS Trust staff have responded incredibly well to these challenges.

v  Commented that the pandemic is not just a medical phenomenon the restrictive measures undoubtedly have affected the social and mental health of individuals and the community causing disruption, anxiety, and stress.

v  Welcomed the offer by Royal London Hospital and Barts Health NHS Trust to investigate individual experiences of outpatients with particular reference to those awaiting treatment for adult and paediatric eye conditions.

v  Noted that a few months ago or pre pandemic the Royal London Hospital and Barts Health NHS Trust would expect every single patient to be offered an individual appointment. The challenge now with outpatients is that some of the clinics are now virtual and because the Trust moved to virtual very, very quickly during the pandemic and has yet to catch up with the different ways of working. It is a big piece of work to make sure that the Trust can offer patients appropriate face to face; telephone; virtual or whatever they require. However, the expectation, is that every patient ideally should have an individual appointment.

v  Observed that most long-waiting patients on the surgical waiting list will have agreed to undergo operative treatment before the coronavirus pandemic started. Many people’s circumstances may have changed because of the pandemic or other factors since then, and some patients may now have changed their minds about having surgery or wish to defer this until the pandemic is over. Similarly, some people’s condition may have changed, which they may not have wanted to inform their GP or specialist about.  Such patients are categorised under the P5 category, and its introduction will allow the Trust to view the waiting list including and excluding those patients listed as a P5.

v  Understood that as patients in the P5 category have deferred rather than declined treatment, they must not be discharged back to their GP, unless this is in their clinical interest and has been agreed by them following a conversation with their clinician.  Patients are given a review date to make sure their condition or preference has not changed. The maximum time before a review date is six months. Where a patient has been clinically prioritised for treatment in less than six months’ time, the review date and clinical prioritisation will be aligned.

v  Was mindful that the pandemic has had a big impact on the Trust and noted that they are working to resume services and keep patients safe at the same time as they continue to treat COVID-19 cases. They are reviewing all patients to see what they want and prioritise those in most urgent need. The Trust is doing its utmost to ensure that patients get the treatment they require as soon as possible.

v  Noted that the Trust rarely brings patients in, in batches, although occasionally they bring a few patients in at that time as the Trust might change the order in operating theatres to ensure that theatre teams work more effectively together to improve the quality of patient experience, the safety and outcomes of surgical services, the effective use of theatre time and staff.

v  Observed that good waiting list management involves treating according to clinical priority, and then treating in turn those patients who have waited the longest.

v  Noted that a local weekly Patient Tracking List (PTL) can be used by the Trust to provide the data required to manage patients’ pathways, by showing clearly which patients are approaching the maximum waiting time so operational staff can offer dates according to clinical priority and within maximum waiting times.

v  Noted that it is an aspiration to have a common PTL in specialties across the Trust, but it is not easy to implement.

v  Was informed that the Royal London and Mile End through the Patient and Family Contact Centre provides help and advice to patients, relatives, and visitors to address their concerns quickly.  However, during the lockdowns visitors, families and loved ones could not visit the hospitals and the Trust had, had a lot of conversations with their local community through the multi faith forums and CEO, Royal London and Mile End Hospitals, Barts Health NHS Trust and her team had actually met on a regular basis with some of the families and community leaders and one of the things that came out of that was a model that worked really, really well on critical care.  However, in the general wards where visitors could not come in and this did present challenges.  Therefore, the Trust following discussions with the local community and have altered visiting procedures.

v  Noted that the Trust are working hard to really improve communication and open lines of dialogue so that patients are not having to go to their back to their GP to ask questions about what is happening in the relevant hospitals.

v  Noted that the Trust have been working in collaboration with the Patient Welfare Association and Healthwatch and would be happy to give an update on the family Contact Centre at a future meeting or offline if the Sub-Committee considers that to be helpful.

v  Welcomed the action being taken to tackle waiting lists in the local hospitals.

v  Acknowledged that tackling waiting lists is one of the main challenges for the Trust and stated that amid the pandemic-related pressures on the health system the action being undertaken by the Trust was welcomed and looked forward to being involved in the development of the ongoing dialogue on this issue.

Following a full and wide-ranging discussion, the Chair thanked all those Committee Members in attendance together with (i) Jackie Sullivan, (ii) Stephen Edmondson, (iii) Lisa Dinh, (iv) Kathriona Davison and (v) Alenka Daniel for their contributions to the discussions on this important issue.