The Healthcare Commission’s annual health check, published in October 2007, again rated Barts and The London’s hospitals as among the best in England for the quality of our clinical services.

Performing well against national targets contributes to this success, but strong partnerships with other local healthcare providers are also crucial. Close co-operation with primary care colleagues, neighbouring hospitals and sector-wide clinical networks means that we can ensure that our patients see the right professionals in the right setting at the right time.

Our work has been enhanced this year in light of Healthcare for London, the review carried out by NHS London to consider future models of health care for the capital.

This section looks at some of our initiatives to speed up and improve patients’ access to our services, including joint working arrangements with partner organisations.

Lean thinking

Barts and The London has launched an ambitious transformation programme using ‘lean’, an improvement methodology, based on a system developed by Toyota and now used by many industries and public sector organisations. It aims to remove inefficiencies, duplication and other wastage from patient pathways more rapidly than other transformation methods. Lean also develops a continuous improvement culture, in which our staff are empowered to make improvements.

Lean pilots started in four key areas in June 2007 and are already making a real difference to patients’ care, see box (right).

“The new approach has led to a dramatic fall in the number of surgical cancellations, and a corresponding rise in the number of procedures performed on each operating list” – Consultant  Nephrologist, Prof Alistair Chesser.

Nurse-led discharge

Nurses now discharge thousands of patients a year, enabling patients to return home quicker and freeing up hospital beds so that more patients can be admitted to receive treatment. The initiative also saves us thousands of pounds, which can be re-invested in patient care.

Senior nurses and medical staff have worked together to agree clear criteria under which patients can be discharged by senior nursing staff, instead of having to wait for a doctor to make a final assessment. 

Improved access to advanced diagnostics

A second state-of-the-art 64-slice CT scanner was installed at The Royal London Hospital in Autumn 2007

New equipment in key services is also speeding up patients’ access to care at Barts and The London’s hospitals, as well as enhancing the standard of care and diagnoses they receive.

Second 64-slice CT scanner

The A&E department at The Royal London is unique in the UK for having two 64-slice CT scanners, following the installation of a second £650,000 machine in autumn 2007. Having two machines contributes to reducing waiting times for patients attending A&E. Compared with earlier models, the new scanners can produce four times as many cross-section images, building up pictures of any body part and producing detailed 3-D images of, for example, the bones, blood vessels, heart, head and neck, or growths such as tumours. Both machines have also been modified so they can perform cardiac CT scans.

£2 million PET CT scanner

Our new £2 million PET CT scanner was installed at Barts

Our new £2 million PET CT scanner, funded by Barts and The London Charity offers the latest in high-tech diagnostic imaging, predominantly for tertiary cancer patients. One of only a handful of such machines in the UK, the scanner is housed in a purpose-built facility in the East Wing at Barts. 

The new scanner provides high quality images for more effective diagnosis and treatment plans. It is more comfortable and less claustrophobic for patients than other types of scanner, and can perform several diagnostic functions in one session. Not only can it show the precise location of a tumour, for example, but it can also give a very early indication of how tumours are responding to treatment.

Our new £2 million PET CT scanner was installed at Barts

Waiting times for the PET CT scanner are low: patients are scanned within ten days of our staff receiving a referral.

Cardiac MRI scanner

A new cardiac MRI scanner was installed at The London Chest Hospital in spring 2008, meaning that cardiac patients no longer have to be transferred to other hospitals for this type of scan. In addition, the scanner plays an important role in our pioneering stem cells research trials – see page 20.

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Healthcare for London

A key focus of the Healthcare for London recent review was on where healthcare should be provided. We have also been considering where care is best provided across the range of healthcare settings suggested in the review, including patients’ own homes, local hospitals, major acute hospitals, planned care (elective) centres and specialist hospitals.  In particular, Barts and The London is working closely with other local healthcare organisations to explore the idea of polyclinics suggested in the review.  These new community facilities would provide a one-stop-shop, offering a range of GP services, clinical specialists, diagnostics, community services, urgent care, healthy living classes and other health services.

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Strategic partnerships

Barts and The London already enjoys strong relationships with many local hospitals, with whom we work in partnership to improve patients’ access to the best possible standards of care to maximise clinical outcomes. 

On 1 November 2007, we started to manage the rheumatology and dermatology services previously provided at Newham Hospital, following a detailed review by Newham Primary Care Trust. Clinics continue to be provided on the Newham Hospital site, both for new patients and those requiring follow-up appointments, while some patients who require more complex treatments now attend one of Barts and The London’s hospitals.

An additional consultant has been appointed to treat choroidal melanoma, an especially rare form of eye cancer, as a result of partnership working with Moorfields Eye Hospital. All surgery is now carried out at Barts Hospital and is supported by an outpatient clinic at Moorfields.

We also continue to work collaboratively with Whipps Cross and Barking, Havering and Redbridge hospitals to implement the recommendations of Professor Sir George Alberti’s review of services in outer north-east London, published in October 2007.

Joint working with primary care colleagues

During 2007/08, staff at Barts and The London Trauma and Emergency Care Centre continued to work with colleagues at Tower Hamlets Primary Care Trust to ensure that local people use the healthcare service most appropriate for their needs and attend A&E only in a genuine emergency.

This work built on the successful ‘Local Heroes’ campaign in 2006, which raised awareness of alternatives to A&E for health advice, and contributed to a 6.4 per cent decline in attendances at The Royal London’s A&E department.

This year, our staff contributed to the development of a new resource pack, ‘Get the Right Treatment,’ which offers advice to local residents on whether their condition requires self-treatment, advice from a health professional or emergency attention.

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Reaching out into our communities

Local women now have the option of giving birth in a non-hospital setting, following the opening of the Barts and The London Birth Centre in January 2008.  A joint initiative with Tower Hamlets Primary Care Trust, the centre is located in the £12 million Barkantine Health Centre on the Isle of Dogs.

We also opened two new outreach dental services, in Southend and on the Isle of Dogs, early in 2008. The Barts and The London Academic Dental Clinic in Southend was developed as a partnership with Barts and The London School of Medicine and Dentistry, South East Essex Primary Care Trust and the University of Essex. It is based in Southend Health and Dental Care, a broader NHS health and dental facility on the university’s Southend campus.

The dental clinic on the Isle of Dogs is a partnership with the medical school and Tower Hamlets Primary Care Trust. It is based in the Barkantine Health Centre, along with the birth centre and a range of other healthcare services.

Both clinics are housed in state-of-the-art facilities and offer a range of free dental care to adults and children. Treatment is provided by senior dental students from Barts and The London under the supervision of qualified academic staff and local dentists.

“The staff at Barts and The London Academic Dental Clinic are indeed a great team – my compliments to all concerned for this excellent service.” Peter Davies, patient.

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Choosing a convenient appointment

The number of referrals to our hospitals received via Choose and Book continues to rise steadily – to 28,374 in 2007/08 from 16,931 in 2006/07. Choose and Book is a national initiative that allows patients to choose where they are treated, as well as a mutually convenient date and time for their appointment. At present, patients need to call our dedicated central appointments centre to book their appointment. Following the introduction of the Care Records Service (CRS) – see page 45 – patients should be able to book appointments directly from their GP surgery from later in 2008. 

Performance against national access targets 2007/08