In this, the 60^th year of the NHS, Barts and The London celebrated its part in making the NHS the institution of which the nation is justly proud.  We also looked forward to how, together with our healthcare partners in east London, we can make care even better for the people we serve.  We have been guided in this by ‘High Quality Care for All’, the final report of Lord Darzi's NHS Next Stage Review.  Published in June 2008, the report sets out a vision for an NHS with quality at its heart. 

Our annual report this year includes the progress we have made in the three dimensions of quality set out by Lord Darzi – clinical effectiveness, the patient experience, and safety. We report excellent performance in the dimensions of clinical quality and safety, with some of the highest standards in the country.  And we recognise the areas where our performance has fallen short of these high standards, particularly in ensuring that all patients have prompt access to our care – an important part of the patient experience.

World Class Clinical Quality

During the year, our specialist hospitals and centres continued to earn their reputation for clinical quality with some outstanding results and achievements. 

Excellent survival rates

Publication of Hospital Standardised Mortality Ratios on the NHS Choices website in April 2009 confirmed that Barts and The London is one of the best hospitals in the country for survival rates. The Trust's performance was 15.6% better than would be expected, given the nature and complexity of the cases we see.  Survival rates are generally regarded as strong indicators of clinical quality overall, and Barts and The London has maintained one of the best survival rate records in the country since the rates were first published in 2002. 

Top ranking for research quality

The Barts and The London School of Medicine and Dentistry continues to push back the frontiers of medical knowledge to speed new cures and treatments from the scientist’s bench to the patient’s bedside. In December 2008, we were assessed as the top medical school in London for quality and fourth in the UK, in the Research Assessment Exercise (RAE).  This is the basis on which research funding is allocated nationally, and the ranking reflects our high percentage of 4-star and 3-star outputs – quality that is world-leading or internationally excellent in terms of originality, significance, rigour and quality. 

Innovative new structure to drive innovation

In July, we launched an innovative new organisational structure that brings research and teaching much closer to clinical practice.  Evidence from around the world demonstrates the profound role played by world-class research and teaching in driving innovation in healthcare.  By improving the coherence of this tripartite mission – education, research and clinical practice – we aim to ensure that our patients get even faster access to ground-breaking new treatments and cures.  Our new clinically-led structure of specialties and divisions is configured to maximise these clinical and academic synergies by ensuring that clinical, research and teaching staff work in concert to unified plans.

Safe Hands

Excellent rating for managing risk
During the year, the NHS Litigation Authority (NHSLA) – the body that insures trusts against claims of clinical negligence – assessed Barts and The London as Level 2 out of a maximum of three, with a 96% compliance score for minimising the risk that patients will suffer harm during their NHS care. The NHSLA assesses all NHS trusts, to identify how well they are working to minimise these risks – only 26% of NHS trusts achieve Level 2 or above. 

The rigorous assessment looked at standards of risk management throughout the organisation, including whether the Trust has implemented the necessary policies and procedures to ensure the safety of patients, staff and others. It included visits to wards, interviews with key staff and an examination of documentary evidence provided by the Trust. 

Hospital acquired infection – target zero

Barts and The London was one of 10 partnerships chosen to take part in the Safer Patients Initiative, an international programme run by The Health Foundation and the US-based Institute for Healthcare Improvements (IHI), which concluded this year. The initiative focused on improving patient safety on the wards, before, during and after surgery, and in critical care. 

In each setting, clinicians worked on improving a range of safety indicators, including infection control.  During the year, we made significant progress in reducing the incidence of infections, with 31% fewer MRSA bacteraemia cases for 2008/09 than for the same period in 2007/08, and the number of cases of Clostridium difficile (C.diff) down by 38% on the previous year.  But no level of hospital-acquired infection is acceptable, and we are implementing a target zero policy across the organisation.

Improving the Patient Experience

Accessing our services

In April 2008, we became the first major teaching hospital to go live with the NHS Care Record Service (CRS), creating a platform for a truly 21^st century IT system.  Unfortunately, the new computer system, together with weaknesses in our information and administration systems following its installation, have resulted in some of our patients waiting longer than the national maximum waiting time guarantees.  We deeply regret this, and have apologised both to our patients and our healthcare partners who commission services on their behalf.  A comprehensive improvement programme is in place to ensure that we address our access issues as a high priority.

Listening, responding, improving

In 2008/09, we participated in national surveys of inpatients, outpatients, young people, and patients who had been through Accident & Emergency. In the inpatient survey, undertaken in summer 2008, nine out of 10 of our patients rated their care as ‘good’, ‘very good’ or ‘excellent’. The survey also highlighted aspects of our care that we need to improve, relative to other trusts, if we are to achieve a high quality patient experience consistently. 

Dr Keith Palmer, Chairman

Peter Morris, Interim Chief Executive