Fast and Easy Access

Patient Access

Objective for 2008/09

To treat our patients on time, every time and in the most appropriate setting.

Lean thinking

Barts and The London December 2008: Lean methodology – pioneered by Toyota over 50 years ago – is increasingly being used by the Trust as a management tool for streamlining and optimising services. It has been successful in reducing the number of separate visits patients have to make to, as well as decreasing their time in, hospital. This has been achieved by creating new integrated outpatient clinics, revising theatre schedules, and speeding up results from pathology.

Choosing a convenient appointment

The number of referrals to our hospitals received via Choose and Book continues to rise steadily – to 33,813 in 2008/09 from 28,374 last year.

Meeting national minimum access standards

Performing well against national minimum access standards is vital to the Trust’s performance rating from the Care Quality Commission.

Performance against national priorities & existing commitments which form the basis of the Care Quality Commission’s Annual Health Check 2008/2009[1]

Area	What we promised for 2008/2009	What we are likely to achieve when assessed	Current Progress
Cancer care	Maximum waiting time of two weeks from urgent GP referral to date first seen for all urgent suspect cancer referrals.	Achieved	The Trust met the cancer waiting times targets during 2008/2009. In January 2009, the arrangements for the measurement of cancer waits were changed nationally. The Trust is currently implementing new systems and processes to support delivery of these revised measurement arrangements. The thresholds for performance from Jan 2009 are yet to be published.
	Maximum one month wait from diagnosis to treatment · maximum waiting time of 31 days from diagnosis to treatment for all cancers · maximum waiting time of 31 days for subsequent treatments for all cancers.	Achieved
	Maximum two month wait from referral to treatment for all cancers.	Achieved
Elective care waiting times	90% of pathways for admitted hospital treatments to be completed within 18-weeks.	Failed	The delivery of these access targets has been a challenge to the Trust as a result of the difficult implementation of the CRS PAS system and inadequate supporting operational management arrangements.
	95% of pathways for non-admitted hospital treatments to be completed within 18-weeks.	Failed
	Maximum wait of 13-weeks for an outpatient appointment.	Failed
	Maximum wait of 26-weeks for an inpatient appointment.	Under achieved
	Maximum two-week wait for a Rapid Access Chest Pain Clinic.	Achieved	We have consistently achieved these targets since their introduction in 2003/04.
	Three-month maximum wait for revascularisation.	Achieved
	Cancelled operations and those not readmitted within 28-days.	Under achieved	The Trust is enhancing the inpatient and day case scheduling arrangements to support a reduction in cancellations for 2009/10.
Emergency Care Waiting Times	Maximum waiting time of four hours in A&E from arrival to admission, transfer or discharge.	Under achieved	The A&E department experienced a significant growth in attendances during 2008/09, this is coupled with an increasing complexity in cases. The Trust has implemented revised systems to support efficient patient flow through the organisation including streaming to the Walk-in Centre.
Sexual Health Services	Access to Genito-Urinary Medicine (GUM) clinics - All patients will be offered an appointment to be seen within 48-hours of contacting the service.	Achieved	The Trust has met this target during 2008/2009.

[1] The Care Quality Commission replaced the Healthcare Commission on 1 April 2009 and brought together The Healthcare Commission, the Mental Health Commission and the Commission for Social Care Inspection to become the regulator of health and social care in England.

Improved access to diagnostics

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.

Centre for Experimental Cancer Medicine

April saw the launch of the Barts and The London Centre for Experimental Cancer Medicine. A joint initiative between the Trust and Barts and The London School of Medicine and Dentistry, the Centre gives patients who are not responding to existing drug therapies access to new medicines or new combinations of medicines. Supported by £2 million of funding over the next five years, the Centre brings together laboratory and clinical research, which will enable doctors to involve patients at an early stage in testing drugs and from there progress more quickly to the introduction of new treatments.

Mobile digital x-ray machines

Six new mobile digital x-ray machines were installed in the summer, enabling staff to provide quicker diagnosis of seriously ill patients who are unable to leave a ward due to their clinical condition. Using digital technology, pictures are instantly displayed on a screen on the x-ray machine, allowing clinicians to assess patients on the spot. The equipment is also used in operating theatres, where, thanks to the enhanced technology, the machine provides surgeons with clearer images of blood vessels, making vessels more distinct from bone and tissue than was previously possible.

Quick Check STI tests

A new sexual health screening ‘Quick Check’ at Barts and The London Sexual Health Centre is resulting in significantly decreased waiting times for patients wishing to be screened for sexually transmitted infections (STIs), allowing medical staff to address more complex sexual health cases. The ‘Quick Check’ has reduced waiting time for patients by an average of 30 minutes with testing of patients not showing any symptoms of a STI taking an average of 15 minutes. The survey showed that 100% of patients were satisfied with the new care pathway.

Gift of equipment helps cancer patients

The chemotherapy treatment of Barts and The London cancer patients has been enhanced, thanks to the installation of new mobile computers funded by the Barts Guild and Smyrk Trust. The equipment, which is used in both outpatient day wards and inpatient wards at Barts, enables the multidisciplinary team to check all the necessary information on haematology and biochemistry test results, prescriptions and drugs directly at the patient's bed or chair-side, increasing the accuracy of information and reducing the need for paper prescription records.

Strategic partnerships

Barts and The London has developed strong clinical partnerships with neighbouring hospitals as well as our primary care healthcare partners, with whom we work collaboratively to improve access to the best possible care and to maximise clinical outcomes. We are also working as part of the NHS in north-east London to develop proposals that take forward the recommendations in ‘Healthcare for London – A Framework for Action” at a local level.

Seminar for community nurses

Over 40 local community nurses took part in a two-day seminar held in the Great Hall at Barts in late January. The multi-disciplinary event focused in particular on caring for orthopaedic and plastic surgery patients. The seminar covered topics such as external fixation, wound closure techniques, infection control, scar management and skin graft dressings, together with advice on handling post-traumatic stress and identifying patients at risk of fracture. It was the first event of its kind organised in the Trust and feedback from participants was that it gave “a good sense of collaborative working between primary and secondary care”.

Winter A&E campaign

During 2008/09, staff at Barts and The London Trauma and Emergency Care Centre continued to work with colleagues at NHS Tower Hamlets to ensure that local people use the healthcare service most appropriate for their needs and attend A&E only in a genuine emergency.

And in January, Barts and The London joined forces with NHS Tower Hamlets as part of a pan-London campaign aimed at taking the strain off hospital A&E departments to help front-line services cope with increased demand at A&E over the winter.

Joint project to improve cervical screening

Barts and The London has been selected as one of 10 sites in England to pilot an NHS Improvement project for cervical screening to ensure all women receive their test results within 14 days of a sample being taken. The project, which is being undertaken using the Lean methodology as part of the service transformation programme for pathology services, involves a multi-disciplinary team from across Barts and The London and NHS Tower Hamlets.

First birthday for Barkantine Centre

The pioneering Barkantine Birth Centre in Westferry Road, run by Barts and The London NHS Trust and developed jointly with NHS Tower Hamlets, celebrated its first birthday in January. Since it opened in January 2008, 330 babies have been born there.

Healthcare for London

Following pan-London public consultation last year on where healthcare should be provided, the planning for Healthcare for London took the next step forward at a local level with a public consultation focusing on:

Stroke services–proposals to develop a small number of designated hospitals as specialists in the provision of stroke services across the capital
Trauma services– proposals to develop a small number of designated hospitals as specialists in the provision of complex trauma care.

The public consultation was launched in January 2009 and ran for 14 weeks. The preferred option identifies The Royal London Hospital as a specialist centre for both trauma and stroke services.

In north-east London, a review has commenced to look in detail at where and how acute services should be delivered locally to ensure equitable and sustainable delivery of high quality services, effective use of resources and increasingly better outcomes for the people of north-east London. The increasing population in north-east London is a key driver for change in the way health services are provided in the area, with increased demand for health services and therefore increased expectations of health service providers.