Queen Elizabeth Hospital in Woolwich has been under serious pressure for nine out of the first 10 working days of 2020, one of its senior managers told Greenwich councillors on Thursday night.
Kelly Lewis-Towler, its divisional director of operations, spoke of the “phenomenal” pressure on the hospital as she and Ben Travis, the chief executive of Lewisham and Greenwich NHS Trust, spoke to the council’s health scrutiny panel.
The hospital on Woolwich Common has been on “level black” for most working days this year, she told councillors. “Level black” is part of an internal escalation system which is less urgent than Opel Level 4 – also known as a “black alert” – which is the most serious alert in the NHS. (An earlier version of this story had the hospital on black alerts rather than “level black” – apologies.)
Travis told councillors that the trust, which also runs Lewisham Hospital, faced a “challenging” budget situation, and it had been asked to save four per cent on its spending next year.
Asked by the panel’s chair, Mark James, to outline how many days the hospital had been on level black so far this year, Lewis-Towler said: “Just in the last two weeks, nine working days out of 10. Almost every day. The pressure has been absolutely phenomenal.”
Travis added: “One of the real risks is that normally, you expect a cycle, you sign up to it being incredibly busy in December, January, February and March, and the rest of the time is that it waxes and wanes a bit but it’s generally less pressurised.
“This last year, we didn’t have eight months where it came down a notch, it’s been at full pelt all the way through. So we are really aware of the challenges in terms of burnout and just being able to keep going.”
When a member of the public spoke to voice fears that the relentless pressure on staff and facilities was making the hospital dangerous, Travis said: “Even when we’ve got people [waiting for a bed] in the public corridor, we’ve very rigorously-enforced protocols around people going in and checking on people. We are confident that we are getting the basics right in terms of safety in these very challenging circumstances.”
Travis and Lewis-Towler explained to councillors how teams from the hospital, local clinical commissioning groups and Bexley and Greenwich councils’ social care teams were working together to try to ease problems when the hospital was under pressure.
He said that staff from all around the hospital were alerted to the situation by screen savers on their computers. “It might come across as a bit dramatic, but actually, it’s been incredibly successful in mobilising everyone across the site.”
Travis said that patients having to wait in a hospital corridor was a “red line”, adding that use of the corridor had dropped thanks to better working across the hospital to free space.
But he added: “We often have 40 patients who we’ve decided need to be admitted to hospital, but there isn’t a bed, so they’ll be waiting somewhere inappropriate.”
Lack of capacity was a running theme of the session, and not just in terms of Greenwich borough’s fast-growing population. The hospital was opened in 2001 to serve Greenwich borough, however, with the reduction in services at Queen Mary’s Hospital in Sidcup, 40% of its patients now come from the borough of Bexley.
In addition, the notorious private finance initiative deal which created the hospital has left it with power and water supply problems. Despite this, Travis said the hospital was hoping to have a plan to develop the site by the summer.
“There’s now a national conversation within the NHS that we might need some beds,” he added. “There’s always been a sense that we needed to improve our processes, but for the first time, before Christmas, I heard Simon Stevens, the head of the NHS, say we need more beds. So we need to do some work about that and think about what that means for our site.”
Travis said the trust had a target to keep its deficit down to £43 million, and that if it could hit that, it would get more funding that would take the deficit down to £15 million – but it was “touch and go” whether it would reach that target by the end of the financial year. However, he added: “It is dependent on each quarter, so we already have three-quarters of it.”
The trust has been asked to deliver savings of four per cent next year, which he said was “a very big ask indeed”. “It’s difficult, but it’s a similar ask for colleagues across the region.” He said that if the target was hit, extra funding would be released and the trust would break even for the first time.
Asked by Labour councillor Mariam Lolovar if this would mean cuts, Travis said the trust would aim to reduce the use of temporary staff, make their operating theatres more productive, and attempt to reduce the number of patients who do attend appointment. “And on any given day, there are about 100 people in hospital who shouldn’t be there,” he added.
“It makes me nervous, if you look nationally, there aren’t many organisations nationally who can deliver more than two per cent. It’s a big challenge but we’ll do the best we can.”
Greenwich Council does not video scrutiny sessions. However, selected parts of the Lewisham and Greenwich NHS Trust session, including on other topics not mentioned in this story, can be seen on this Vimeo playlist.
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