One Message
The monthly staff briefing
from the Chief Executive
Annual Health Check for St George’s
Dear Colleague,
The outcome of the annual review into Trust’s
past performance will be published nationally
tomorrow. But rather than you read of this in
the morning papers, I wanted to let you know
first hand how we performed.
The results of the 2006/2007 Annual Health
Check are disappointing. In spite of the
considerable hard work and commitment of
our staff, the Trust has only been awarded ‘fair’
for the quality of its clinical services, when last
year we were awarded a rating of ‘good.’
Run independently by the Healthcare
Commission, the Annual Health Check has
replaced the old star rating system for assess-
ing the performance of all NHS organisations.
As such, it is an important tool for gaining the
confidence of our patients and reassuring
them that we are performing to the best of
our abilities. This report focuses on our per-
formance last year, and so it does not reflect
the progress we have made since then. We
are now in a much stronger position thanks to
your determination.
Existing national targets met
The Health Check assessment does highlight
our solid performance against many national
targets. Our patient waiting times are shorter
Our values + Treat all
people with respect than ever before, and we are on track to meet
the 18 week target for GP referral to first treat-
and dignity + Deliver
ment. We also successfully met the waiting
care in partnership with
time target for A&E seeing almost 98 per
others + Continually cent of patients within four hours. However,
strive for excellence despite the best efforts of our staff, it is only
+ Ensure probity and by a small percentage that we met this target.
transparency in spend- This is primarily due to the sheer volume of
ing public money + Be patients who are increasingly coming to
an exemplary employer St George’s for emergency treatment. It is
crucial that we continue to work with our col-
+ Be committed to
leagues in primary care to support our staff on
education, training and
the front line to deliver fast and high-
research + Be open quality patient care, but I will talk further
and honest with each about this shortly.
other
October 2007
While we have performed well in all these
areas, it is our performance against new
national targets that have let us down.
Combating MRSA
The main cause for the fall in our performance
rating is our success against reducing the
number of cases of MRSA bloodstream infec-
tions. As I have discussed with you on many
occasions, we faced a considerable challenge
with our infection control rates last year, but
to our credit we took immediate action and
have since seen our results improve drastically.
Last year, the number of cases of MRSA bacter-
aemia was above the level agreed with the
Department of Health. We did not shy away
from this fact and took direct steps to address
the issue.
The Infection Control Taskforce has been the
drive behind many of the measures put in
place to bring our infection rates down and
it is important that each of you understand
your responsibilities and the impact you
have in reducing hospital acquired infections,
especially MRSA and Clostridium difficle. From
compulsory hand hygiene to the cleanliness
of our wards, each of us has an important part
to play to protect our patients.
The Trust has also introduced new measures
to help us further strengthen the control of
infection: we have begun a rolling pro-
gramme of ‘deep cleaning’ our wards to
ensure the highest standards of cleanliness
across the Trust; all patients coming to us for
elective surgery are now screened for MRSA
prior to admission; and we have introduced
new technology to increase our speed of
diagnosis to just two hours.
With all of these measures in place, the Trust
is now back inline with its agreed trajectory to
reduce MRSA by 60 per cent by 2008. Perhaps
one of the best examples of our progress so
far is that of our General Intensive Care Unit.
 Thanks to the efforts of all of our intensive care
and support staff, GICU has not seen a single
case of MRSA bacteraemia since December
2006, but that said we must not become com-
placent. I cannot stress enough how serious
this subject is and how serious the conse-
quences are for our patients. Regardless of all
our groundbreaking services or
improvements in care, if there is one thing
that will undermine our hard work and our
patients’ perceptions of us, it is poor infection
control. And as we have seen with the recent
press coverage surrounding Maidstone and
Tunbridge Wells NHS Trust, there is a price to
pay in the loss of our patients’ confidence if we
get this wrong.
Financial health
The Annual Health Check also assesses the
Trust’s financial performance. For this, St
George’s was rated as ‘weak’ but again this
does not really reflect the progress we have
made over the past four years to turn our
finances around.
Any trust with a deficit was given an automatic
‘weak’ for its use of resources. While we are
now in a far better position than last year, we
still have an underlying historic financial defi-
cit which we must pay back. We must there-
fore continue with our reforms and push on
with our ambition to transform St George’s.
To achieve this we cannot simply ask staff to
work harder than they already are. Instead,
we must find ways in which we can become
more efficient and grow as an organisation.
This requires our focus to change from the
need to make savings to the need to generate
Our values + Treat all surpluses. This year, the Trust is projecting a £2
people with respect million pound surplus – the first time in seven
years, but there is still a long way to go. We
and dignity + Deliver
care in partnership with must therefore deal with the debts accumu-
lated in the past and remain vigilant about our
others + Continually
current spending to ensure our good progress
strive for excellence continues.
+ Ensure probity and
transparency in spend-
Emergency care pressures
ing public money + Be
an exemplary employer
In early anticipation of our next annual health
+ Be committed to check it is perhaps fitting that we look at our
education, training and current performance, and in particular the
research + Be open current pressures faced by our staff in
and honest with each Accident & Emergency and Emergency
other Medicine.
The number of patients coming to St George’s
for emergency treatment is continuing to
rise. This demand has peaked on a number of
days over the past few weeks and the Trust is
now on full alert. Many of the patients we are
seeing have serious conditions that require
admission, which is increasing the demand for
beds. The Trust is doing everything possible
in partnership with primary care to identify
additional bed capacity and we are working
closely with London Ambulance Service and
our neighbouring trusts to manage demand.
What this does highlight is the impact these
pressures could potentially have on our
standards of patient care, staff morale and
our performance against national targets. We
must not let this happen, nor should we be
disheartened by this year’s Health Check
assessment. Instead, we must take it on the
chin and look forward. We are now in a much
stronger position when compared to last
year and we must not falter in our efforts to
improve the quality of our care and the
efficiency of our performance. In doing so,
next year’s Health Check assessment will truly
reflect the consistent quality of care that staff
at every level of this Trust gives to our patients.
There is a lot for us to do, and to start we must
make sure that we get the basics right so that
from our patients’ first perceptions of
St George’s to the outcome of their
treatment is of the highest quality.
The full details of our Annual Health Check
assessment will be available on the Healthcare
Commission’s website from Thursday 19th
October. For further details, please visit
www.healthcarecommission.org.uk.
Thank you as always for your continuing hard
work and I look forward to writing to you
again soon in the next One Message.
Best wishes,
David Astley
Chief Executive