As the country emerged from the first wave of the COVID-19 pandemic, Croydon set up an elective centre to provide care for non-COVID-19 patients. This was done by creating a ‘hospital within a hospital’ – a COVID-19 protected zone, which included its main theatres and separated elective and emergency care. This transformed both clinical and real pathways through its hospitals. The initiative enabled the trust to continue with clinically prioritised elective work during the second wave of the pandemic and to offer assistance to other south-west London trusts, ensuring those who needed care got it.
What the organisation and wider system did
Croydon Health Services NHS Trust decided to make drastic changes to its hospital footprint in the summer of 2020, harnessing the ideas and enthusiasm of clinical staff who were keen to re-establish elective care.
The trust worked with estates and infection prevention and control experts to safely develop the Croydon Elective Centre. At the same time, the trust opened an emergency surgical centre, redesigning its day surgery complex to provide dedicated theatres for non-elective activity.
The trust’s Purley War Memorial Community Hospital has since been transformed into a further high volume, low acuity elective centre doing elective care which does not require a theatre such as joint injections.
The trust has been a net provider of mutual aid to other trusts, taking 1,500 to 1,600 patients from other trusts within the South West London Integrated Care System over the last two to three months for high volume, low acuity procedures. These have included gynaecology, ENT, general surgery and urology patients. In some cases, consultants have come from the referring trust to carry out the procedures – and this has provided insight into how clinical teams could work across an ICS in the future.
Results and benefits
“I think that piece of work really re-energised a significant part of the workforce,” says Lee McPhail, chief operating officer. “During the summer last year we were one of only a few NHS trusts that got back to cancer standard compliance and started to significantly reduce the number of patients waiting over 52 weeks for treatment.”
When the second wave hit last winter, despite the pressures on NHS staff, the trust was able to continue with some level of planned care, with around 50 to 60 per cent of patients still receiving treatment, prioritising those who were most clinically urgent. Infection prevention and control measures across the Croydon Elective Centre are particularly stringent, and only one patient going through the elective centre at that time reported a positive COVID-19 test.
The transformation of the community hospital in Purley has freed up additional capacity on the Croydon University Hospital site.
The trust’s referral-to-treatment performance is improving towards 18 weeks compliance as part of its recovery plan.
The trust is seeing increasing numbers of new referrals (back to pre-pandemic levels in some areas) as well as winter levels of A&E demand, putting pressure on all areas of the organisation. As a result, rigorous clinical validation of the waiting list and assessment of how urgently patients needed to be treated has been particularly important in supporting recovery.
Patient and public engagement
The pandemic saw the removal of much red tape, allowing developments to be mobilised swiftly, without the normal need for a traditional business case process. However, the speed at which changes such as the elective centre were made, made it difficult to involve patients during some of the initial plans and the team is instead having to use real time patient feedback to ensure services meet the needs of those they care for. But more recent plans, such as a new paediatric unit and a £12m rebuild of the trust’s intensive care unit, have drawn on the experiences of past patients and relatives.
And Mr McPhail says the trust is still in the early stages of looking at how its recovery can contribute to reducing health inequalities within the borough. Clinical prioritisation is used for the waiting list. “While we are making progress on health inequalities across Croydon, I think we are some way off from having a sophisticated operational system which fully accounts for the health inequalities of the local population,” he says. “It is mainly bandwidth and capacity but also probably a bit of technical expertise. As a chief operating officer, I absolutely recognise how critical it is to do this and improving access and reducing inequalities forms a huge part of the trust’s long-term strategy.”
After 18 months of fighting a global pandemic, NHS staff are tired and Mr McPhail feels the momentum around using staff skills in different ways is slowing. However, he is passionate about taking the opportunity to learn from recent experiences to look at how staff are deployed and can diversify into different roles – such as broadening the scope advanced clinical practitioners and AHPs in A&E. There could also be more working across boundaries with, for example, district nurses potentially working more closely with social care partners.
The trust has been encouraging staff to take annual leave, insisting they need a break before winter hits. This has meant the amount of elective work it could do in August was lower than previous months.
Mr McPhail predicts yet another difficult winter for the NHS – including flu, RSV in children and still potentially many covid patients to care for – and recognises some of the trust’s challenges may come around respiratory services, general acute beds and staff. Yet system wide discussions are still very much around ICU capacity – which may not, in the end, be the pinchpoint, he says.
“As part of our planning for winter we are already expanding our bed capacity and refitting a number of wards with additional side rooms to support the isolation of patients with infections diseases. However, capital resource has been an issue in the NHS for many years and we are continuing to feel this locally,” he says.
The demands for external reporting, while valuable, have also increased and are taking up a significant amount of time, with requirements for information changing frequently, reflecting the changing picture of healthcare needs.
- Harnessing clinicians’ enthusiasm can drive a project forward – and they will be keen to see more patients accessing elective surgery and diagnostic procedures.
- Over time, some procedures may have been carried out in areas with higher specifications than they need. Relocating them can open up opportunities to increase other surgery.
- Moments of crisis give opportunities for change – such as using staff differently – but these can soon fade as people return to old habits.
For further information, contact Lee McPhail.
Find out more
Learn more about Croydon's approach in this episode of Health on the Line, featuring Croydon Health Services' chief executive, Matthew Kershaw.
Integration in Action
This case study forms part of our Integration in Action series, a collection of publications, podcasts and webinars which explores how effective partnership working is helping to address the biggest challenges facing health and care.