Delayed referrals to treatment Barking, Havering and Redbridge University Hospitals Trust

Healthwatch Havering carried out a joint review, to examine the issues regarding the significant delays in the care of patients between January 2016 to March 2017. The work was done as part of the Joint Topic Group, formed by Healthwatch Havering and Havering Health Overview Scrutiny Sub-Committee, to examine the delays issue at Queen’s Hospital and King George Hospital.

The Joint Topic Group held several meetings with officers from the BHRU Trust, NHS Improvement, BHR CCGs, London Borough of Havering Adult Services, and North East London Foundation Trust (NELFT) which is the local mental health provider.

The report identifies a number of key issues. The waiting time from the point of GP referral to receiving treatment was very long. It was the most long waiting patients list in the country, with some patients waiting more than 52 weeks. The Trust implemented a new IT system to manage patients’ data. The implementation of the new system was done very rapidly. This highlighted a number of administrative issues. The issues were not discovered by management but until very late. The recruitment of consultants was challenging, which resulted in a backlog of referrals. Some GP referrals were made direct to individual hospital consultants, not via the referral Central Team. As a result, direct referrals to consultants were not monitored or were missed in the system. The referral Central Team had access to the diaries and availability of individual consultants, and were in a better position to manage referrals than GP direct referrals. Different IT systems operating within the hospitals made data-sharing more difficult. Additional hospital activities were needed, such as more appointments, more consultants and more operations, to clear the backlog of referrals. Funding hospital additional activity to clear the backlog incurred significant financial costs on CCGs. There were concerns raised by Havering Adult Services that delays in treatment could lead to increasing demand on social care. However, no known clinical harm to patients, or increasing demand on social care were observed because of the long waiting time. NHS Improvement and NHS Trust Development Authority provided strategic support on referral management, service quality, and leadership.

BHRUT is now expected to be able to achieve the referral national target by the end of September 2017. By the end of March 2017, GPs had directed a total of 26,000 patients into alternative services to reduce demand on the hospitals. Additional hospital activities are being outsourced to the private sector. Recruitment initiative is in place to recruit from overseas, provide joint appointments, and establish academic consultant posts.

Responses to this report were received from BHR CCG, BHRU Trust, and NHS Improvement.

The report made the following recommendations:

- BHRUT to review its IT arrangements to ensure robust steps are taken to mitigate the ‘loss’ of data that occasioned the delays

- BHRUT and partners to review their IT systems to ensure that they are sufficiently compatible with each other to permit free, secure exchange of patient data between them, and with GPs and other points of referral such as polyclinics and walk-in centres

- CCGs to review options in partnership with BHRUT for elective referral activity to optimise patient access and experience

- CCGs to work with GPs to develop procedures to ensure referrals are followed up in a timely fashion and that patient is seen by the most relevant health processional.