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This year, as the NHS marked its 75th birthday, NHS teams working across Croydon once again demonstrated their resilience, enthusiasm for innovation, and commitment to high quality care, in an ever more challenging environment.
Whilst there has been ongoing industrial action, the lingering effects of the pandemic as well as pressures on staff and systems we worked to reduce elective care backlogs. At the same our financial position has meant we have continued to work within the financial resource allocation, using innovative ways to deliver high-quality care within an ever-tightening budget. At the same time we have continued to care for the people of Croydon when they needed us most and we have made more progress in our ambitions to deliver excellent care for all.
July 2023 marked a watershed moment for the borough’s health services as we launched our first ever clinical strategy, a five-year shared framework across Croydon’s NHS services to help us tackle the next phase of our transformation, further joining up care and improving the health, wellbeing and quality of life of local residents over the next five years.
Our strategy focuses on six key areas where we can – and should – make the biggest difference over the next five years, placing significant emphasis on prevention and proactive care in the heart of local communities. And with our renewed focus, we are already making great progress on our ambitious plans and improvements to a number of our services.
This year, we were proud to open a number of new and improved facilities for our patients; including a £15 million state of the art intensive care unit, doubling our critical care footprint, as well as modernised wards and clinic spaces for our stroke and paediatric patients.
As well as improving our facilities, this year we have been focussed on increasing capacity for those who need us. We’ve been boosting the number of diagnostic tests and procedures we can deliver for local people to support early interventions, playing our part in tackling COVID-19 backlogs across the Capital, whilst reducing health inequalities in areas of most need with schemes like our Community Diagnostic Centres, the first of which opened in Purley in January 2024.
At the same time, we have remained focused on providing more efficient care for those undergoing cancer testing, meeting the national faster diagnostic standard to ensure that people who are waiting for a diagnosis are able to find out within 28 days of their testing and, in February, performing second best in the country; an achievement that cannot be understated in providing much needed assurance and timely access to care for our patients and their families.
Alongside this, we are working to deliver care even closer to home continuing our plans to grow our Integrated Care Networks (ICN+) as a key part of how we embed services in the heart of the community. As part of this work, we have been piloting neighbourhood based huddles with a small number of GP practices, to create an even more local approach to supporting patients at risk of hospital admission, enabling them to maintain their independence and reducing social isolation.
As we look ahead to 2024-25, our ultimate goal remains to ensure timely and equitable access to person-centred care via neighbourhood-based, integrated, multidisciplinary teams that work with the wider system, people’s strengths and community assets to offer a seamless experience of care, preventing ill health and helping people live well.
Hand in hand with the care of our patients is the care of our staff and this year, alongside the publication of the NHS workforce plan in June 2023, we embarked on a plan to improve our organisational culture, which included our most successful ‘Croydon Stars’ staff awards to date. Whilst there is much more to do, we are seeing some positive results through our annual staff survey. Even with the challenges we face and the impact on staff we are working hard to address, more of our teams are enthusiastic about their role and being empowered with the opportunity to show initiative, our strongest results since 2019.
Many of the achievements I have shared with you will be illustrated in the pages that follow and I want to take a moment to reflect on the role of Croydon’s integration journey in making many of these a success. Our achievements can only be as a result of direct collaboration; amongst our teams, with patients and local residents and with other health and care organisations across the borough, demonstrating what we already knew - that we are more than the sum of our parts.
Despite these achievements, I acknowledge the issues we continue to face. The NHS, nationwide, continues to operate under significant pressure, and in the year that follows, we will need to respond to the changing state of health of our local people, as well as delivering care within the constraints of a challenged financial and operational position.
However, I remain confident in our ability to navigate these challenges. Our community deserves nothing less, and I am confident that, with the unwavering dedication and collaborative spirit of our NHS teams, we will continue to work to deliver on that promise as we look ahead to 2024-25 and beyond.
Matthew Kershaw
Chief Executive and Place-Based Leader for Health
As Matthew has eloquently highlighted, the 2023/24 financial year has been yet another remarkable one for Croydon Health Services NHS Trust. It has been a privilege to join the Trust Board as Chair during this dynamic period, and I am deeply impressed by the dedication and ingenuity displayed by our staff, partners, and community throughout the year.
Looking back, I share Matthew's pride in the many achievements outlined in his foreword. The Trust's unwavering commitment to delivering high-quality care, alongside its focus on innovation and collaboration, is truly inspiring. As Chair, I have witnessed first-hand the transformative power of these efforts, not only in improving patient experiences but also in fostering a culture of continuous improvement within the organisation.
At the same time, I have had the pleasure of welcoming a number of new Non-Executive and Executive Director colleagues to the Board, bringing a wealth of additional experience to lead and support the borough’s health system.
I know that as we move into the coming year, we will benefit significantly from their knowledge and experience, as well as fresh ideas, robust challenge and oversight, as we oversee the delivery of the Trust’s new clinical strategy and its renewed commitment to tackling health inequalities, whilst maintaining a high quality, accessible and financially secure health system for Croydon.
In 2024-25, we will continue in our efforts to provide the best possible care to Croydon residents, keeping them healthier for longer and caring for them when they need us most.
To progress this work, we are committed to ongoing collaborations with local authorities, community groups, and other healthcare providers to deliver more holistic and integrated care for our population and I know that working across the One Croydon alliance, there is real enthusiasm for this continued growth.
At the same, we need to continue to support and develop the incredibly talented staff who work in our services, prioritising their wellbeing and creating a positive working environment that fosters excellence, compassion and quality care for our patients and for each other.
Finally, we need tackle some of the challenges we will face head on, ensuring we are managing our finances even more tightly and maintaining a sustainable financial position, which allows us to continue delivering high quality care, while exploring innovative ways to improve efficiency and value for money.
This ambitious agenda requires the collective effort of not only our own teams, but all of the colleagues and partners that work alongside Croydon Health Services NHS Trust. I have no doubt that, by working together with purpose, passion, and a shared commitment to serving our community, we can achieve great things in the year ahead.
On behalf of the Trust Board, I express my sincere gratitude to all who have contributed to our success in the past year. I am excited to embark on this journey with you as we strive to build a brighter, healthier future for the people of Croydon.
With warm regards,
Yemisi Gibbons
Chair of the Trust Board, Croydon Health Services NHS Trust
It is our mission to provide excellent health and care for all and to help people in Croydon to live healthier lives. We are working toward achieving this ambition by working together across Croydon’s health and care system to join up the care and support available in our communities, setting objectives by which we can measure our success.
Our one-year objectives are refreshed annually to monitor our progress and priorities to achieving our vision for excellent health and care for all.
Our objectives are clinically-led and community focused to change the way we deliver care and support our staff with five key priorities, in line with our ambitious five-year strategy for Croydon's NHS. In 2023/24, we aimed to deliver the following:
· Review all existing projects tackling health inequalities to ensure their effectiveness.
· Launch four community hubs and six local partnerships run by the voluntary sector, to help prevent ill-health.
· Make progress on our plans to deliver state of the art Community Diagnostic Centres in Purley and New Addington, offering faster access to checks, scans and tests and supporting early diagnosis.
We want local people to feel confident in our care, and for our staff to feel proud to work here. Our values shape everything we do, every single day. They determine our behaviour and the experience of those we look after.
We will always be professional, compassionate, respectful and safe.
Professional
Compassionate
Respectful
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In January 2024, we formally launched the borough’s newest Community Diagnostic Centre, based at Purley War Memorial Hospital., making it easier for residents in the south of the borough who have been referred for diagnostic testing to access to essential health services such as x-rays, CT scans, cardiology and respiratory screening.
Alongside an expansion of existing imaging services, which will support the early identification of serious illnesses such as cancer and heart disease, the Trust can now offer additional services in the community setting, including respiratory screening including asthma and COPD testing and clinics, echocardiography, ambulatory ECG monitoring and blood pressure monitoring.
These additions will not only benefit individual patients but also the wider health and care system, preventing the worsening of existing health issues through faster diagnosis and earlier treatment whilst improving patient experience by reducing the need for residents to travel for essential tests.
A second community diagnostic centre, based in New Addington, is set to open in early 2025, completing the £14 million expansion of community services, forming part of a network of almost 40 in community locations across the country. The opening of this centre is another fantastic step forward as we continue to work to improve the care that we provide to all Croydon residents and address health inequalities.
As part of a £1.5 million investment across the Capital, patients in Croydon living with sickle cell disorders will soon benefit from new life-changing equipment to bolster sickle cell treatment in the borough.
There are around 300 adult patients with sickle cell disorders living in Croydon, of which 183 patients being routinely monitored by the Trust. Of this group, a number will now be able to get the treatment closer to home, thanks to this additional investment in care at Croydon University Hospital.
The equipment helps by automating red blood cell exchanges which reduces the necessity for top-up transfusions, effectively manage pain, and lower the risk of experiencing a crisis. Eligible patients can receive treatment every six to eight weeks.
The funding means that a red cell apheresis service will be established on site at Croydon University Hospital to support patients undergoing treatment and reduce waiting times and intervals between apheresis sessions, increasing the support we can offer locally to our diverse population.
As part of the work of the One Croydon alliance, we have been working to expand our integrated model of care via the Integrated Community Networks (ICN+), which provides a person-centred approach to managing an individual's health.
The networks, which include community nursing teams, social workers, dedicated pharmacists, GPs and the voluntary sector, have been hugely successful since their implementation, with colleagues working in cross-organisation, multi-disciplinary teams (MDTs) to support patients at risk of hospital admission, enable and maintain independence and reduce social isolation.
Over this past year, around 2,700 people were supported through this model and 1,145 people were able to stay in the place they call home, avoiding an unnecessary stay in hospital.
This year, Croydon has recruited a new team of health professionals supporting people who are frailer, usually older people. The team works to support people in both community and hospital settings. They are also working with GP practices to identify and support people to help people stay healthy and avoid their frailty deteriorating.
This year the ICN+ programme has expanded to include dermatology (skin) and anticoagulation services (reducing the risk of blood clots), in partnership with Croydon GP practices. The new way of working for both services provides people with care closer to home and makes better use of clinical time.
Building on these successes, we are working across the health and care system to further develop this model using a neighbourhood based approach.
We are also piloting neighbourhood based huddles with four GP practices based within one of the borough’s primary care networks, to understand the potential impact.
As we move into 2024-25, our focus continues to be on strengthening the engagement between our Trust, community and primary care teams and furthering our understanding of what neighbourhoods mean to them and their patients. We will also be upskilling teams, implementing new systems and ways of working to improve how MDTs work together and proactively support those particularly frail people living in our communities.
Across Croydon, we work closely with local voluntary and community sector organisations, to make the most local community assets and keep residents fit and healthy longer by connecting people with their neighbours and communities.
We have established a Local Community Partnership in each of Croydon’s six localities and through each Community Partnership, local community and voluntary organisations are funded to deliver activities which reduce health inequalities.
This year, five different targeted programmes were delivered including: supporting children, young people and adults to maintain a healthy weight; supporting people with their mental health and wellbeing; and supporting residents to better manage their long-term conditions and stay healthy.
In addition, together the Community Partnerships have established three Community Hubs which see over 2,000 people per year - offering a range of support including housing, benefits advice and health checks and place to meet other people.
Following the successful rollout of The Ethnicity Mental Health Improvement Programme in Wandsworth to address inequalities for black and minority ethnic people in mental health care, partners in Croydon have worked together to co-design a model that works for the Croydon population.
In August 2023, NHS South West London, Croydon BME Forum and South London and Maudsley NHS Foundation Trust launched mobile mental health support in non-clinical settings across the borough working with VCSE organisations including Croydon Health and Wellbeing Space, New Testament Church of God, Centre of Change and Off the Record.
Family Hubs are a new way of bringing together all the support children and families may need from pregnancy through to young people turning 19 years, or 25 if they have a disability. Croydon’s first hub opened in January 2024 in the south of the borough at Woodlands Children's Centre. Another two hubs will launch over the next two years.
In each hub there will be children’s activities for young children and a wide range of support for families with older children. Family hubs are run by services working together to support families, such as health services, the council, and the voluntary and community sectors.
From a population of approximately 1.5 million in South West London, approximately 340,000 residents live in the most deprived 20% of the national population – often referred to as the ‘Core20’ population. In South West London, 50% of this Core20 population live in Croydon.
These residents have lower healthy life expectancy than the rest of the population and are more likely to have multiple long-term conditions.
Working with the South West London Integrated Care Board, we are committed to using local intelligence to identify emerging issues and to monitor changes in health inequalities, healthcare inequalities and health disparities.
This year, a dashboard of outcome measures for health inequalities was developed, to track the progress and impact that our actions are having on our aim to reduce health inequalities. We use this information alongside regional and national data sources to better understand the needs of our population and to detect where there may be widening gaps, for example as a result of cost of living crisis.
South West London’s health management platform, Health Insights, brings together real-time data from health and care organisations across our integrated care system, creating an integrated health and care record for each patient. These are used to create dashboards on different topics, for example long term conditions and vaccination uptake.
All dashboards enable monitoring by different equality dimensions, for example ethnicity, deprivation, gender, age, to highlight inequalities in delivery or care and health inequalities and data can be shown at GP practice, PCN level, provider, borough and ICS level. This has enabled us to better understand the inequalities in our population and to better target our interventions.
This year partners across Croydon made a firm commitment to deliver better care and support to people living with dementia, and their carers, to lead full and active lives.
Croydon’s new Dementia Strategic Plan, published in November, outlines how partners across the borough will fulfil the pledges made to achieve its Dementia Friendly status, which was regained in May 2023. The accolade was awarded by the Alzheimer’s Society, the UK’s leading dementia charity.
The plan was developed by Croydon’s Dementia Action Alliance, which includes the Trust, Croydon Council, Age UK Croydon, other local health and social care services, emergency services, the voluntary sector and more.
The alliance works in partnership with the Alzheimer’s Society and people affected by dementia to make the borough more inclusive for over 3,500 people estimated to be living with the condition. This includes Age UK Croydon’s Memory Tree Café, which offers a range of interactive social activities, information, and advice to prevent those affected by the condition feeling isolated from their community.
Five key themes in the plan demonstrate the commitment to people living with dementia, their families and carers will be actioned – they are:
1. Preventing Well – supporting people to look after their health and wellbeing to reduce the risk of dementia
2. Diagnosing Well – delivering a dementia diagnosis in a timely and compassionate way
3. Living Well – helping people come to terms with their diagnosis and manage their condition
4. Supporting Well – helping people to live as well as possible with dementia in safe and accepting communities
5. Ending Life Well – ensuring those with the condition are able to die with dignity in the place of their choosing.
The Dementia Action Alliance and the Croydon Dementia Steering Group, senior representatives from commissioning and provider organisations, will monitor the progress of the plan across the coming year.
The Sexual Health Services team engaged with thousands of people throughout the year, using population health data to understand where our residents with the greatest need and inequalities were and going to them to have conversations, build trust and offer advice and guidance.
They also provided their popular mobile sexual health service over the summer in various locations in Croydon for young people.
As part of their outreach work, the team attended the Croydon Pride festival in Wandle Park on Saturday (15 July) and then in collaboration with Croydon Council, KWA Africa and other local services, carried out HIV Point-of-care testing, PrEP and delivered STI self-testing kits to many of the local LGBTQ+ partners and wider community.
Easily accessible locations were chosen, along with those in underserved areas of the community, both enabling engagement with a wide range of residents and an opportunity to provide a friendly, confidential, non-judgemental consultation to a number of our young Croydon residents.
The team’s onboard mobile services provided:
· Free condoms – C-Card Scheme
· STI self-test kits
· Advice and support
· Signposting to contraception and further sexual health services
Residents have also been able to meet the team at several community venues including Woodlands Children’s Centre, Woodside Community Hub, the BME Wellness Centre and Croydon Town centre, and after identifying a need for increased services in the southeast of the borough, the team also recently launched their new monthly sexual health drop-in at the Community Hub at the Fieldway Centre, New Addington in March.
Alongside these outreach events, the team have continued to provide relationships and sex education to local schools, colleges and PRUs throughout the academic year. This has allowed them to build a good rapport, creating a safe environment for young people to get the information they need.
A new mental health strategy setting out the ways the NHS in south west London will improve and support the mental health of everyone who lives, works or studies in Croydon, Kingston, Merton, Richmond, Sutton and Wandsworth over the next five years was launched in July.
The Strategy, which will be delivered by the NHS South West London Integrated Care Board (ICB) together with the two local mental health NHS trusts, South West London and St George’s and South London and Maudsley, is the first ICB-wide strategy of its kind in London.
The vision is to make South West London the best place to live for emotional wellbeing, with everyone having access to high quality, accessible wellbeing and mental health services.
Demand for mental health services has increased nationally in recent years, especially for children and adolescents and this demand is being felt in South West London, with a higher proportion of under-18s accessing community mental health services compared to anywhere else in the capital.
The strategy focuses on going further and faster for children and young people, whilst also increasing equity of access, experience and outcomes for all South West Londoners and tackling issues earlier to prevent mental ill health.
In the first year of the strategy, the focus will be on children and young people and embedding the transformation of community services for adults with serious mental illness.
We know that a person’s health is impacted by a number of social, economic and environmental factors and we take our role in minimising the environmental impacts of our work seriously.
The Trust’s Green Plan, published in 2021, outlines the Trust’s commitments to environmental sustainability, social value and the Trust’s role as an anchor institution. Significant developments have been made in 2023/24 against both environmental and social value targets, and progress has been made against many aspects of the NHS Standard Contract requirements.
Among our achievements, highlights include tangible steps to embed carbon reduction. From completing ground floor double glazing at PGMC to fabric upgrades and the installation of Air Source Heat Pumps, the organisation’s commitment to sustainable practices has brought tangible results over the past year.
The Trust secured £1 million in Low Carbon Skills Funding to cover feasibility studies, design and developing a heat decarbonisation plan to support the Trusts’ Public Sector Decarbonisation Scheme (PSDS) application up to RIBA stage 4. A successful application would lead to significant decarbonisation of the Trust carbon emissions and further propels our net zero initiatives, showcasing our dedication to fostering a greener future.
In addressing waste, particularly the elimination of single-use plastic, our catering service has made remarkable strides, achieving a 90% reduction. Additionally, conscientious decisions such as ceasing desflurane usage since January 2023 and introducing reusable theatre hats, as approved by IPC, along with including a 10% weighting for sustainability and social values as part of our procurement tender process underscores the Trust’s commitment to sustainable healthcare practices.
There has been significant input from various Trust departments to support the Green Plan, reflecting the diverse challenges we face both Trust wide and in the wider community. A collaborative effort is key, our plan linking in with the SWL Green plan, aligning with the Croydon Council Carbon neutral action plan, and contribute to the overarching NHS net zero road map.
The numbers show positive progress with a 29% decrease in the organisation's footprint emissions from the baseline year 2013/14 to 2023/24, a testament to our collective commitment to be a more sustainable, greener NHS Trust.
We have cared for more than 200,000 people our urgent and emergency care services in 2023/2024 across our urgent and emergency care services, a similar number of patients when compared to the previous year. However, the seriousness and complexity of conditions that patients have needed treatment for, combined with high bed occupancy and challenges with the flow of patients into, through and out of the hospital, have put pressure on the emergency pathway throughout the year.
This pressure has also been felt across other areas in the NHS, including in primary care and through London Ambulance Service.
We have continued to work hard to attain the reduce the time patients spend in A&E from when they arrive to when they leave the department to be admitted, transferred or discharged, ensuring that wherever possible, this happens within four hours.
Our four-hour performance remained challenged throughout the year, below the national target of 76% of patients. However, we remained comparable to other London Trusts, even during the winter months.
In January 2024, we made a number of small changes within the Emergency Department and across the Trust to support improvements to patient flow and, following improved performance, we achieved the 76% standard by the end of March 2024.
This year, we have again seen an increase in the number of seriously ill or injured patients, including those brought to hospital by blue-light ambulance, or who require life-dependent care and resuscitation. As a result, ambulance conveyances to the Emergency Department have steadily risen from over 7,600 in the first quarter of the year (April – June) to over 8,300 in the last quarter (January – March), making the Trust’s Emergency Department one of the busiest in south west London.
As a result, the Emergency Department has experienced periods of significant demand and patient cohorting has been implemented throughout the winter period, to allow patients to be safely monitored whilst they await further clinical care. We recognise that in many cases, patients will have experienced longer waits than we would like. In order to maintain patient safety during these periods, additional nursing staff have been placed within the Department to care for these patients.
T he number of patients staying in hospital for more than 7 days has increased by more than 20% since 2022-23, from an average of 253 to 285 in 2023-24.
These extended lengths of stay for patients, who are medically well enough to be discharged can be attributed to a number of factors, including the increasingly serious and complex care needs of our patients and the wider social determinants affecting our local population, including those requiring housing support, social care provision or ongoing community care.
This presents a challenge for the Place system with rising demands for domiciliary care provision, provision of accommodation for those experiencing homeless with care and support needs and particularly placement in 24 hour care settings.
To mitigate the increase in long stays, our clinical and operational teams have focused on streamlining processes to speed up the delivery of diagnostic tests or assessment from specialist teams, in order to reduce unnecessary delays to discharge. Further work is underway at both ward and department level to further review our processes and to support the safe and timely discharge of patients who no longer need to stay in hospital.
At the same time, Croydon Health Services NHS Trust has been an active part of the Frontrunner programme, working alongside our One Croydon partners.
A detailed assessment has been completed across Croydon as a place to understand the challenges we are facing. Following this we have developed a Transfer of Care Hub (TOCH) to support those with the most complex health and social care needs to leave hospital and remain supported in the community. This hub is now being implemented and is expected to be fully operational in 2024-25.
We know that the work needed to reduce unnecessary hospital stays extends outside on the traditional acute setting and we are also drawing on the expertise of our community rehabilitation and reablement services, which have been a key part of this planning. As such, we are undertaking a remodelling of these services to improve timeliness of transfer to the community and to support patients to live independently and with reduced reliance on health and social care services.
In order to maintain the safe and effective flow of patients requiring admission through the emergency care pathway and ensure that national performance standards can be delivered, the Trust aims to maintain below 92% bed occupancy. This means that at any given time, up to 8% of the Trust’s inpatient beds are available for new patients.
A sustained increase in the seriousness and complexity of conditions that patients are presenting with has directly increased the number of people requiring hospital admission. As a result, bed occupancy remained higher than the Trust target but steady at around 98.78% throughout our busiest periods.
We have continued to take action to mitigate this wherever possible, using our admissions and discharge unit to support patient flow and reduction in pressure on our Emergency Department.
We have also has also implemented a number of other initiatives, including the launch of a Frailty Same Day Emergency Care service during the winter period to support our frailest and most vulnerable adults. This service offers specialist review outside of the Emergency Department, allowing for the assessment and discharge of 95% of eligible patients on the day they are seen, reducing the need for hospital admission. We will be working with our clinical teams to further develop this model in 2024-25.
Despite the increasing number of patients arriving by blue light ambulance, the Trust has maintained its ambulance handover performance this year. In Autumn 2023, London Ambulance Service implemented a 45 minute handover target, with the aim of ensuring patients are formally handed over to the Emergency Department in a timely manner and to allow ambulance crews to respond to more patients in the community. The majority of ambulance patients conveyed to Croydon continue to be handed over in a timely way, with waits of more than one hour equating to on average 2 patients a day.
As well as increasing our nurse staffing to support this initiative and maintain the delivery of safe care during periods of peak demand, we have further expanded the pathways for our Same Day Emergency Care (SDEC) service.
The service continues to receive ambulances for patients requiring assessment, investigation and treatment without an overnight stay, via the Trusted Assessor Model, which has removed the need for the LAS to call ahead and diverted patients away from the Emergency Department.
Working with our primary care partners, we also provide an Integrated See, Triage and Treat (ISTAT) service within the Emergency Department to reduce waits where possible.
Throughout the year, we have worked to reduce the waiting times for our patients, ensuring that as many people as possible are offered treatment within 18 weeks of a referral. However, we have continued to experience a number of challenges in reducing this number, including the lasting impact of the COVID-19 backlogs and the additional reduction in services as a result of ongoing industrial action. As of February 2024, 71.3% of our patients were seen within 18 weeks, against a national target of 92%.
Throughout the year, our priority has been to reduce waiting times and provide treatment to those patients who have been waiting the longest, as well as those who take clinical priority. We have worked across all specialities to ensure that we have no patient waiting over 104+ weeks and have achieved this target within 2023-24.
At the same time, we have steadily reduced the number of patients waiting longer than 52+ weeks, with the ambition of clearing all waits over 78 weeks. As we move into 2024-25, our work will continue, as we aim to ensure no patients wait more than 65 weeks for care.
There are areas in which our waiting times are particularly challenged; Trauma and Orthopaedics, ENT, Max Fac, Pain Management and Gynaecology. To support improvements in these areas, a centralised validation team was formed to ensure there were standardised processes across all specialties to ensure high quality validation and support to the services to manage their waiting lists, maintaining regular clinical reviews and strong utilisation of our services.
Whilst our position still remains within the top 5 performing Trusts within the Capital, we know that there is more work to do so that our patients receive the care they need, as soon as possible.
The COVID-19 pandemic resulted in a significantly reduced level of diagnostic activity, and since services have reopened to patients, demand has remained high throughout the year for imaging.
To tackle the backlog our teams have looked at additional ways to make sure patients are seen as soon as possible. During the year, this has included increased staffing and evening clinics. In March 2022, our onsite diagnostic services received a major boost with three new MRI scanners at Croydon University Hospital, increasing the Trust’s overall capacity for diagnostic scans and tests in the north of the borough and in south, at Purley War MemorialHospital. A new Dexa unit was also supplied in November, resulting in both MRI and Dexa being compliant against the interim DM01 5% target in 23/24.
Whilst like many NHS trusts, we still have some way to go to fully recover services after COVID-19, we ended the year with 76.54% of patients waiting less than six weeks for diagnostic tests which is 23.46% below the standard. The department have had two X-ray room replacements approved which will be online from Q1 in 2024.
Throughout 2023-24, we have been working hard in a proactive approach to ensure the Croydon community receive high quality cancer care.
We have a dedicated Cancer team who work closely with clinical and operational teams throughout the Trust to ensure we are effectively collaborating and putting the patient at the centre of all we do. This approach has enabled us to see improvements in the national Cancer Wait Time (CWT) performance standards and we are pleased to be sharing our approach with other Trusts both locally and nationally to share learning and help others achieve similar improvements.
Due to an extremely challenged 2022-23 performance, the Trust was placed on Tier 2 monitoring by NHS England. This is a form of monitoring that is attributed to the most under-performing trusts. Understanding that performance is a key quality indicator, the Trust invested in a Director of Cancer to work with the cancer management team to provide leadership and obtain assurance on actions to improve performance in CWT standards.
Improvements have been made to the faster diagnosis standard, which has translated into improved 62 day backlog figures. In real terms, this means that our patients find out if they have cancer sooner and can start treatment within 62 days, improving the patient experience and outcomes.
Once diagnosed with a cancer, patients are given single point of contact with Macmillan Support Officers and Clinical Nurse Specialists as their keyworkers and are supported throughout their cancer treatment journey.
Following a compliant FDS submission in October 2023, the Trust were no longer deemed to require NHS England performance monitoring and were praised by NHS England (London Region) for their improvements.
FDS compliance has been sustained since then,, despite the high levels of seasonal leave and industrial action and preliminary data for February shows CHS at its highest ever submission of 87%.
62 Day backlog and performance has also improved, with the Trust submitting performance of 84.4% in December which is a great improvement on 64.7% at the beginning of the year. The snapshot below shows the position as of March 2024, where the Trust submitted only 16 patients waiting for treatment or diagnosis over 62 days .
Monthly breech panels are held to review all cancer patients that have breached 62 days (waited longer than 62 days for treatment). These cases are reviewed clinically and operationally, with quality and safety teams present. Cases are reported on Radar and action plans are put in place to improve the quality and safety within cancer.
Providing high quality cancer care requires a team approach, strong leadership and accountability – putting the patient at the centre of all we do. Tumour site leads are briefed on their performance through monthly specialty meetings and have access to all quality and performance reports. The Cancer team are currently developing a dashboard which will be accessible to teams and will display live performance against each of the metrics for Cancer Waiting Times.
The year saw the largest industrial action in the history of the NHS, with both junior doctors and consultants amongst those striking in ongoing disputes with the Government over pay.
A total of 13 periods of action impacted the system over the twelve months, with the first ever joint junior doctor and consultant strikes taking place in October 2023.
During the junior doctor strikes, the Trust ran a reduced planned care service to free up our consultants to work where they were needed the most, including supporting our urgent and emergency care services. Similar mitigations were made during consultant strikes, where we ensured key services could operate despite the reduction in staff.
As always, patient safety remained our utmost priority as we continued to support our junior doctors and consultants’ right to strike both as professionals and individuals. Staff from across the Trust went above and beyond during each period of industrial action with our wider clinical teams, including nursing and therapist colleagues, together with those in our pharmacy, admin and corporate teams showing professionalism and compassion to care directly for those with most urgent needs, contacting patients to reschedule appointments and leading teams during the strike action.
Despite our best efforts, industrial action has significantly impacted planned care appointments and although we were able to maintain a higher level of activity during some strike periods, there has been a major impact on the length of time our patients are waiting to be seen for treatment.
Before the strikes began in early 2023, we were leading the way to clear the COVID-19 backlogs and to reduce long waits for planned care, however the number of people now waiting more than a year for treatment in Croydon has almost doubled.
In total, more than 10,000 appointments or procedures have had to be postponed at our Trust since the start of strike action. The financial implications for the Trust are also significant, with each strike costing up to £1 million.
Community services has seen an increase all round in referrals from January 2023 to January 2024. The single point of access service has processed 46,225 referrals. The primary request is for district nursing which has seen 30,758 referrals into their service.
Our d istrict nursing teams have continued to provide high quality nursing care at home for adults who are sick or have a disability or long-term health condition. They work closely with GPs and social services to plan care tailored to meet the individual patient’s health needs.
District nurses provide the following services:
· Management of long term conditions
· Post-operative, traumatic and chronic wound management
· End of life care
· Continuing care assessment
· Specialist nursing equipment for patients with nursing needs
· Diagnostic tests and screening
· Intravenous medication therapy
· Patient education and health promotion- teaching patients and carers to gain skills to
promote self-care and to aid recovery from illness.
· Medicines management, for example teaching self-administration of Insulin
· Nutritional monitoring and management
· Continence management
District nurses have also been working closer with the integrated care networks which includes GP’s, social workers, pharmacists and the voluntary sector. There has been a push to enable multi-disciplinary teams (MDTs) working to try and improve the health of the residents of Croydon and reduce health inequality. There has been an increase in residents taken to the MDTs with positive outcomes for many of the residents and their care network.
The vaccination service has also seen in an increase of referrals year to date there has been a 47% increase on referrals from the previous year, this equates to 3399 requests for Flu and COVID vaccinations with an uptake of 2795 total of vaccinations given. The staff have worked extremely hard to achieve this to ensure that our most vulnerable residents are protected.
Our Rapid Response team are based within the community and aim to reduce the number of avoidable admissions, enabling residents to get the care they need at home safely and conveniently, whilst freeing-up beds for people who need to be cared for in hospital. The team also provide an in-reach service helping within the Emergency Department, Acute Medical Unit (AMU) and Same Day Emergency Care Unit (SDEC) to identify patients who could benefit from care through community services.
The team have also been utilising new technology to care for patients with acute and long term conditions including heart failure hypertension, chronic obstructive pulmonary disease, asthma and long COVID.
If suitable for virtual ward care, patients are trained in how to use a device which sends continuous observations including saturation, heart rate and skin temperature direct to the Remote Monitoring Hub team, who will monitor the data 24 hours a day. If there is a sign of deterioration in a patient, the Rapid Response team will ensure the patient is visited within two hours of receiving a referral.
Since January 2023, 5,029 patients have been cared for by our local virtual ward service, with an average length of stay of 5 days. As a result, over 21,000 hospital bed days have been saved. These patients have not required technology but have required a mixture of daily telephone calls and face to face visits.
There have been an additional 426 patients that have been monitored on technology with a length of stay of 8.5 days and a total length of stay of 3,441 days from January 2023-2024.
The Trust has a number of measures in place to manage and monitor quality-related risks effectively. A comprehensive quality strategy is executed through multiple work streams, with further information available in the Trust’s annual quality account.
Chaired by a clinician Non-Executive Director, the Quality Committee, a sub-committee of the Board, have monthly meetings to monitor performance against annual quality objectives. They are also supported by the Integrated Quality Assurance Group, as well as local Directorate level Quality Governance meetings.
Every year the Trust sets specific quality priorities which are reported in the annual Quality Account after consultation with internal and external stakeholders. Regular reviews against these priorities occur within quality governance structures, including assessments against the Care Quality Commission (CQC) standards under the new single oversight framework.
Quality performance is regularly reviewed across the year to ensure that improvements are consolidated and that any learning is integrated to form as part of a wider quality improvement plan. Our quality metrics are evaluated at monthly performance review meetings and during every quarter, the performance review meetings are chaired by an Executive Director to ensure Executive oversight.
The Trust has an established Clinical Audit programme as detailed in the Trust ’ s Quality Account. The programme aims to drive continuous improvement of services and quality of care. The Clinical Audit Programme priorities in 2023-24 were primarily:
· The National Clinical Audit and Confidential Enquiries Programme
· Mandatory Audits
· NICE Guidance and Quality Standards
· Trust Wide Governance and Risk Audits and
· Local Clinical Specialty level Audits.
The overall monitoring and reporting of Clinical Audit activity within the Trust is established through a range of structures, systems and processes and is led by the Quality Team, supported by Directorate Level Governance.
Controlling and preventing the spread of infection is a constant concern in a Healthcare setting and is one of our top priorities to ensure our patients are safe and protected. This is overseen by the Trust’s Director of Infection Prevention and Control (DIPC) who is ultimately responsible for ensuring that strategies, processes and resources are in place to prevent healthcare associated infections at all levels.
The Infection Prevention and Control team continue to monitor testing and manage of COVID-19 across the Trust in line with national guidance. Despite our best efforts, there were small periods of increased incidents of COVID-19 on some of our elderly care wards. These clusters were contained in one bay and managed robustly which prevented further spread to other areas. The total number of positive cases of COVID-19 from 1st April 2023 – 22nd March 2024 is 1041, of these cases 3 were healthcare workers. Majority of patients who tested positive for COVID-19 were between the ages of 40-79 years.
Patients with confirmed test result for COVID-19 are isolated in a single room to prevent and control the risk of cross transmission to other vulnerable patients. This ensures that any additional precautions required over and above Standard Infection Control Principles (SICP) are followed.
The trust has a side room prioritisation guide which ensures appropriate use of our 65 side rooms, of which 6 are negative pressure. The side room prioritisation guide has been embedded across the Trust. The six negative pressure isolation rooms continue to be prioritised for nursing patients with infections spread by aerosols, such as open pulmonary Tuberculosis.
Direct observations of healthcare workers within the clinical setting are also carried out to monitor hand hygiene practice and compliance. Clinical staff carry out peer hand hygiene audits weekly on the wards and in other clinical departments on monthly basis.
Quality assurance audits are carried out monthly by the Infection Prevention and Control team (IPCT) and results are fed back in real time.
Collated results are included in the Infection Control Monthly Report that goes to all Consultants and senior management teams. The results are then uploaded onto the Tendable App and are reported in the monthly IPC Taskforce, IPC Committee and published quarterly on the IC notice boards.
The NHS Standard Contract 2022/23 includes quality requirements for NHS Trusts to minimise rates of Clostridiodes difficile (C. difficile) infections to threshold levels set by NHS England and NHS Improvement.
The Trusts threshold trajectory for April 2023 to March 2024 = < 19. The total number of C. difficile cases attributed to the Trust is 24, of which there have been 11 Community Onset cases and 13 Hospital Onset HA cases. Unfortunately, the Trust breached this trajectory and detailed root cause analysis of each was undertaken and common themes including lesson learnt were disseminated across all directorates for shared learning.
A Taskforce was also set up in June 2023 to focus on the robust reduction plan including antimicrobial stewardship and environmental issues.
There has been an increase in Measles cases nationally. A total of 7 patients have been confirmed with community onset measles infections at Croydon University Hospital in the last few weeks. The IPC team undertook contact tracing and informed contacts where relevant.
The Measles management flow chart has been updated in line with recent guidance and circulated to all wards including the emergency department. The IPC team continues to raise awareness on early identification, prompt isolation and appropriate use of personal protective equipment.
National guidance advises that all patients with respiratory symptoms should be tested for respiratory viruses on admission to the hospital.
A total of 891 Influenza positive cases since April 2023 were recorded. Most of which were community onset and 54 hospital onset. All confirmed cases needing hospital admission were isolated and managed in line with national guidelines. No outbreak reported.
Monitoring mortality is an integral part of the Trust’s Safety and Governance agenda and reflects the quality of care provided in the hospital. HSMR (Hospital Standardised Mortality Rate), the ratio of observed deaths to expected deaths for a basket of 56 diagnosis groups, which represents 80% of all inpatient deaths is 88.4 for the most recent published period of Dec 22 to Nov 23 and is statistically lower than expected when compare to acute trusts nationally.
SHMI (Summary Hospital-level Mortality Indicator) measures in-hospital mortality performance for all diagnosis groups, and uses ONS data to capture mortality performance for patients 30 days post-discharge and is published by NHS Digital. The most recent SHMI for the Trust for the period Oct 22 to Sept 23 is 105.5, is within the expected mortality range but above the NHS Benchmark of 100. This is due to Croydon’s involvement in the SDEC pilot (which all trusts will join by the end of the year) as acknowledged by NHS England*.
There are no diagnosis groups flagging under both indicators.
*A number of trusts are currently engaging in a pilot to submit Same Day Emergency Care (SDEC) data to the Emergency Care Data Set (ECDS), rather than the Admitted Patient Care (APC) dataset. As the SHMI is calculated using APC data, this has the potential to impact on the SHMI value for these trusts. Trusts with SDEC activity removed from the APC data have generally seen an increase in the SHMI value. This is because the observed number of deaths remains approximately the same as the mortality rate for this cohort very low; secondly, the expected number of deaths decreases because a large number of spells are removed, all of which would have had a small, non-zero risk of mortality contributing to the expected number of deaths.
All staff are responsible for managing risks within the scope of their role and responsibilities as employees of the Trust. There are structured processes in place for incident reporting, and keeping line with national guidance, from July 2023 we adopted a new Patient Safety Incident Response Framework (PSIRF). The new framework's four key objectives are around providing:
PSIRF is a major step towards improving safety management across the healthcare system in England and will greatly support the NHS to embed the key principles of a patient safety culture. It will ensure the NHS focuses on understanding how incidents happen, rather than assigning blame on individuals; allowing for more effective learning and improvement, and ultimately making NHS care safer for patients.
As part of this, the Trust has a clear Patient Safety Incident Response Plan (PSIRP) which articulates the identified patient safety risk profile for the organisation, directing how we improve.
The Trust has a new online incident reporting system called Radar, which is available to all staff. It’s a new system making it easier to manage risks, report incidents, record complaints and PALs enquiries and collect other useful data to provide better insights into the quality and safety of the care we provide to our patients. This system also supports the management of wider Quality Governance and assurance. The responsibility for patient risk management is clearly mapped to all staff, the Trust Board, Non-Executive Directors and Executive Directors, department heads, managers and senior clinicians.
Over the course of the year, patient satisfaction has been monitored through a number of surveys that looking at how we perform in some key areas. It is an opportunity for patients to provide feedback on our service and for the Trust to make improvements based on the results.
The inpatient survey, the maternity survey and the Urgent and Emergency Care Survey have all taken place over the course of this year.
The annual CQC survey of inpatients , those staying overnight in hospital, rated the care they receive at Croydon University Hospital as being 9 out of 10, with patients saying they were treated with dignity and respect.
The survey which covers hospitals nationally scored Croydon University Hospital 7.8 out of 10, which is about the same as the previous year, with more improvements still to be made.
Fewer patients said they knew who to contact if they were worried, putting us below the average of 7.5 and 2 points behind our previous score of 6.6. Many patients are also waiting longer than we would like for hospital admission, showing the pressures on our services.
Overall, we’re placed relatively well compared to other Trusts and we are incredibly proud of the work we do here in Croydon. As we move forward, the comfort and wellbeing of our patients remain our utmost priority, and we are unwavering in our commitment to delivering excellent care for all.
For the 2023/24 Urgent and Emergency Care Survey, the CQC gathered feedback from 36,000 people across England, asking them about the care they had received in NHS Urgent and Emergency services. The survey results showed that people generally had a worse experience this year than last but positively, many patients said that they felt more involved in conversations about their care and they thought doctors and nurses were taking more time to listen to what people had to say.
Patients said they felt listened to and understood by our doctors and nurses. When asked if a doctor or nurse had explained their condition and treatment in a way they could understand, our patients gave a score of 8.1 out of 10. This was above the national average of 7.7, which once again highlights the professionalism and empathy of our healthcare workers here at Croydon.
When asked if they felt listened to, patients gave a score of 8.9, better than the national average of 8.6. Although this number has fallen from 9.1 two years ago, this figure is still an improvement upon our previous surveys in 2016 and 2018.
Patients say they have confidence in our doctors in nurses. Confidence and trust in our doctors and nurses also remained high at 8.4 out of 10 – the same as the national average. Despite being one of London’s busiest A&Es, our patients also felt they had good levels of privacy and dignity, scoring the Trust 8.8 out of 10, matching the national average but a decline on our previous score of 9.4 in 2020.
However, the survey showed where improvements needed to be made. This included shortening the waiting time for patients to be seen by a doctor or nurse, which scored 3.7. This was a continued decline compared to previous years and worse than the national average of 4.9.
Our overall waiting times in A&E were scored 5.6, which is our lowest score since 2016, and yet, we are still above the national average which was 5.2. Nevertheless, with many of our patients waiting longer than we would like, this is an area we are working hard to address.
When asked if doctors or nurses talked about patients as if they weren’t there, we scored 8.2, which is both below the national average, and our usual standard, and is clearly something the Trust needs to work on to improve.
Where there were patients who needed additional support because they spoke a different language, or they had disability needs, our score of 5.7 came in at below the national average, so this has been marked as an area or improvement.
Staff helping patients with their communications needs, with different languages or assistance needed related to disability, also scored below the average at 5.7 and we will be working closely with our teams and collaborating with wider services to see how we can provide further support in this area.
The survey results also highlighted the need for us to do more with our partners in the borough to join-up the care and support available to people after hospital treatment. When asked if health and social care staff had information of their A&E visit, patients appointed us a score of 5, below the national average of 6 out of 10.
The most recent results of the maternity survey were published in February 2024 and the showed that patients who visited our maternity unity were generally pleased with the service they received, however it is clear that there are some areas where further improvements can be made.
Out of the 1,250 patients who were invited to take part in the survey, 30% responded.
It was pleasing to see that 350 of those responding rated their overall experience in our maternity services as 7.8/10. This showed a steady improvement from the Trust’s score of 7.7 in the previous year (2021),
H owever, the survey also highlighted some areas where improvements could be made.
A fewer number of patients than the previous year said they didn’t mind waiting as long as they did for admission, scoring the hospital 7.7 out of 10. This was a sharp decline on the previous year’s figure of 8.0 (2021) but placed the Trust better than the 7.2 average.
But with more patients saying waits are a concern, there is room for improvements although there are concerted efforts continuing across the Trust to reduce delays and improve the experience that patients have when being discharged from hospital after an inpatient stay.
There were fewer patients saying they knew who to contact if they were worried after leaving hospital, scoring 6.6, putting us well below the average of 7.5 and 4 points behind our previous score of 6.0 (2021).
Whilst many patients felt they were given information on what they should and shouldn’t do after hospital (an increase of 1.4 to 8.2 in 2022), an overall score of 8.5 was given, that said they understood the information given to them. This fell by 3 points - below our previous score in 2021 (8.8) and slightly below the average (8.9).
Positively, the feedback from patients was that they generally felt more involved in their own care and there was better communication with the medical staff around them.
When asked if staff explained the reasons for a ward move, our patients gave a score of 6.7 out of 10, and this showed an improvement from 5.8 (2021) and in line with the national average. Many patients also said they were given information about their medicine at discharge (5.2) - an increase from last year (4.4).
Crucially, more patients felt involved in decisions about their care and treatment, scoring the Trust at 6.7, an increase from last year’s score of 6.4. A further score of 8.3 was given to show that many patients felt that their doctors included them in conversations, up from 2021 at 8.0 and slightly below the average of 8.6 score.
Patients also said they felt able to take their own medication whenever they needed, scoring us above the average (8.1) at 8 out of 10.
Patients also felt confident that there were enough staff to support them. When asked if there were mostly enough nurses on duty, we received a score of 7.1, taking us slightly above our previous score of 7.0 showing slow improvements, and putting us in line with the average in the country.
Overall, more patients had confidence in the doctors and nurses treating them – showing a 0.5 improvement for confidence in our nurses compared to 2021, whilst our doctors remained high at 9.1 out of 10 – up 0.2 points on the previous year.
Opening our new Intensive Care Unit (ITU)
In December 2023, our brand new £15m intensive treatment unit (ITU) fully opened to patients, providing 22 new beds for Croydon’s most critically ill individuals.
The facility doubles the space within the unit, allowing patients and their families increased privacy during their care.
As well as transforming the delivery of care for our patients, the new unit provides an improved working environment for our specialist teams who deliver dedicated care for the sickest individuals in the borough.
Doctors, nurses, former patients and their relatives played a key role in the design of the new ITU, which provides more private rooms, an enhanced waiting area and access to a quiet room to support patient families at some of the most difficult times in their lives.
The unit was built over 18 months and is home to the latest cutting-edge technology and equipment required to provide a modern, patient-focused environment, with high-tech facilities and more personal space around bedsides, increasing privacy and dignity for patients receiving life dependent care.
In December 2023, we opened our newly renovated Willow’s Outpatient Department, thoughtfully designed to cater to some of our youngest patients. This modern facility, now home to the children’s department, has provided our patients with a brighter, more child-friendly environment and an expanded space, providing additional consulting rooms and the latest equipment to ensure we are continuing to deliver a high-quality service to the borough’s sickest children.
The new space also aims to improve patient experience through enhanced comfort - thanks to the new-state-of-the-art ventilation and heating system, ensuring a more pleasant atmosphere for our patients and their families. The new department also has a dedicated space for Dramatherapy, as well as two, brand-new phlebotomy areas so patients can get their bloods tests taken after booking an appointment, ensuring more efficient care for our patients who need it most.
The GIRFT programme undertakes clinically-led reviews of specialties, combining wide-ranging data analysis with the input and professional knowledge of senior clinicians to examine how things are currently being done and identify changes that will help improve care and patient outcomes, as well as delivering efficiencies, such as the reduction of unnecessary procedures, and cost savings.
In November we were joined by a team of external reviewers from the NHS England ‘ Get it Right First Time ’ (GIRFT) programme, who visited teams in the Croydon Elective Centre to find out more about the care we ’ re providing to Croydon patients. As a result of the visit, we have recently been awarded the status of Surgical Hub Accreditation for Adults and Paediatric units.
This year, the Trust was named as a National Joint Registry (NJR) Quality Data Provider after successfully completing a national programme of local data audits, thanks to the great work of our Trauma and Orthopaedics team.
The NJR monitors the performance of hip, knee, ankle, elbow and shoulder joint replacement procedures to improve clinical outcomes for the benefit of patients. They collect high quality orthopaedic data in order to provide evidence to support patient safety, standards in quality of care, and overall value in joint replacement surgery.
In order to achieve the award, hospitals are required to meet a series of six ambitious targets during the audit period 2022/23. One of the targets which hospitals are required to complete is compliance with the NJR ’ s mandatory national audit aimed at assessing data completeness and quality within the registry.
The NJR Data Quality Audit compares the number of joint replacement procedures submitted to the registry to the number carried out and recorded in the local hospital Patient Administration System.
Care for our elderly and frail population is changing in Croydon, and in November 2022 our Emergency Department’s Liaison team were amalgamated and reshaped into what has now become the Acute Liaison Frailty Assessment team (ALFA).
The ALFA team care for the frail and elderly patients who arrive in our Emergency Department (ED), working with the patient’s families to perform a comprehensive geriatric assessment in order to safely discharge those patients. They also look at solutions to try and prevent the cycle of readmission that can impact this group of patients.
Under the previous approach, a patient would arrive at our ED, wait a long time to be seen by the right doctor, then go on to be seen by the corresponding service. With their specific expertise, the ALFA team can provide patients with the right medication and the right support services, within a much quicker timeframe than if they had simply stayed in ED. The aim is to then discharge these patients back to their home on the same day, as w hen they are at home after getting the treatment they need, it has been shown that they become more independent and are likely to get back on their feet more quickly, and more importantly, are less likely to be readmitted to ED.
Between 62% and 68% of people that are seen by the ALFA team are discharged again on the same day. Of those, less than 10% of come back to hospital within a 72-hour period. When comparing readmission rates from June to September over the span of 30, 60 and 72 days, the ALFA team have seen lower readmission rates at each of the data points. Plans are currently in place to consider the expansion of the team, as well as creating a dedicated permanent space for them in our ED, as the results show a clear need for this type of service to provide enhanced care for our patients.
Our dedicated community teams have also been actively engaged in raising awareness about frailty throughout the borough of Croydon. This extends not only to colleagues at our Trust, but also across the different agencie s we are working collaboratively with in the One Croydon Alliance, including Age UK, Mind, SLaM, social services, and the local authorities.
Our ICN+ community teams deliver education and training to provide our colleagues and wider collaborative partners with the knowledge and skills necessary to conduct frailty training and assessments. Their primary focus is on enhancing the overall understanding of frailty, emphasising both its identification and management strategies. It's important to recognise that frailty isn't solely a concern within hospital settings; in fact, the majority of individuals affected by frailty reside in their own homes and our community teams play a crucial role in their care.
To foster a comprehensive approach, our ICN+ teams convene regularly at GP surgeries to discuss and co-ordinate complex cases, including those involving frail patients. Through proactive measures, such as Rapid Response initiatives and close collaboration with ICN teams, the work of our ICN+ teams strives to prevent unnecessary hospital admissions, whilst extending support to patients following discharge, ensuring continuity of care once patients are back at home.
We understand the importance of recognising the value in the voices of our patients and communities and engage directly with local people, as well as working with partners in the voluntary sector, Healthwatch Croydon and the South West London ICB to reach into our communities and learn from our patients and residents.
Following the roll-out of our virtual ward patient monitoring service, Healthwatch Croydon talked to people and their carers who are at a high likelihood of being offered a virtual ward placement about their views on the models. The Health Innovation Network led the work and are using the evidence to inform the roll out of virtual wards across south west London.
In Summer 2023, we were also supported by South West London ICB to deliver some targeted engagement to understand the views of local people on a proposed move of a diabetes diagnosis service from the Croydon University Hospital site to a community setting. 26,000 people in Croydon have a diabetes diagnosis and are entitled to an annual retinal screening to prevent sight loss. The engagement showed that the move risked disproportionately impacting those people with protected characteristics and as a result, the Senior Executive Group in Croydon agreed that the risks could not be fully mitigated and paused the proposed move until a more suitable venue could be found.
Our workforce is key to ensuring that we continue to deliver high quality care to our patients in the Croydon community. We are proud of our staff, and without them, would be unable to deliver the standard of care or provide the range of clinical services that we do.
We are committed to ensuring that staff are offered the best experience to help them deliver the best possible care and through our ongoing commitment to provide an improved working environment for our staff.
Our previous NHS Staff Survey results suggested that some significant changes were required to deliver this, and a key commitment for 2023/24 has focused on delivering our People Plan and improving our organisational culture.
Aligning with the NHS People Plan, our very own People Plan focuses on how we should look after each other and foster a culture of inclusion and belonging, as well as identifying actions to grow our workforce, train our people, and work together differently to deliver patient care.
Our People Plan priorities are as follows:
Several initiatives have been launched to support the implementation of these priorities over the past year. These include a new internal temporary staffing service for AHPs and non-clinical staff to address workforce demand challenges; the development of a Living Library where staff share skills, knowledge and good practice; and executing our health and wellbeing strategy to enhance our staff experience.
Creating the right culture is a top priority for the Trust and our senior leaders are committed to ensuring our culture change is embedded for the long term while we continue to work with staff to instil our values of compassionate, safe, professional, respectful and safe within all individuals across the organisation. These underpin the way we all work to deliver the best quality of service.
Focusing on the big issues that impact our organisational culture starts with our leaders. Last May, over a hundred leaders came together to discuss the actions needed to start the culture change. The conversations outlined immediate changes such as a process to allow peer to peer thank you messages, which has now been implemented across the Trust, as well as our long-term goals to ensure that everyone understands our shared vision and their role within it.
The barriers to these improvements were also discussed, including change fatigue, operational pressures and unconscious bias – all of which the Trust is committed to tackling. This commitment was reaffirmed in a dedicated culture workshop held with the Trust Board, in which an increase in the oversight of our culture programme at Board level was agreed.
One of these was the introduction of Board Breakfasts, an intimate, informal way to improve engagement from the Board to the wards and far beyond, inviting small groups of colleagues with varying roles, experiences and cultures to come together and have an open conversation about their time in the Trust. The first was held in November and since then, over 70 staff from both our acute and community sites have participated in valuable discussions with our Chair and Chief Executive.
The Trust’s ‘Compassionate Leaders Programme’ continued in 2024/25, giving Band 5-7 team leaders and junior doctors a safe space to reflect on their leadership styles, learn how to develop their teams and create healthy cultures.
The programme was created after engagement with colleagues during the Race in the Workplace sessions, listening events run in several departments across the Trust, the feedback collected from participants of the Middle Leaders Programme and the feedback provided through the NHS Staff Survey.
75 members of staff took advantage of the course during the year. It was designed by the Learning and Organisational Development Team, based on the latest leadership trends, theories and resources, tailored to the Trust’s unique needs and allows delegates to directly apply their knowledge and skills gained from the course to their local areas.
There is still much work to do with our leaders and wider workforce on our path to a cultural reset at the Trust throughout 2024/25 but listening to our staff, improving how we work together, and developing our people will are all positive steps towards providing culturally competent and compassionate services for each other and our patients.
The results of the 2023 NHS staff survey were published in March 2024, giving a detailed analysis of staff views and experiences of working in the NHS and provides important local information about the experiences of staff working for the Trust.
The results, gathered between September – November 2023 are reported against the seven People Promises as set out by NHS England and demonstrate the areas where we have made progress and are seeing stronger levels of staff satisfaction, whilst also highlighting those areas where we need to make further progress.
Overall, the Trust continued to perform better than 2022 in some areas, including for motivation, team working and empowering staff to feel involved, with results demonstrating that staff look forward to going to work and are enthusiastic about their jobs.
Colleagues also reported that they had opportunities to show initiative frequently and feel that their role makes a difference to patients and service users and at the same time feel supported by some of the processes and systems in place at the Trust, including appraisals, team meetings and shared organisational objectives.
Whilst we have more work to do to support our staff to fully recover from the impact of the COVID-19 pandemic, we are beginning to see some positive changes in self-reported wellbeing scores, with fewer staff reporting that they feel frustrated, burnt out or worn out at work. Indeed, many of our teams felt that the organisation was committed to helping balance work and home life and slightly more staff felt able to achieve this, though there is more work to do to support teams to work flexibly.
However, too many of our staff reported that they had experienced physical violence from patients/service users, their relatives or other members of the public (18%) and we are continuing to take action to reduce this wherever possible. A cross-departmental violence and aggression reduction group has been created and we are working to develop robust policies and action plans, increase staff training and improve our reporting framework to ensure as much support is available to staff as possible.
There was an increased number of staff reporting of violence, harassment and abuse, through our new incident reporting system, but it's known that historically these issues are underreported within the NHS and we will continue to work to understand the full scale of the issue in the coming months and respond to it.
At the same time, staff reported that more needs to be done to support them to speak up about anything that they are worried about, and increasing confidence in the teams that will address their concerns. Since the survey was completed, the Trust has launched a new, independent Freedom to Speak Up provider, allowing teams to raise concerns anonymously and with clear escalation processes in place - feedback of the service to date has been positive.
It's important the Trust continues our focus on delivering high quality services and increasing staff pride in their work, and the work of the whole Trust, in caring for local people. Whilst slightly fewer staff said that they often think of leaving the organisation than in the last survey, this remained lower than the national average, so it's important that the reasons for this are identified, understood and addressed so that aspiring and established talent choose to continue their careers here at the Trust and feel proud to be part of Team Croydon.
We also need to do even more to improve interpersonal relationships within teams and to strengthen our commitment to inclusivity. The continued efforts of the Trust’s five staff networks remains important in supporting staff, educating others and giving our colleagues a voice. They, along with our Equality, Diversity and Inclusion team will be key stakeholders and contributors to the work we are embarking on to transform the culture of the organisation and embed our core values; to be compassionate, professional, respectful and safe.
To address staff feedback, directorate leads will be working with their teams to develop clear action plans to tackle the issues shared and understand the achievements in their area and where they need to make improvements, combining these with our Trust-wide plans to make Croydon a great place to work for all.
Colleagues attended online and face to face staff survey feedback sessions in March and work continues with senior leaders across every Directorate to identify solutions that will support their teams into 2024/25.
The full Staff Survey results can be viewed here.
Croydon Health Services prides itself on being one of the most diverse NHS trusts in London, reflecting its community and the people it serves. We are proactive in our focus and efforts to be an inclusive employer and promote equality and diversity for our patients and staff.
We are committed to promoting and advancing equality of opportunity, celebrating and valuing diversity, eliminating unlawful discrimination, harassment and victimisation, and promoting good relations between all people, including those with different protected characteristics.
The Trust works to promote equality for all by reducing discrimination in employment on the grounds of the protected characteristics covered by the Equality Act 2020.
Workforce Race Equality Standard (WRES) and Workforce Disability Equality Standard (WDES) data highlights the differences in the experience of BAME and White staff, and disabled and non-disabled staff.
Our WRES and WDES submissions contain the experience of staff from the targeted groups, comparing data predominately over the last three years from 2019-2020, 2020-2021 and 2021-2022. The submissions are statutory, annual requirements that are usually submitted in May each year.
The purpose of the WRES and WDES is to highlight the differences in the experience of BAME and White staff, and disabled and non-disabled staff. Our WRES and WDES submissions contain the experience of staff from the targeted groups, comparing data predominately over the last three years from 2019-2020, 2020-2021 and 2021-2022. The submissions are statutory, annual requirements that are usually submitted in May each year.
WRES data, for the most part has improved since last year, evidencing the progress achieved from focused efforts across 2021-2022. However, WDES data has broadly remained the same, highlighting the need for increased targeted efforts and initiatives for the upcoming year.
Although progress is not consistent across the WRES and WDES, the Trust is reflecting on the progress made with WRES over recent years and is developing plans to apply a similar, concentrated approach to improving working life at CHS for disabled staff.
Our workforce is predominantly from the Global Ethnic Majority (G.E.M.) at 63%, overall. White staff make up 32% and 5% are “unknown”. As the largest staff group, Nursing and Midwifery Registered have the highest number of BAME staff (1037 people) but the largest proportion of G.E.M. people are students (75%). Allied Health Professionals are currently the most underrepresented staff group at the Trust in comparison to Trust averages with ethnic minority staff, of 103 (38.3%).
164 members of staff have declared a disability (long-term health conditions are not specified in this data). This is 3.72% of our workforce. In the 2022 NHS Staff Survey, 336 (17.7%) respondents anonymously declared a disability. A total of “unspecified”, “unknown”, “undeclared” or “prefer not to say” is 904 (20.2%). Estates and Ancillary have zero declarations. Creating a safe space to enable colleagues to declare a disability and access extra support if required will be a key area of focus in 2024/5, as well as reviewing our policies and procedures and supporting managers to support staff.
In 2023, we committed to embedding a strong strategic anti-racism approach across our health and care system, acknowledging that the repeated negative experiences of staff from multiple ethnic groups within the NHS arise from embedded policies, practices and processes, many of which have become normalised and unchallenged in our systems; representing (for staff) institutionalised racism.
To tackle this, we have signed up to the NHS England - London Promise, a pledge to become an anti-racist organisation that actively seeks to identify, measure and call out discriminatory practice and to take steps to deal consistently and effectively with poor behaviour where present in any of our staff or organisations. In partnership with NHS England – London Promise ant racism statement, we will;
· Listen and hear when staff raise concerns
· Choose to be curious, humble and considerate and avoid defensive thinking. We will take action where discrimination is evident
· Pro-actively co-design new systems with staff and stakeholders and institute polices, practices and cultural expectations for belonging and inclusion
· Embed a strategic approach to commissioning to help reduce systemic bias, focused on creating the right environment for reducing systemic bias in commissioning that will improve patient care and experience
· Hold ourselves accountable, individually and collectively, as leaders to delivering to these commitments
The Trust will adopt the principles of the anti-racism statement through the delivery of our EDI Strategy and the WRES Action Plan and it will be demonstrated through daily working practices with staff and service delivery to patients and service users.
The success of the Trust’s Recruitment Inclusion Scheme (RIS) initiative has been attributed to the improvement in our WRES metrics for 2022-2023, which showed that the likelihood of white staff are 1.33 times more time likely to be appointed after making an application, compared to Black and minority ethnic candidates. This is a decrease from the previous year where the relative likelihood was 1.43 and evidences our progress to deliver a fair and equitable recruitment process for those applying for roles at our Trust.
Across the year we have increased the number of RIS from 40 to 73 and since the beginning of 2023, we have improved our collaboration with SW London Recruitment Hub, resulting in a robust performance monitoring process. Our objective is that all interviews for posts Band 7 and above have a RIS present and whilst we are close to hitting this target, the short time frame between shortlisting and interview date is identified as a barrier to 100% compliance.
Continuous support for Recruitment Inclusion Specialists is imperative and our EDI team ensure bi-monthly RIS forums are held providing a platform for feedback and discussion of their experience on interview panels.
The positive progress of the initiative in Croydon means that our RIS scheme is held up as a beacon of good practice and is the most successful of all South West London trusts.
Croydon Health Services recognises that staff who feel supported, valued and recognised provide safer patient care. The Trust has shown progress and commitment to developing and maturing their staff networks and these have become a credit and valuable tool for employee engagement within the organisation.
There are currently five staff networks:
· Croydon Ability Network
· LGBTQIA+ Network
· Race Equality Network
· Religion and Belief Network
· Women's Network
Each network operates differently, engaging with staff via local forums and various calendar events.
Religion and Belief Network
Our Religion and Belief Network is intertwined with the overall pastoral care of all staff working for and patients using Croydon Health Services NHS Trust.
In the last year, the forum has focused on some key areas to improve the knowledge and belief of different faiths and beliefs. This has been done through the celebration in the worship centre of key faith festivals including those observed by the Muslim, Christian and Sikh communities.
The Chaplaincy and Spiritual Care Team continue to ensure that the education of faiths and beliefs is available to our staff and that they are included in providing appropriate care to our staff and volunteers at the Trust.
Croydon Ability Network (CAN)
This network is a major resource for all staff with a long-term health condition and/or disability and allies. It offers advice and guidance and signposts colleagues to sources of information and support.
Membership of the group includes representatives of clinical and admin and clerical who action and monitor progress on the various initiatives to raise awareness of the experience and issues faced by staff with a visible or non-visible disabilities and long-term conditions.
In line with our mandatory reporting requirements, the CAN has been working closely with the EDI team to implement the Trust's WDES action plan. Alongside this, the network actively celebrated Disability History Month in November. They also played a major role in the recent launch of the Disability Advice Line and are producing a toolkit for managers to support staff with disabilities.
LGBTQIA+ Network
The LGBTQIA+ Network has been the most active of the networks during 2023/24.
They have held numerous activities for their network members, celebrating LGBT History Month, attending the Croydon Pride festival and supporting our Sexual Health team on World AIDS Day.
The network has helped to introduce important training wider LGBTQIA+ training, specifically around the trans community, and has also raised awareness of gender-neutral and inclusive language and has plans to work with others in the Trust to produce a Transgender Policy.
Their continued promotion of the progress badge scheme, which has 271 members, gives confidence to our patients that our staff are alert to their differences and can be trusted to talk to safely. Further training and support are provided by the network and they are looking forward to representing the Trust at the ever-popular London Pride in 2024.
Race Equality Network
The Race Equality Network (REN) has continued to work proactively to raise the profile of Black and minority ethnic staff at CHS.
They celebrated their first ever South Asian Heritage Month, with a vibrant get together and other cultural activities involving staff across the Trust during the summer. This was followed by the continuation of the long-standing partnership with Croydon Council and the Croydon BME Forum for a successful Black History Month in October.
The network also launched its Tea with REN series focusing on conversations about race, inclusion, belonging and career development, the first of which welcomed our chair Yemisi Gibbons to the virtual floor.
Whilst celebrating diversity the network has not shied away from the difficult issues in the Trust. The Estates and Facilities team were supported by the network to continue its independent equality, diversity and inclusion project, heavily modelled on our Trust-wide Race in The Workplace series that was once again held for staff to attend.
Women's Network
2023/24 was a development year for this network, with new co-chairs settling into position and identifying key priorities of focus. Activities over the year included the celebration of International Women's Day and the organisation of menopause support talks. Spearheaded by health and wellbeing experts, these sessions garnered heartfelt appreciation, emphasising the network's commitment to addressing diverse needs.
Going forward, plans are to:
· Focus on empowerment, support, and professional development, advocating for gender equality in various spheres
· Hold dedicated membership drives.
· Progress a strategic focus on closing the gender pay gap.
Collaborative efforts with the Croydon Training Hub have also commenced, enabling resource sharing and fostering a more robust support system for all involved.
The health and wellbeing of our staff has always been an integral pillar to our workplace, and this has only been strengthened since the expansion of our Health and Wellbeing team this year. The team’s primary focus is on supporting the mental health of staff and their overall wellbeing.
The team do this by providing helpful resources for guidance, including signposting to our Employee Assistance Programme, counselling and interventions to address stress, burnout, and other challenges that health care professionals face - ultimately aiming to enhance job satisfaction and performance while promoting a positive, healthy work environment.
The Health and Wellbeing team continue to visit staff on wards, departments and across community sites to ensure staff feel included, valued and recognised for their hard work and commitment to the Trust.
The Health and Wellbeing team are working closely with key stakeholders to create a bespoke wellbeing strategy to help us continue supporting the wellbeing needs of our diverse workforce effectively. The strategy will focus on encouraging and supporting staff to make healthy lifestyle choices, alongside a proactive approach to supporting staff mental and physical and financial wellbeing through national and local wellbeing support and programmes. The strategy will be rolled out in Spring 2024.
In November 2023 the team held their very first ‘Wellbeing week’, organising a variety of events across the Trust to raise awareness of the importance of self-care, also highlighting the wellbeing support available to staff within the organisation.
The week started with a wellbeing event in the Austin Seminar Room, which saw over 180 staff attend to meet wellbeing experts, offering advice and support around mental, physical and financial wellbeing. During the event, activities on offer included hand reflexology, 10 minute chair massages, mindfulness sessions, healthy snacks and a session with a therapy dog to help staff take time out for themselves. To reach our teams out in the community, wellbeing boxes were also delivered to staff to say a huge thank you for all their hard work and commitment to looking after the community. The week was a raging success, and the team empowered colleagues across the Trust to engage and connect with the many different wellbeing resources and key themes.
In November the Trust was pleased to have launched a new, independent and confidential ‘Freedom to Speak up uardian service. The 24/7 service will ensure a 'Freedom to Speak Up Guardian' is available at all times to provide information and emotional support for colleagues in a confidential, non-judgmental manner.
This will provide staff with an alternative way to raise concerns relating to patient care and safety, whistleblowing, bullying and harassment, and work grievances. Whilst this is not recommended as the first port of call for colleagues who have concerns – it is available to anyone, including those who feel they have been unable to discuss these issues with their line manager, HR or any of our other internal support functions.
We have already seen a positive response to our new Guardian service, with Trust-wide engagement and our local Guardian Jackie, has been actively promoting the service and meeting with teams to foster a positive working environment.
As well as ensuring access to wellbeing initiatives to ensure staff feel adequately supported whilst they are at work, the Trust has a well-developed programme of staff recognition so they are aware that we, as an organisation, appreciate their valuable commitment and contributions.
In March 2024, for the third year running, we celebrated Employee Appreciation Day as a way to develop on building a culture of gratitude amongst colleagues. This year our Health and Wellbeing team conducted walkabouts to connect with employees at their workstations, personally delivering tokens of appreciation in the form of thank-you sweets, taking take time out to say thank you for the work they do. As per previous years, staff were able post their message of thanks on an online interactive digital whiteboard, which received around 50 heartfelt thank you posts.
We understand the importance of employees at the Trust feeling recognised and valued, and that as a result, this can increase staff morale and improve patient care.
The Health and Wellbeing Team have worked closely with the Patient Experience Team and Communications Team to create a way to recognise staff all year around using the Excellence Reporting function in RADAR. Staff will be able to upload this information indicating which Trust value was demonstrated.
A personalised thank you card and badge will be presented to the member of staff and also there will be editable PDF sent to recognise staff not on site at Croydon University Hospital.
Quarterly excellence reports will be prepared and shared with senior leaders to celebrate staff and teams recognised for going above and beyond.
In November we celebrated the commitment and care of just some of our devoted staff members during our annual awards ceremony, giving recognition to the dedicated healthcare professionals who serve our community. With over 200 attendees, the event celebrated individuals who went above and beyond by delivering and supporting exceptional care to Croydon residents.
The high volume of nominations received had exceeded last year’s numbers, showcasing not only the talent in Croydon but also the strong camaraderie between colleagues. With over 700 nominations, shortlisting was tough, and there was a fantastic range of detailed nominations with inspiring stories.
The ceremony recognised winners in several categories including Leading by Example, Team of the Year and Star Behind-the-Scenes. The ever-popular ‘Star of the Year’ category invited nominations from the public, giving patients a chance to thank the staff members who made a significant impact on their lives, including this year’s winner, Occupational Therapist Latoya Doyley, who went above and beyond to save the life of a patient she was caring for in the community.
As well as recognising some of the significant achievements of the borough’s NHS workers, the event served as a celebration of some of our longest serving colleagues who have dedicated over 30 and 40 years’ of their career to the health service, with a special ceremony recognising ‘Long Service’ recipients. With a 450 years combined length of continuous service here in Croydon, we took the time during the Croydon Stars ceremony to thank these colleagues for their dedication to the Trust.
Advancing staff careers has been a key focus of 2023-2024, resulting in increased participation/ over 100 apprentices in our apprenticeship programmes across various roles, from Occupational Therapists to Project Managers. A strategic partnership with South East Coast Ambulance Service has been established to ensure excess levy is spent before expiry, and as of March 2024, 15 paramedics are currently being trained through the Trust’s levy transfer.
In the coming year, we will be introducing monthly roving career clinics to further bolster staff development, specifically at community sites. Additionally, our Accelerated Career Development programme will be relaunched in collaboration with Health and Wellbeing, recognising that career development encompasses more than just interview skills; it is also about building confidence and resilience. Participants will complete four workshops and personal coaching sessions.
The growth of our acclaimed Functional Skills Night School, honoured with the Mayor of London prize for inclusivity, has enabled many staff to seize new opportunities. This programme has provided individuals from Band 2 to 8b with the equivalent of a C grade in Maths and English, essential for university or apprenticeship entry.
Leadership training remains integral to fostering a culture of team performance within the trust. Over 100 colleagues have completed our Compassionate Leader Programme or pursued leadership qualifications up to Masters Level, underscoring our dedication to nurturing leadership talent at all levels. Moreover, our internal programmes now offer accreditation from esteemed bodies such as the Institute of Leadership (ILM) or the Chartered Management Institute (CMI), promoting continuous learning and professional growth.
The establishment of a manned Core Skills Lab within Shirley House aims to facilitate mandatory training and provide support to individuals facing access challenges. This initiative has been enhanced through collaboration with Croydon College and our supported intern project, further solidifying the Trust's position as the largest employer within the borough.
As we move forward in 2024, the Trust is poised to become a training hub for the Oliver McGowan initiative, providing mandatory training on learning disabilities and autism, signalling our commitment to advancing inclusivity and excellence in education and training.
Since January 2024, the Learning and Development team have reinstated face-to-face inductions, with a renewed emphasis on our Trust values as the cornerstone of our learning materials. The half-day induction has garnered excellent feedback from a diverse group of newly onboarded staff members. A new marketplace of additional activity launched at the end of March providing an opportunity for new staff members to connect with essential services, from Freedom to Speak Up Guardians to staff networks, ensuring they have a strong sense of belonging within their first few weeks.
July 2023 marked the diamond birthday of the NHS, and Croydon Health Services celebrated with colleagues and the wider Croydon community during the organisation’s biggest birthday celebrations yet.
To honour the significant milestone of the NHS turning 75, we held a series of exciting events engaging both staff and the community. The celebratory activities included hosting the annual NHS Big Tea garden party, some encouraging words from Croydon Civic Mayor, traditional Mauritian Sega dancers, as well as music by an in-house guitarist from Team Croydon.
Sharing their birthday with the NHS, five frontline staff who together had given 75 years of dedicated service to the health service, also joined the Trust’s celebrations. The staff celebrating their birthday with the NHS demonstrated the wide range of skills and expertise that has helped make the NHS the much-loved institution that it is today, including a doctor, a healthcare assistant, nurse and manager.
Croydon Health Services has collaborated closely with the South West London Recruitment Hub to attract and onboard staff across various departments, ensuring we have the necessary workforce to deliver high-quality care to our patients.
The Capital Nursing programme has been instrumental in welcoming 71 internationally educated nurses since April 2023, with even more expected by April 2024. Additionally, a similar initiative has been launched to attract overseas Allied Health Professionals, further expanding our talent pool.
Domestic recruitment efforts have also produced positive results in several key areas.
The ongoing Theatres Operating Department Practitioners (ODP) Campaign utilises webinars, overseas recruitment, and targeted outreach to newly qualified staff and is making headway towards achieving recruitment goals within the directorate.
We are pleased to report that the majority of our final-year student nurses have been successfully recruited, ensuring a smooth transition into the workforce. Consistent monthly campaigns within the Adult Care Directorate have also led to filling numerous Healthcare Assistant (HCA) vacancies.
Maternity Services saw a successful recruitment event in July 2022 that went on to fill 20 positions. A planning phase is currently underway for a fresh initiative aimed at recruiting midwives. By actively updating our microsite and conducting targeted campaigns, we have filled 20 nursing vacancies and welcomed 103 new HCAs since April 2023.
As a Trust we offer ample support to newly qualified nurses, having made 37 offers and facilitated the onboarding of 30 individuals this year. This includes support for those awaiting registration or requiring exam re-sits. Beyond recruitment, volunteer activity at has doubled this past year through effective collaboration with the Volunteers Services team.
We are actively engaged in an improvement programme to standardise and streamline processes, leading to increased efficiency and improved service quality. Additionally, we are better utilising technology through the implementation of a new Applicant Tracking System (ATS), which is expected to be fully operational within the next year.
The Trust recognises a variety of national unions, each with workplace representatives and stewards covering diverse professional disciplines within the organisation. In cases where workplace representatives are absent, regional Full Time Officers (FTOs) provide direct support to these unions.
Throughout the Trust, these unions are actively engaged with representatives actively participating in crucial meetings and committees where matters affecting staff directly are discussed. These include:
• Joint Staff Consultative Committee (JSCC)
• Health and Safety Committee
• Risk Assurance and Policy Group (RAPG)
• Job Matching Panels
• HR and Staff Side Policy Group
• Equalities Groups, encompassing race, disability, and LGBTQ+ issues
The trade unions and Staff Side work to maintain positive relationships, operating in partnership, to ensure fair and unbiased outcomes for members and wider staff. Staff Side Representatives are involved in pre-consultation discussions to uphold policy adherence and contribute to processes, with a focus on minimising adverse impacts on members.
Unions actively combat workplace bullying and harassment, advocating for the rights of all workers, including women, LGBTQ+ individuals, Black and minority ethnic workers, and disabled workers. A strong union presence can often lead to a better work-life balance and improved working conditions.
Members of unions have the assurance that concerns related to health and safety will be diligently addressed, with representatives advocating for thorough investigations and resolutions. They also benefit from representation and support in sickness reviews, disciplinary cases and hearings, and can seek general advice and assistance from union representatives. There is also support available for members facing financial hardship, particularly due to long-term sickness.
Joining a union empowers individuals to collectively campaign for improved working conditions, fair treatment, and a healthier workplace environment. Each union offers a range of benefits tailored to its members' needs, and as a Trust, we encourage staff to align with the union that best serves these.
The Trust remains committed to providing a safe and secure environment for those who use or work at Croydon Health Services so that the highest possible standard of care can be delivered.
We have a responsibility to keep our staff safe from violence and abuse from work colleagues and patients so that they can carry out their roles confidently, free from harm and intimidation. Therefore, a zero tolerance approach to any physical or verbal attacks continues to remain a priority across our organisation.
The Trust has a duty of care of safeguarding staff from workplace threats and violence. It is imperative that every staff member within the Trust experiences a sense of safety and assurance so they can continue to perform their duties at a high level, free from fear or apprehension. Staff should feel confident that there are robust management procedures and policies in place to ensure that effective action can be taken, should they find themselves in a threatening or abusive situation and in need of immediate help.
The Trust is unwavering in its commitment to maintaining a zero-tolerance stance towards staff being subjected to abusive, violent, and otherwise unacceptable behaviours. To meet the requirements of the Workplace health and safety standards, we have set up a multi-disciplinary steering working group in the trust to identify and implement goals based on policies, measures, procedures training and good practice.
This year, we have also set up a Sexual Safety Charter task and finish group in response to the NHS England recommendation to tackle any unwanted, inappropriate or harmful sexual behaviour in the workplace. Those who work, train and learn within the healthcare system have the right to be safe and feel supported at work.
We are committed to working towards ensuring Sexual Safety Charter principles are in place by July 2024 by promoting a culture that fosters openness and transparency, To do this, we are taking an intersectional approach to the sexual safety of our workforce by recognising that certain groups will experience sexual harassment and abuse at a disproportionate rate, and by clearly communicating the standards of behaviour supported by clear policies and appropriate training.
The Trust is committed to ensuring that no modern slavery or human trafficking takes place in any part of its business or supply chain. The Trust is fully aware of the responsibilities we bear towards our service users, employees and local communities.
We have a zero tolerance for slavery and human trafficking and staff are expected to report concerns about slavery and human trafficking and management will act upon them. The Trust also expects those companies that the Trust does business with to adhere to these same principles. The Annual Statement is discussed at Executive Management Board prior to sign off by the Trust Board.
CHS is reporting 1.4m favourable variance against plan (£1.9m deficit against a revised full year plan of £3.3m). This includes £13.1m additional deficit funding from NHSE/I to support cash flow (this reduced our plan from £16.4m deficit to £3.3m deficit).
The Trust also did better than expected in delivering its ERF plan. Achieving 113% of 19/20 activity against a plan of 108%. This resulted in the Trust receiving an additional £2.9m of income.
The Trust also achieved compliance with other financial targets and in particular performance against the Better Payment Practice Code whereby 95% of invoices should be paid within 30 days. Performance against this target for Non-NHS invoices was 96% and for NHS invoices was 94%.
Capital Investments of £33.9m were made during the year, improving the hospital environment, facilities, IT and medical equipment. Of this £9m was spent on the development of our Community Diagnostic Centre with a total planned spend of £14.6m and £8.6m on our Elective Theatres with a total planned spend of £14.9m.
The Trust prepares its accounts in accordance with International Financial Reporting Standards (IFRS). There have been no significant amendments to the accounting standards in 2023/24 and HM Treasury requirements, so our accounting policies remain largely unchanged.
Croydon Health Services NHS Trust’s annual report and accounts have been prepared on a going concern basis. Non- trading entities in the public sector are assumed to be going concerns where the continued provision of a service in the future is anticipated, as evidenced by inclusion of financial provision for that service in published documents.
In 2023/24, the Trust did not ask for cash support from the DHSC and have a strong closing cash balance of £44.6m. The Trust has a reasonable expectation that adequate resources, from a cash perspective, will be available to continue in operation for at least 12 months from the date of preparation of the 2023/24 accounts.
The NHS’s financial arrangements for 2024-25 will continue to support a system-based approach to planning and delivery across South West London ICS.
The Trust continues to face a significant challenge to manage its cost base within the funding available through a combination of historic savings not achieved, cost pressures and new efficiency requirements. The size of this challenge, alongside pressures in the care system, cannot be under estimated. Clinically led service redesign to address the run rate issue has commenced with a view to delivering 5.5% (£26.4m) efficiency savings in year.
The table below sets out Croydon Health Services NHS Trust’s financial targets, and its performance against these:
|
Metric |
Target |
Performance |
Target met? |
|
Breakeven on revenue and operating costs: |
|||
|
- Control Total |
Breakeven |
Met the agreed deficit target |
Y |
|
- Financial Performance (Breakeven Duty) |
Breakeven |
Breached |
N |
|
- Financial Performance (in year) |
Breakeven |
Met the agreed deficit target |
Y |
|
Keep within the capital resource limit (CRL): |
|||
|
- CRL (included IFRS 16 Lease) |
£31.2m |
Achieved |
Y |
|
Remain within the external financing limit (EFL) |
£42.6m |
Undershot by £33.6m |
Y |
|
Keep within a Capital Cost Absorption Rate (CCAR) |
3.5% |
The Trust kept within the 3.5% CCAR. This has resulted in dividend payments of £5.2m to the Department of Health and Social Care. |
Y |
|
Public Sector Payment Policy |
95% |
96% |
Y |
Where our money comes from
The Trust’s total income has grown by 5.5% from £455.2m in 2022/23 to £480.2m this year, due to additional deficit support of £13.2m and an increase in clinical and other funding £11.9m being largely National Tariff uplift and additional CV Income (including Elective Recovery Fund).
The revenue generated from patient care activities principally comes from the following sources: ICBs for delivery of acute and community patient care activities, NHS England for specialised services and local authorities for acute and community services.
The remainder of the trust’s income consists of other operating income such as the Education and Training income that pays for the training of doctors, nurses and other healthcare professionals – which, in doing so, supports the quality of the care the Trust provides. Other elements include items such as catering, accommodation revenues and income for services provided to other third parties.
| Income | % | £000 |
| Acute care income | 89 | 426,193 |
| Health Education England | 3 | 13,589 |
| Local Authority | 2 | 8,221 |
| Other income | 4 | 17,648 |
| ERF income | 2 | 10,366 |
| Vaccination income | 1 | 4,214 |
The COVID pandemic placed considerable strain on the planned service delivery, which had a significant impact on NHS waiting lists nationally. The Trust was set an initial 2023/24 plan of elective value weighted activity target of 112% of 2019/20, however this target was revised downwards to 108% due to doctor’s strikes. Despite the strikes the trust has exceeded the targets set having finished the year achieving 112.9%, earning an additional £2.9m over and above initial ERF funding in the baseline.
Our Trust’s total expenditure in the year was £493.1m. Staff costs are the largest component of expenditure, accounting for 63% of operating expenses followed by supplies and services and premises costs.
There has been a significant increase in activity to clear the Elective backlog whereby we have delivered an additional 12.9% against a 2019/20 baseline. This has resulted in increased expenditure. Recruitment of staff continues to be a focus for the Trust, with a proportion of efficiency savings for 2023/24 allocated towards reduction in temporary staffing.
| Operating Expenditure | % | £000 |
| Staff costs | 63 | 312,747 |
| Consultancy costs | 0 | 311 |
| Drugs | 4 | 19,704 |
| Establishment | 2 | 11,311 |
| Supplies and Services | 14 | 67,641 |
| Education and Training | 0 | 1,084 |
| Clinical Negligence | 4 | 17,969 |
| R&D Staff Costs | 0 | 688 |
| Patient Transport | 1 | 3,889 |
| Premises | 5 | 23,442 |
| Others | 1 | 3,474 |
| Depreciation | 3 | 12,903 |
| Audit Fees (Int/Ext) | 0 | 141 |
| Impairment | 4 | 17,839 |
The capital programme for 2023/24 continues with the on-going investment in patient care and well-being. The Trust’s 5 year capital plan is focusing to ensure it supports operational pressures and helps to meet the Trust’s missions. The plan ensures best use of available capital resources within the confines of SWL Capital Departmental Expenditure Limit (CDEL). Our investment priorities are to ensure business continuity, meets CQC requirements and invest to save scheme. The key strategic developments included in the plan are linked to clinical service delivery, with each development subject to a Business Case Review Group (BCRG) and Capital Planning Group (CPG)-approved business case.
The Trust delivered a capital expenditure against a Capital Departmental Expenditure Limit (“CDEL”) of £31.2m. The capital programme was funded by £16m of the Trust’s own internally generated resources, £15.2m PDC funding from Department of Health and Social Care (DHSC), and £2.7m of donated/granted capital.
The Trust received capital funding of £14.7m to redevelop its Intensive Therapy Unit (ITU) in August 2021. The work was completed this year and was opened in January 2024.
As part of the initiative to tackle the Covid-19 backlog of elective care, the Trust was awarded £14.9m PDC funding to deliver the Elective hub (Surgical Day Case/ Purley Elective Scheme) for elective recovery in a swiftly manner. Work commenced in the last quarter of 2022/23 and is expected to complete in 2024/25.
The business case for War Memorial Hospital and New Addington Community Diagnostic Centre (CDC) was approved and awarded £14.6m capital funding in November 2022. The scheme forms part of the hub and spoke model for the provision of diagnostic services in Croydon. This case focuses on additional diagnostic capacity with investment in equipment and facilities as opposed to ongoing activity. The scheme has been developed to meet demand and capacity requirements, improve access with focus on areas of higher deprivation, address and reduce identified health inequalities, transform and streamline pathways, enabling more personalised care and improved patient experience delivered from digitally connected, multi diagnostic facilities. The project is expected to complete in 2024/25.
In 2023/24 £8.6m was spent in Estates to address backlog maintenance such as new lift installation, LV sub main distribution, replacement of steam pipe, flooring remedial, and site wide roof repairs, replacement of security equipment, mortuary compliance, decommissioning works and reactive infrastructure works.
The Trust spent £3.7m on medical devices during the financial year mainly on diagnostic equipment refresh sterile services equipment, power tools, defibrillators, Dexa scanner surgical equipment, ultrasounds, and fluoroscopy. Investing in modern medical devices is essential to improve the diagnosis and treatment and care of patients.
The provision of a robust IT infrastructure and effective IT service are critical to the safe running of the Hospital. IT department has spent £3.4m on critical infrastructure services that require stabilisation and remediation to bring them up to a level that can support the requirements of the business in term of increasing capacity, enhanced network monitoring and to minimise cyber-attack vulnerability and enhancing protection.
Demand for capital investment remains high for constantly improve care for patients and invest in new technology, facilities, equipment and research. To best meet this demand the Trust will continue to explore funding opportunities with our charity partners and to review our estate strategy to identify any opportunities to enhance saving and productivity to deliver excellent patient care and future business needs.
In December 2023, we launched our Estates Strategic Framework, outlining our ambitions for the estate used to deliver healthcare in Croydon over the next five years, aligned to our borough-wide NHS clinical strategy.
As well as looking at the traditional hospital footprint, this framework provides an overview of the opportunities across Croydon’s community, mental health and primary care facilities, as well as considering the requirements of the support and administrative functions that underpin our services.
A more strategic approach to the use of our NHS sites offers a number of benefits; improving utilisation of spaces and increasing efficiency, whilst also making the most of the funding we have available to us. As a result, we can focus on investing in the areas where there is greatest need, whilst also working to tackle our site maintenance backlogs and ensure the continued provision of safe, high quality care both within the hospital and across our community, primary care and mental health services. The framework also explores investing in our people to grow internal talent whilst sustaining our workforce, a key objective of the Trust.
Over the next five years we will seek to deliver on these ambitions, creating an environment that supports our ambitions to deliver joined up care, supports flexible working and provides a sustainable infrastructure, using this framework as our guide.
This year, we spent over £4 million addressing backlog Estates maintenance, to ensure the continued safety and sustainability of our services. These works, delivered by in-house teams and specialist contractors, included the completion of vital lift repairs, flooring and roofing repairs and improvements, the replacement of security equipment, decommissioning and reactive infrastructure works.
We have also invested over £135,000 to make improvements to our mortuary, following an audit by the Human Tissue Authority (HTA) which recommended the need for additional space, alongside greater governance and supportive staff development and training.
In Croydon, we are committed to further developing as an anchor institution and believe that we have an important role to play beyond the delivery of health and care. We employ over 4,800 people, making us one of the borough’s largest employers and have a responsibility to contribute towards the success of our diverse local communities. We proactively engage with our community partners and people to collaborate on projects, bringing about real and positive change.
We train doctors, nurses and health professionals, not just in Croydon, but from across the capital. Increasingly we are also working with local schools and universities to grow talent and the workforce needed in healthcare, as well as working with local businesses to open doors with new routes to employment.
South West London Integrated Care Partnership continued to invest in local communities with a budget of £5million invested across two financial years until March 2025. This will be targeted to support delivery of the Integrated Care Partnership’s strategic plan and priorities.
80% of the fund will be allocated to supporting the ICP Workforce priority with the remaining 20% allocated to remaining ICP priorities and cross cutting themes, including health inequalities.
The Health Inequalities Fund, a total of £4.3million across South West London, has been awarded by NHS England to tackle health inequalities across South West London. This will be distributed with 75% of funding to continue existing schemes and 25% for new schemes.
For both funds, organisations and groups across the system are working together to identify projects and prioritise applications from Croydon with proposals focusing on developing our workforce, increasing support for young people and working more closely with partners in Croydon and South West London.
Croydon place forms an important part of the South West London Integrated Care System, which operates across 6 local authorities – Croydon, Kingston, Merton, Richmond, Sutton and Wandsworth. These six places work closely with NHS providers, Local Authorities, Primary Care, the voluntary sector and local communities to deliver on the key purposes of place:
Croydon is the largest of our South West London boroughs in terms of population and second largest in London and is also the South West London borough with the widest health inequalities, these are unfair differences in health and health outcomes. 50% of the most deprived South West London residents live in Croydon and 40% of residents who are most likely to have physical and mental health conditions.