About us>>Annual Report>>Section 4: making the most of every pound we spend

Section 4: making the most of every pound we spend

2007/10 objective: achieving the best value from our investments and resources

Barts and The London has an excellent financial record, making small surpluses in 2005/06 and 2006/07, and breaking even in the previous five years.   But, in common with all NHS organisations, we need to continue to identify savings and become more efficient to fulfil the ongoing national requirement to deliver efficiency gains.

Making the most of every pound we spend

Our Best Value programme produced significant savings in 2006/07 and continues to address the challenge to become more efficient. We also aim to make the most of our charitable income and, as we plan for foundation trust status (click here for more information), we will need to ensure we make the most of the financial freedoms that come with being an NHS foundation trust.

At the same time, unprecedented capital investment in new hospital buildings and IT infrastructure will lead to greater efficiency in the longer term, freeing up more of our budget for direct patient care.

Delivering best value to patients

Barts and The London’s Best Value programme, launched in January 2006, aims to ensure we deliver high quality services with the best possible value for our patients.

Newly refurbished premises for clinical services opened in The Royal London's Alex Wing in December 2006
Newly refurbished premises for clinical services opened in The Royal London's Alex Wing in December 2006

Benchmarking ourselves against international best practice, we have redesigned a number of care pathways leading to improvements in the quality of services and patient experience, as well significantly reducing costs. This work is led by a multidisciplinary group, including doctors, nurses, senior managers and union representatives.

In 2006/07, we reached our target for the year with cost reductions of £26.2 million. Building on this, work is now underway to further reduce our costs by £26.8 million in 2007/08 as part of our ongoing service improvement programme.

Streamlining patient pathways

Redesigning patient pathways is one example of how new ways of working can make a real difference to patient care at the same time as reducing costs. Barts and The London has lowered the amount of time patients spend in hospital and the number of separate visits they have to make, cutting half a day overall from the average length of stay for inpatients. This is better for patients, most of whom do not want to stay in hospital any longer than they have to, and frees up beds for other patients, enabling them to be treated more quickly. 

More of our patients now come into hospital on the day of their operation for elective surgery rather than a day or more before, which has reduced the number of people who would otherwise have to be admitted as inpatients. Improved surgery scheduling means there is better use of surgical teams and theatre space, less wasted time and fewer delayed or cancelled operations.  At the same time, better discharge processes mean patients are able to leave hospital as soon as they are fit.

Pre-admission clinics prepare patients for surgery

Most elective surgical patients at Barts and The London now attend a pre-admission clinic before their operation, which helps improve patient pathways, shortens hospital stays, reduces infections and uses fewer hospital resources.  Held a few weeks before a patient is admitted, they offer a one-stop shop, preparing patients for their surgery, ironing out any medical problems and identifying the need for specialist equipment. Although well-established for orthopaedic patients, the clinics are now increasingly used by other specialties such as vascular, urology, general and neurosurgery at The Royal London and for plastics, ENT, and urology at Barts. 

World-class new hospitals 

An artist's impression of the new hospital at The Royal London - most of the new buildings will be ready by 2012 in time for the Olympics
An artist's impression of the new hospital at The Royal London - most of the new buildings will be ready by 2012 in time for the Olympics

Unprecedented capital investment in our hospitals promises to give us world-class building infrastructure to match the clinical quality of our services. The £1 billion programme will transform Barts and The Royal London hospitals, providing brand new healthcare facilities for our current population and the thousands of people who are expected to move into the area as part of the Thames Gateway redevelopment, as well as those who will visit east London when it hosts the Olympics in 2012.

Once complete, the new eight-storey facility at Barts will house the majority of our flagship cancer and cardiac services, including those currently based at The London Chest Hospital, which will transfer at the end of the main construction programme in 2014.

At The Royal London, which is largely being rebuilt, most clinical services, including London’s leading trauma and emergency care centre, one of the UK’s largest children’s hospitals and one of Europe’s largest renal units, will be housed in two purpose-built towers, which are expected to be complete in 2012 in time for the London Olympics. London’s air ambulance will operate from the top of one of the new buildings. Other elements of the redevelopment are due to be finished in 2016.

Clearing the ground for Britain’s biggest new hospital development 

Work began in ernest on the £1 billion new hospitals programme in May 2006
Work began in ernest on the £1 billion new hospitals programme in May 2006

The redevelopment of both Barts and The Royal London began in earnest in May 2006.  More than 180 construction workers are now on site to transform the two historic hospitals. Dramatic progress has already been made, with the first-phase demolition of old buildings now complete and the foundations being laid for the new buildings on both sites.  Practical measures, including special acoustic screens and modern demolition techniques have been deployed to minimise the impact of building work on clinical care and to ensure patient, staff and visitor safety. 

Showcase facilities open for clinical services

An early milestone in the main new hospitals redevelopment was reached in December 2006, with the transfer of three wards into newly refurbished premises in Alex Wing at The Royal London, providing better facilities for patients and staff.  Two floors in the wing, which previously housed offices and laboratories, have been reconfiguredas clinical departments. Designed to similar specifications as those for the new hospitals, the new wards include more privacy for patients, along with separate treatment, interview and staff rest rooms.

Children give their views onnew indoor garden

Young patients at The Royal London and local schoolchildren contributed ideas for a colourful indoor garden area for the new children’s hospital, which will occupy three dedicated floors in the new towers, including a space on the seventh floor for children to play and relax in a controlled and safe environment.  Specially commissioned workshops generated a range of interesting and quirky designs – including a maze, jungle area and small football pitch – the best of which will now be presented to architects and designers to help inform the new hospital design.

Time capsule discovered at Barts

A time capsule discovered during construction work for the new buildings at Barts is now on display in the hospital's museum
A time capsule discovered during construction work for the new buildings at Barts is now on display in the hospital's museum

Construction staff at Barts discovered a rusting time capsule as they prepared to demolish Queen Mary Wing.  Buried after a ceremony led by Queen Mary on 17 September 1921 to commemorate the start of work on the hospital wing named in her honour, the capsule contained an artist’s impression of what the finished building would look like, a programme from the foundation stone ceremony, a treasurer’s report from 1919 and a newsletter from the League of St Bartholomew’s Nurses. The time capsule is now on display to the public in the Barts Hospital museum.

Investment in IT infrastructure

Preparations are gathering pace for the development of the NHS Care Records Service (CRS) across Barts and The London, an important strategic initiative representing a major investment in technology for the future and bringing, over time, significant improvements to the speed, safety and quality of patient care and treatment.

This will be the biggest change to how patient information is handled at our hospitals and will allow us to replace our current system with an IT platform that will put in place the foundations for a fully integrated healthcare information system with a single electronic care record for every patient.

We expect to be one of the first teaching hospital trusts in London to go live with Cerner’s ‘Millennium’ system as part of the National Programme for IT. This will initially provide us with a new patient administration system – including inpatients, outpatients, bed management, correspondence and patient tracking – as well as new systems for A&E and maternity, requesting and results, a theatre booking system and management reporting. The system will also be compliant with Choose and Book technology, enabling us to receive electronic patient bookings directly from GPs.

Revolutionary new imaging system

The Picture Archiving and Communications System (PACS) is trandforming how staff view, analyse, store and share medical images
The Picture Archiving and Communications System (PACS) is trandforming how staff view, analyse, store and share medical images

In November 2006, Barts and The London launched a £5 million imaging system that transforms the way staff view, analyse, store and share medical images.  The Picture Archiving and Communications System (PACS) means that instead of using traditional film, all new radiographic images are stored centrally on an electronic database. 

Clinicians can now access medical images almost immediately, either at specialist workstations or on networked PCs across all of our hospitals.  This enables more efficient diagnosis and treatment of patients and means that images can be shared when specific cases are discussed at multidisciplinary meetings.  The introduction of digital images has removed the need to print on film and to file or distribute new radiographic images manually.

IT team offers nationwide support 

Barts and The London became the first hospital trust in England to win accreditation to provide expert IT support to NHS organisations nationally in February 2007. 

The accreditation allows the team to offer 24-hour frontline support services for National Programme for IT (NPfIT) applications such as Choose and Book, the NHS Care Records Service and the Picture Archiving and Communications System, at the same time as continuing to provide round-the-clock services to more than 20,000 IT customers in east London. 

A partnership for excellence – charitable giving at Barts and The London

Charitable giving has always played, and will continue to play, a vital role in the NHS, helping to provide state-of-the-art facilities, equipment and services beyond the basics, supporting research and ensuring the best possible standards for our patients.  All of our hospitals benefit from financial donations and voluntary support from people both locally and further afield.  All charitable donations are held by the Barts and The London Charity (formerly St Bartholomew’s and The Royal London Charitable Foundation) who work in partnership with hospital staff to fulfil our mission of bringing excellence to life. 

Generous support from Barts and The London Charity

Hospital staff contributing to our charity appeals
Hospital staff contributing to our charity appeals

Barts and The London Charity administers the charitable funds and legacies of all three of our hospitals to assist us in our work, support innovation and improve the quality of patient care. The funding provided by the charity is enhanced by the charitable donations and legacies it receives each year.

New grants in 2006/07 included  £2.1 million for a cardiac MRI scanner, due to be commissioned during 2007/08 at The London Chest, and more than £1 million for new facilities for children’s critical care at The Royal London, which  has greatly enhanced the quality of services and the number of patients who can be treated (click here for more information).

Work is also well underway to create a new adult bone marrow transplant unit in East Wing at Barts, using a £3.3 million grant from the charity.  The unit will use filtered air and positive pressure to prevent external air from coming into areas where patients with low resistance to airborne infections, such as those undergoing bone marrow transplants, are treated.  

Hospital staff contributing to our charity appeals this year included cardiologist Dr Andrew Deaner, who completed a 1,000-mile cycle ride with West Ham United chef Keith Ross, whoose life was saved by Dr Deaner following a heart attack
Hospital staff contributing to our charity appeals this year included cardiologist Dr Andrew Deaner, who completed a 1,000-mile cycle ride with West Ham United chef Keith Ross, whoose life was saved by Dr Deaner following a heart attack

In addition, new grants totalling £600,000 are supporting the procurement of other medical equipment and improvements to clinical departments and other initiatives to ensure our hospitals retain their unique character and traditions. At the same time, the charity supported staff training, development and counselling so that Barts and The London can attract and retain high-quality staff to maintain our tradition of excellence. 

The charity continues to provide support for leading-edge high quality research.  In the past year, several individual researchers as well as large-scale research programmes have been supported.  This helps the Trust and  Barts and The London, Queen Mary’s School of Medicine and Dentistry to remain at the forefront of evidence-based medical intervention and attract leading specialists to work in our hospitals and at the medical school.

Current fundraising appeals

Every year, many patients, local people, charitable trusts and companies help us raise money to make a difference to the care provided in our hospitals. We are particularly grateful to HRH The Duke of Gloucester, Royal Patron of Barts and The London Charity, for his continuing interest in and support for the hospitals.

The dedicated fundraising team at Barts and The London Charity advises donors about how they can support aspects of our work of particular interest to them.  There is a fundraising office at or near each hospital. The fundraising team works in close partnership with our hospital staff to develop the current priority appeals or to identify how charitable donations can be best used to support the well-being of patients and staff.

Last year, the charity’s fundraising team focused on three priority appeals, which provide a range of options to donors.

  • Barts and The London Children’s Hospital: We offer some of the very best children’s care in the country (click here for more information) and, in four years’ time, a dedicated new children’s hospital will open as part of the redeveloped Royal London.  The charity’s Critical Care appeal aims to raise funds to buy life-saving equipment for our children’s critical care unit and to extend and improve the children’s A&E department.
  • Heart Cells research: A major study into a potentially revolutionary treatment for heart disease, led by clinicians from Barts and The London Heart Attack Centre, takes adult stem cells from a patient’s own bone marrow and injects them directly into the patient’s heart to determine whether the procedure is effective and should be made available to patients in the UK.

    The charity and their partner fundraisers, the Heart Cells Foundation, hosted a series of events last year to raise funds, including a highly successful gala film screening of Casino Royale and the Barts and The London Charity Winter Ball.
  • Cancer care and research: In the last year, donations to the Cancer Care appeal have helped to establish accommodation at Barts for patients who can receive treatment in a day-care setting, but might require an overnight stay (click here for more information).  Appeal funds have also been used to improve the hospital environment and to enhance ward facilities.

How you can help

Barts and The London Charity’s fundraising team can advise on how best to support our various appeals, whether you are an individual, a company or a trust and whether you are looking to take part in an event, need help organising your own fundraiser, or wish to make a one-off or regular donation. The fundraising team can advise individuals and companies how to make a gift go further by using tax-effective giving.

To find out more about Barts and The London Charity, please call 020 7618 1717 (general) or 020 7618 1720 (fundraising), e-mail appeals@bartsandthelondoncharity.org.uk or visit

www.bartsandthelondoncharity.org.uk.