Delivering outstanding care, every time · Surrey, Sussex and beyond. We will strengthen and...

Delivering outstanding care,

every time Our strategy

for 2019-2024

2 Delivering outstanding care, every time – our strategy for 2019-24

Delivering outstanding care, every time – our strategy for 2019-24 3

We are delighted to introduce St George’s University Hospitals NHSFoundation Trust’s new strategy for 2019-24. This document sets outour ambition to provide outstanding care, every time for our patients,staff, and the communities we serve. It also lays the ground for how weplan to go about achieving this ambition.

This strategy has been shaped by many, withmore than 500 people attending 26engagement events over the past sixmonths.

This period of listening and talking todifferent people has been so important, andwe are grateful to those who have sharedtheir honest views about St George’s, and theservices we provide; including what we dowell, and where we need to improve.

Despite the challenges of recent years, thedesire of everyone for St George’s to succeed– and aspire to great things – has comethrough loud and clear. The support we’vereceived is a key part of our improvementjourney.

The end result of these conversations is astrategy that builds on our strengths, and theprogress we have made in recent years –while also setting out a roadmap for the nextfive years, and priority areas for developmentand investment.

The NHS is undergoing a period of change,with the Government’s recently publishedLong Term Plan for the health service re-setting accepted norms in healthcaredelivery that will, in many cases, lead toradical changes to the way in which serviceshave traditionally been delivered.

Our new strategy takes account of this newnational agenda to deliver more care closerto where people live, and using technologythat would have been unimaginable whenthe original St George’s Hospital first openedits doors on Hyde Park Corner in the 1700s.

Our strategy is founded on four keypriorities; providing strong foundations,delivering excellent local services, closercollaboration and offering leadingspecialist healthcare. This documentdescribes these priorities in more detail, andwhat we need to do to realise theseambitions.

Many of the long-standing issues we face –including our ageing estate at St George’sHospital, and fragile information technologyinfrastructure across all our sites – will not besolved overnight; and delivery of our strategywill be dependent on our ability to targetinvestment in these key, fundamentalaspects of patient care.

It is also important to our 9,000 staff, whoregularly go above and beyond to deliversome of the best care and treatment bothnationally, and internationally. However, wemustn’t rely on this good will, or thewillingness of staff to continue to work in oldbuildings using outdated technology. A bigpart of championing our staff is making theirworking lives easier, and this is a runningtheme through our new strategy.

These are challenging times for the NHS butwe remain optimistic about the future. Byshaping what we do, and how we engagewith partner organisations, our new strategywill bring us closer to delivering outstandingcare, every time for our patients.

Introduction


Contents

6 Executive summary

9 Context About St George’sThe national and local contextEngaging with staff, patients and stakeholdersStrengths, weaknesses, opportunities and threats

15 PrioritiesSTRONG FOUNDATIONS: an organisation with strong foundations, providing outstanding care, every timeEXCELLENT LOCAL SERVICES: a provider of excellent local hospital services for the people of Wandsworth and MertonCLOSER COLLABORATION: a leading partner in delivering joined up, sustainable healthservices for people across south west LondonLEADING SPECIALIST HEALTHCARE:a provider of leading specialist healthcare for the people ofsouth west London, Surrey, Sussex and beyond

33 Implementing our strategy

35 What this means for individual services

“Our new strategywill enable us todeliver outstandingcare, every time for our patients.”

Delivering outstanding care, every time – our strategy for 2019-246

Executive summary

St George’s is a great organisation, with a proud past, a world-class offering for patients today,and a bright future.

Our new strategy will ensure we continue to meet the demands of the populations we serve –and provide staff, patients and key stakeholders with clarity about what we want to achieve as anorganisation.

Our visionOur vision is to provide outstanding care, every time for patients, staff and the communities weserve.

How we will achieve thisOur new strategy will help us realise this vision, while also tackling the significant financial,workforce and estates challenges that we – like much of the NHS – face.

Our strategy is based on four key priorities. These are:

STRONG FOUNDATIONSWe will be an organisation with strong foundations, providing outstanding care, every time.We will ensure we have the fundamentals in place, including a culture of quality improvement. Wewill provide the right care in the right place at the right time; invest in our staff; balance our booksfinancially; upgrade our buildings and hospital estate; and improve our digital infrastructure.

EXCELLENT LOCAL SERVICES We will be a provider of excellent local hospital services for the people of Wandsworth andMerton. We will seize the opportunities identified by our patients, staff and partners to offerplanned care (such as outpatient appointments) that is designed around the lives of our patientsand delivered using the latest technology; and offer more same day emergency care, so that morepatients can be seen, treated and discharged without needing to be admitted to a hospital bed.

CLOSER COLLABORATION We will be a leading partner in delivering joined up, sustainable health services for peopleacross south west London. We will work more closely with our local GPs, community services andother hospitals in the area to ensure that patients get the right care in the right place at the righttime. We will also work in partnership to respond to the changing needs of our ageing population,and help support the financial sustainability of the wider NHS.

LEADING SPECIALIST HEALTHCAREWe will be a provider of leading specialist healthcare for the people of south west London,Surrey, Sussex and beyond. We will strengthen and develop our specialist services, working inpartnership with other Trusts across south west London and beyond. Crucially, this will involvecontinuing to be the major trauma centre for the region, and acting as a major centre for cancer,children’s and neuroscience services. We will continue to develop our growing strength inresearch. We will also continue to play a key role in training the next generation of clinicians, inpartnership with St George’s, University of London.

These are the priorities that will drive what we do, and inform the key decisions we take, for thenext five years; and they are set out in more detail on page seven.


Our vision is to provide outstanding care, every time for our patients, staff and the communities we serve.

We will do this through four priorities. The graphic below setsthese out, as well as the detailed actions we will take to achieveour vision of providing outstanding care, every time.

STRONG FOUNDATIONS

EXCELLENT LOCAL SERVICES

CLOSER COLLABORATION

LEADING SPECIALIST HEALTHCARE

A provider of leading specialist services for the people of south

west London, Surrey, Sussex

and beyond

• We will continue to be the main

provider of specialist services

for our region, including as the

major trauma centre

• We will be a major centre for cancer,

children’s and neuroscience

services

• We will pursue commercial

opportunities that enable us to invest more

in NHS patient care

• We will develop tomorrow’s

treatments, today, through innovation,

research and training

A partner in delivering joined up, sustainable health services

for people across south west

London

• We will work with our partners

to provide care closer to home

• We will work with neighbouring

hospitals to ensure patients get

the right care, in the right place, at the right time

• We will work collaboratively to

meet the changing needs of our ageing

population

A provider of excellent local

hospital services for the people

of Wandsworth and Merton

• We will provide planned care

that fits around our patients’ lives,

using the latest technology

• We will provide more same day emergency care

An organisation with strong foundations

that provides outstanding care,

every time

• We will provide outstanding care,

every time

• We will provide the right care,

in the right place, at the right time

• We will invest in our staff

• We will balance the books and

invest in our future

• We will improve our buildings and

hospital estate

• We will ensure our staff and patients have access to the digital technology and information they need, when and where they

need it


The context

St George’s is a great institution, with a proud past, a world-classoffering for patients today, and a bright future.

The original St George’s Hospital first openedits doors in the 1700s, and has made asignificant mark on the practice of medicineworld-wide in the three centuries since, fromthe development of the world’s first vaccineto the world’s first ever computedtomography (CT) scan on a human being.

Today, St George’s is one of London’s biggestand busiest hospital Trusts. We provideservices out of two main hospital sites (StGeorge’s Hospital in Tooting and QueenMary’s Hospital in Roehampton), as well ashealth centres, GP surgeries, schools andpeople’s homes.

9,000staff

Each year atSt George’s:

Serving a population of

3.5 million peopleacross south west London, Surrey, Sussex,Hampshire and beyond

5,000babies born

150,000people seen in our emergency department

50,000planned operations

650,000outpatientappointments

50,000patients admittedfor unplanned care


St George’s Hospital is one of four majortrauma centres in London, and home tohyper acute stroke and heart attack centres.

In addition, we are also:

• a major centre for cancer services:St George’s Hospital is one of only twodesignated children’s cancer centres inLondon, in partnership with the RoyalMarsden, and one of the largestcentres for cancersurgery/chemotherapy in London

• one of London’s biggest children’shospitals: We are home to one of onlyfour paediatric trauma units in London,the only paediatric intensive care unitin south west London, in the top threecentres for specialist paediatric surgeryin London,1 and a centre of excellencein fetal medicine

• a major centre for neurosciences:We are the third largest centre inLondon for neurosurgery and thesecond largest centre in London forneurology2 – offering innovative newtreatments for patients, such as thecountry’s first 24/7 mechanicalthrombectomy service, surgicallyremoving blood clots from the brain forpatients who have had a stroke.

Our clinical teams also have growinginfluence in research, with more clinical trialsundertaken during 2017/18 than ever before,benefitting from St George's, University ofLondon being co-located on the St George’sHospital site in Tooting.

This means that we have a huge amount tobe proud of – and we can be optimisticabout what more St George’s can achieveover the next five years.

Our changing population, andnational and local priorities forthe NHS, need to shape ourfuture direction However, the population we serve, and thepriorities of the wider NHS, are changing.

Across England, the population is ageing,with the result that the NHS has to meet theneeds of more patients who are sometimesfrail, who are more likely to develop cancer,and who often have one or more long-termconditions such as diabetes or dementia.

Wandsworth and Merton are both relativelyaffluent boroughs, despite pockets ofdeprivation, and their populations are alsorelatively young. Nevertheless, that nationaltrend also applies here.

The way we live is also changing – the foodwe eat, the activity and work we do, the waywe interact – and that also means differentchallenges for the NHS. More than half ofadults in Wandsworth and Merton are nowoverweight or obese.3 Again this means thatthe NHS needs to meet the needs of morepeople with cancer or long-term conditionssuch as diabetes.

Public awareness and concern aboutdifferent health conditions is also changing.There is growing visibility of the longstanding,previously unmet health needs of childrenand adults with mental illness or a learningdisability, who die on average 15-20 yearsearlier than the general population.4

That means the key health challenges facingthe NHS in south west London are changing– and we need to respond as anorganisation.

1 Dr Foster, 2017/18 data, 2 Dr Foster, 2017/18 data, 3 Merton Joint Strategic Needs Assessment (2015), Wandsworth Joint Strategic Needs Assessment (2017), 4 NHS Long Term Plan (2019)


In this changing environment, the NHS setout a new set of national priorities in theLong Term Plan, published in January 2019.

This included a focus on:

• integrated local care systems, withlocal providers and commissionerscollaborating to take responsibility forthe health of local populations

• stronger networks of GPs andcommunity services with a focus onpreventing illness and managing morelong-term conditions in the community

• radically transformed outpatientservices within acute hospital settings– with patients able to interact with thehospital online or by phone, andhospital consultants working closelywith GPs to avoid patients being sentfor unnecessary trips to hospital

• patients increasingly being diagnosed,treated and discharged in one day inemergencies; rather than needing to beadmitted to a hospital bed

• specific commitments relating to arange of priority areas, includingmaternity and children’s services,cancer and stroke.


Merton Wandsworth

Start well • Emotional wellbeing and mental health

• Children’s and young people’scommunity services

• Developing pathways to adulthood

• Childhood obesity• Risky behaviours• Children’s and young people’s

mental health

Live well • East Merton Model of Health and Wellbeing

• Diabetes • Primary mental health care • Primary care at scale

• Integrating physical and mental health approaches

• Chronic disease management – diabetes

Age well • Integrated health and social care • Isolation • Dementia • Health and social care integration

At a local level, the NHS and local government in Merton and Wandsworth haveproposed priorities that reflect these national ambitions:

We’ve engaged with more than500 staff and patients over thepast year, all of whom havehelped develop our strategy forthe future We have held nine dedicated events open tothe public, 15 events for staff, and two eventsfor diverse groups of patients, staff andwider stakeholders.

We have held meetings with local GPs,patient groups, trade unions and clinical andmanagerial leadership teams at the Trust.

We have also communicated regularly withstaff, stakeholders and patients about thedevelopment of our strategy, andopportunities for them to get involved.

All this has informed the analysisof our strengths, weaknesses,opportunities and threats thatour strategy is built upon, as setout on the page opposite.


This analysis of our strengths, weaknesses,opportunities and threats has led us to astrategy focused on four priorities to supportdelivery of our vision of providing outstandingcare, every time: namely strong foundations,excellent local services, closer collaboration,and leading specialist healthcare.

The following chapters set out that strategy inmore detail.

Strengths Weaknesses

• Comprehensive services • Clinical excellence • Our 9,000 staff • Partnership with St George’s, University of

London, and our growing influence in research• Partnerships (with GPs and community services,

other local hospitals, the voluntary sector)

• Estates, with a large maintenance backlog andthe current arrangement of our services

• Financial position • Digital infrastructure • Quality issues: while St George’s offers some of

the best care in the country in places, we alsoknow we have more to do to deliver outstandingcare, every time

Opportunities Threats

• Improve patient outcomes in key national andlocal priority areas (e.g. cancer)

• Build on and develop our specialist services,working in partnership with other Trusts acrosssouth west London and beyond

• Deliver planned care in a way that better fitsaround our patients’ lives, including use ofinnovative technology and working in closerpartnership with GPs

• Offer more same day emergency care, so that ifpatients do have an emergency they can beseen, treated and discharged without needing tobe admitted to a hospital bed overnight

- Deliver services differently, e.g. by using adifferent combination of workforce skills

• Financial constraints (for St George’s and for the partners we rely on in south west Londonand beyond)

• Growing demand for our services• Our ability to recruit or retain all the staff we

need


We will provide outstandingcare, every timeAs we look to the future, our staff,stakeholders and patients rightly haveambitious ideas about what St George’s canachieve over the coming five years. But whilesome of our services are among the best inEurope, we know there are times when wedo not deliver to that high standard – andour first objective has to be to provideoutstanding care, every time.

Our aim is to embed quality improvementthroughout the organisation, and we haveestablished a Quality Improvement Academyat the Trust to make this ambition a reality.Ultimately, our aim is for the quality of carewe provide to be outstanding across theorganisation. This focus on quality will remaina major priority for the Trust over the comingfive years, and drive everything we do.

We will provide the rightcare, in the right place, at the right time We know that across the NHS, partly due torapidly growing demand for healthcare, toomany patients end up waiting longer thanthey should to receive care – whether that ispatients waiting too long in A&E, or waitingtoo long for a diagnosis or operation.

At St George’s, patients attending ouremergency department (ED) are being seenmore quickly than in the past, despitesignificant increases in the number of peopleattending. St George’s performs well againstnational standards for the speed at whichcancer patients are seen, and diagnostictests carried out. Patients referred to StGeorge’s today are more likely to be treatedwithin 18 weeks than they were in the past.

But we know we have further to go, and soover the coming five years one of our keypriorities will be to see, diagnose and treatpatients more rapidly – publicly reportingagainst, and meeting, all nationalperformance standards for all our services.

We will invest in our staffOur staff are our most valuable asset, andconsistently seen as such by the public andour wider stakeholders. Investing in andsupporting our staff will be key tosuccessfully delivering our strategy.

Our ambition is to be an employer of choicein south west London, working in genuinepartnership across the local health economy,ensuring we have the right workforce todeliver our strategy.

For us, this means having an empoweredworkforce that is both modern and flexible,with a culture that supports people to delivertheir best.

Strong foundations An organisation with strong foundationsthat provides outstanding care, every time


Our focus for the next five years is toradically change the culture of ourorganisation, so that we make greater use ofnew and innovative roles, by recruiting anddeveloping more specialist nurses, associatephysicians and allied health professionals.

We will invest in the continuous professionaland personal development of our staff;tackle bullying and harassment head on;improve the health and wellbeing of ourstaff; become a model diversity and inclusion(D&I) employer; and continue to grow anddevelop our leaders of the future.

We will also continue to champion ourorganisational values, which are a key part ofmaking St George’s a place people want towork.

Our forthcoming workforce strategy will setout this ambition in more detail.

We will balance the booksand invest in our future A combination of rapidly growing demand forhealthcare and slower growth in funding hasbeen a major challenge for the NHS as awhole in recent years, and St George’s is noexception.

We have made progress in improving ourfinancial position in recent times, but clearlywe have further to go. Over the next fiveyears, we will:

• work with our system partners to createa five year plan which places the southwest London health economy as awhole on a sustainable financial footing,and is consistent with the NHS LongTerm Plan

• utilise Model Hospital and Getting ItRight First Time (GIRFT) initiatives to

drive greater efficiencies as well asimprovements in patient care

• embrace digital technologies tosupport transformational changeacross our services, particularly inrelation to how outpatient services aredelivered

• further reduce our financial deficit in2019/20 with an intention to eliminateit within two years.

Our medium term financial plan will set outthis ambition in more detail later in 2019.

We will improve our buildings and hospitalestate at St George’sThe Trust has an ageing estate at St George’sHospital that has suffered from a lack ofinvestment over a number of years, and wenow face a maintenance backlog across theTrust in excess of £200 million.

To enable us to deliver our strategy, keypriorities for our estate over the comingyears will include:

• investing in the quality of our buildingsand hospital estates, maintainingoperational stability, functionality andstatutory compliance

• making best use of the space we haveavailable, avoiding overcrowded areason the one hand or underused spaceson the other, and making sure ourservices are optimally located acrossour sites

• ensuring that our buildings enableservices to be delivered in line with the‘service model for the twenty firstcentury’ set out in the national NHSLong Term Plan (for instance with more


virtual outpatient clinics, or anexpansion in ambulatory care)

• ensuring that our buildings enable us togive the best possible care to our ageingpopulation, with the increase indementia and frail older patients thatentails.

Our forthcoming estates strategy will set outthis ambition in more detail.

We will ensure our staff and patients have access tothe digital technology andinformation they need, whenand where they need it Easier access to information, includingthrough digital technology, is reshaping theway we live our lives, and the way we accessand interact with services. The opportunitiesin healthcare were a consistent theme in ourengagement with our staff, patients and localpartners such as GPs.

Many of our patients told us they want easieraccess to information about their conditionor clinical expertise on how to manage it –including being able to access thatinformation online or by phone, rather thanmaking a trip to hospital. Many of our staffalso want easier access to the clinicalinformation they need to make decisionsabout their patients, such as the results ofdiagnostic tests or previous treatmentcarried out elsewhere.

The Trust has made significant progress inseeking to seize these opportunities, but weknow we have much further to go.

Over the next five years, a major priority forSt George’s will be to:

• give our staff access to the informationand tools they need, when and wherethey need it – such as integratedelectronic health records at St George’sand across south west London, andgreater use of clinical support toolssuch as those based on voicerecognition or artificial intelligence

• give our patients access to theinformation they need, when andwhere they need it – including greaterability to make and changeappointments online or by text, and toaccess clinical information or expertiseonline or over the phone (for instancethrough patient portals, apps andvirtual outpatient appointments).

This will underpin the implementation of theobjectives set out in the rest of this strategy,and help deliver efficient, high quality andsafe clinical care to our patients.

Our digital strategy will set out this ambitionin more detail later in 2019.

STRONGFOUNDATIONS


A key part of our vision is for St George’s to be a provider of excellent local hospitalservices for the people of Wandsworth and Merton.

We will provide planned care that fits around our patients’ lives, using the latest technologyOur patients have told us they want the carewe offer to be designed around them –minimising the number of trips they have tomake to hospital, supporting more diagnosisand treatment of conditions in thecommunity, offering more of a ‘one stopshop’ when they do need to come to hospitalrather than a series of appointments spreadout over time, and giving them more choiceabout when they come to hospital.

Patients, our staff and our local GPs told usthey wanted this to be enabled by better useof technology, with patients able tocommunicate with clinicians by phone oronline as well as face to face, and hospitalstaff and GPs supported by technology towork together in caring for their patients.Improving our outpatient services has been amajor priority for the Trust over the past fewyears, and we have made significantprogress, making greater use of digitaltechnology and introducing a range of newmodels of care.

But we know we have further to go, and thatis why a priority for St George’s over thecoming five years will be to transform ouroutpatient offering.

For our patients, this will mean:

• their valuable time is treated withrespect: patients’ assessment,diagnosis, treatment and care iscoordinated into a single attendanceas far as possible. Patients withmultiple comorbidities (e.g. olderpeople with multiple long-termconditions) are able to access jointclinics. Patients are admitted for theirsurgery on the day where possible, atthe right time, and with all pre-operative work completed in advance

• care is delivered closer to home.Patients have the information and toolsthey need to manage their own healthand care. GPs have timely access to allof the information and tools that theyneed to support patient care withinprimary care as far as possible,including advice and guidance from StGeorge’s staff. Patients who do notneed to come to hospital receive theircare virtually (e.g. by video, phone, letteror via a portal)

• care is delivered when patients need it.Patients with ongoing or urgent needsare able to access the right clinicalexpertise when they need it.

Excellent local services A provider of excellent local hospital services for the people of Wandsworth and Merton


Patients can choose the date and timeof their appointments.

For the Trust, this will mean:

• provision of more virtual clinics, betteruse of the non-consultant workforce(allied health professionals, specialistnurses, associate physicians), andsupporting more patients to be caredfor at home/in primary care, freeing upspace and workforce to develop andgrow more innovative, specialisttreatments for the people of southwest London and beyond, enabling usto be responsive to changing patientdemand

• our estate supports the delivery of safe,caring, effective care. Greater use ofvirtual clinics, and rationalisation of whatis provided where, supportsimprovement to the physicalenvironment that patients and staffexperience

• better use of resources: our workforceis deployed in a way that getsmaximum patient benefit from everytaxpayer pound we spend. Technologysupports clinicians to review patientcases more efficiently (e.g. throughvirtual clinics, patient apps).

Going beyond outpatient care, we will look tocontinue developing services so that we candeliver more surgery on the day, so thatfewer patients have to stay in hospitalovernight after an operation.

We also know that when patients needsurgery, their lifestyle in the lead up to andafter an operation has a significant impact ontheir outcomes and recovery times. Buildingon recent innovations at St George’s such as‘surgery school’ to help prepare cancerpatients for operations, we will also seek tobecome a leader in the care we offer topatients before and after surgery, minimisingthe amount of time they need to take out oftheir lives to spend in hospital, andmaximising the benefit of their time with us.

Finally, we will continue to makeimprovements to the way our maternityservices are delivered, in line with nationalambitions for care to be safer and morepersonalised, incorporating mental healthsupport where it is needed, providing womenwith easier access to maternity notes andother information including via smartphone,and based on continuity of carer, strongermulti professional working, and organisationsworking together across boundaries.

“We will usetechnology to improvehow we deliver care.”


We will provide more same day emergency careEvery year, around 150,000 people are seenin our emergency department at St George’sHospital, making it one of the busiestdepartments in the country.

One of the key priorities in the national NHSLong Term Plan is to reduce pressure onemergency hospital services, including byoffering more same day emergency care – sothat more patients are diagnosed, treatedand discharged on the same day, rather thanbeing admitted to hospital overnight.

A priority for St George’s over the coming fiveyears will be to offer more same dayemergency care, focusing on:

• improving access to ambulatory careservices (for instance, by exploringextended opening hours)

• making more ambulatory careprovision available for particularconditions, such as gastroenterology

• ensuring we have the right capacity toprovide same day emergency care formore vulnerable groups, such as thefrail elderly

• reflecting our desire to provide more ambulatory care in our estatesstrategy.

EXCELLENTLOCAL SERVICES


Our vision for St George’s over the next fiveyears is as a proactive partner in the widerhealth and care system, collaborating withothers to ensure that patients get the rightcare, in the right place, at the right time.

We will work with ourpartners to offer care closer to homeIn helping us develop this strategy, patientstold us that they wanted to receive the rightcare as close to home as possible, avoidingtrips to hospital where they could.

We know this is possible – both foremergency care and planned care – asevidenced by pilot projects undertaken inother parts of England. We also haveexamples here at St George’s. For example, arange of recent partnership initiativesbetween St George’s and our local GPs areshowing positive early signs that with theright advice and guidance from hospitalconsultants to GPs and better triage ofreferrals, more patients can be supported inthe community and unnecessary referrals foroutpatient appointments avoided.

A key priority for St George’s over the comingfive years will be to work with our partners inprimary and community care to help themsupport more patients in the community,thereby avoiding unnecessary emergencytrips to our emergency department oravoidable hospital outpatient appointments.

We will work with partners to respond to the changingneeds of our ageingpopulation Our population is getting older, which meansthat we will need to support more peoplewith long term conditions, more people whoare frail, and more people with dementia.

Our strategy is to work with partners toensure that we are able to provide the bestpossible care to the changing needs of ourageing population, by:

• ensuring that St George’s sites areappropriate environments for frailolder people

• adapting our services, such asoutpatient clinics or ambulatory careservices, to better meet the needs offrail older people

• acting as a source of expertise andsupport for partners across the healthand social care system (e.g. byproviding training and support tonursing and care homes)

• working with partners to ensure thecare that different organisationsprovide is seamless for our patients(e.g. through more integrated patientrecord sharing, or collaboration withcommunity health and social careservices to discharge older patients assoon as they are ready to go home).

Closer collaboration: A partner in delivering joined up,sustainable health services for peopleacross south west London


We will also work with partners to ensure ourservices cater to the needs of our wholepopulation: for instance, with voluntaryorganisations to support more vulnerablepatient groups in our emergency department,with South West London and St George’sMental Health Trust to better support patientswith long term conditions and mental illness,or patients with mental illness who present toour emergency department in a crisis. We willcontinue to provide additional support topatients with a learning disability to ensurethey receive outstanding care, every timewhen they come to St George’s, in line withthe NHS Long Term Plan.

We will work withneighbouring hospitals to ensure patients get theright care, in the right place, at the right timeIn addition to close joint working with ourlocal GPs, community and social careservices, St George’s will also strengthen ourpartnership working with other hospitals insouth west London and beyond.

We know that there is an opportunity to offercare closer to home. Large numbers ofpatients come to St George’s from acrosssouth west London for common treatmentsthat could be provided to an equally highstandard by district general hospitals closerto where they live, such as Croydon, Kingstonor Epsom and St Helier. Similarly, manypatients who require rarer, more complexcare and treatment are travelling acrossLondon to receive it, when St George’s wouldbe able to offer them the same specialisttreatment if our staff and theatres werefreed up to do so.


We also know that there is an opportunity toimprove the quality of the care we offer topatients, either by reducing unwarrantedvariation across south west London, or byconcentrating expertise in the delivery ofmore complex care in the way that we havealready done in some services such as strokeor major trauma services.

By collaborating we can improve thetimeliness with which patients access care,offering patients access to treatment atanother hospital in south west London iftheir first choice of hospital has longerwaiting lists.

Finally, we know that by collaborating withother hospitals across south west London wecan support the sustainability of the hospitalsector across our region. Together, we cansave money through collaboration on areassuch as procurement; and together, we cantackle our workforce challenges: e.g. in areaswhere there is a scarcity of experienced staff,it can be difficult for all four hospital Trustsacross south west London to provide 24/7on call rotas. Working together could make iteasier to provide that on call cover acrossthe region.

We have made important progress againstthese opportunities, collaborating with otherTrusts in a range of areas from pathology toorthopaedic surgery, but we know there ismore we can do together.

So a key priority for St George’s over thecoming five years will be to workcollaboratively with our partner hospitalsacross south west London – and for some ofour specialist services, across the widersouth London footprint and beyond.

Through that collaboration we will deliver:

• the right care: reducing unwarrantedvariation in clinical practice andprocesses, implementing evidence-based standardised clinical practice,and ensuring more specialisttreatments are delivered at sufficientscale to deliver high standards of care

• care in the right place: improvingaccess to services, enabling patients toaccess both common treatments andrarer, more specialist care as close tohome as possible within south westLondon

• care at the right time: improvingwaiting times by making the best use of the capacity available across St George’s and our partner hospitals

• sustainable NHS services in south westLondon: including collaborating withour partners on financial challenges

• the best use of our limited workforcethrough joint working

• better use of digital technology tomeet the needs of our patients.

CLOSERCOLLABORATION

SURREY

WEST SUSSEX EAST SUSSEX

Richmondupon

Thames WandsworthLambeth

Croydon

Sutton

MertonKingston

uponThames

St George’s HospitalQueen Mary’s Hospital

Kingston HospitalCroydon Hospital

King’s College Hospital

Royal MarsdenGuy’s and St Thomas’

Epsom General Hospital

St Helier HospitalAshford and Peter’s

Frimley Park

Brighton and Sussex

Royal Surrey Surrey and Sussex

West Sussex

26

We will work with neighbouring hospitals to ensurepatients get the right care, in the right place, at the right time.



We will continue to be the main provider ofspecialist services for our region, including asthe major trauma centre.

St George’s provides a wide range of specialistservices for the people of south west London,Surrey, Sussex and beyond – services notprovided by most hospitals, but by a smallernumber of specialist centres of expertise.

For example:

• patients from across south westLondon, Surrey and Sussex who havesuffered major trauma are brought byambulance or helicopter past otherlocal hospitals to St George’s, as amajor trauma centre

• patients from across south westLondon, Surrey and Sussex in need of akidney transplant come to St George’s

• St George’s is the busiest of London’seight designated heart attack centres

• our fetal medicine service is a nationalleader, with women and their babiescoming from across the south east ofEngland or even further afield

• patients come to St George’s forthoracic surgery from across southwest London, Surrey and Sussex

• St George’s critical care unit is by farthe largest in south west London, withother hospitals across the regionreferring patients to us

• our vascular service is one of thelargest in the country, with patientstravelling from across south westLondon, Surrey and Sussex fortreatment at St George’s

• patients come to St George’s fromacross the region for bone marrowtransplant

• St George’s is one of only two tertiarylymphoedema clinics in the country

• patients are referred from across theregion for specialist clinics in diabetes,endocrinology, dermatology,rheumatology and respiratorymedicine

• St George’s is the south west Londonhub for services catering to patientswith intestinal failure, and the jointlead for the south London hepatitisnetwork

• St George’s is the largest clinicalinfection unit in south London, withpatients travelling to the hospital fromacross south west London and Surrey

• patients requiring more complexsurgery are referred to St George’sfrom across south west London and insome cases from across the country.For instance, patients come fromacross the country for bariatricsurgery, and from across the region forcomplex maxillofacial surgery and

Leading specialist healthcareA provider of leading specialist servicesfor the people of south west London,Surrey, Sussex and beyond


dental surgery; St George’s is the onlytertiary voice disorders unit in southwest London, is the tertiary referralcentre for complex stone disease,lower urinary tract reconstruction andneuro-urology; and the hospitalincorporates the largest pelvic andacetabular fracture unit in the south ofEngland, providing specialist servicesnot available in other hospitals.

For patients across south west London,Surrey and Sussex, these services are a life-saving asset, and in many cases we arenational leaders in the relevant field.

A key part of our strategy for the coming fiveyears will be to strengthen and furtherdevelop these specialist services, offeringpatients in south west London, Surrey,Sussex and beyond a growing range ofpioneering treatments for the most complexconditions.

We will do so working in increasingly closepartnership with other hospitals across theregion – both local district general hospitals(such as Epsom and St Helier, Croydon,Kingston, Ashford and St Peter’s, Royal SurreyCounty Hospital, Frimley Park, Surrey andSussex Healthcare, East Sussex Healthcareand Western Sussex Hospitals) and otherspecialist hospitals (such as Guy’s and StThomas’, King’s College Hospital, Moorfieldsand the Royal Marsden). By working inpartnership with these other hospitals wewill seek to ensure that patients get the rightcare in the right place at the right time.

We will be a major centre forcancer, children’s services and neurosciences

CancerAcross the country, cancer is now the biggestcause of premature death among childrenand young people aged 5-14 years,5 and it isnow the leading cause of death for people ofall ages locally.6 One in two people in the UKwill experience a cancer diagnosis at somepoint in their lives.7

Cancer accounts for 10% of all activity at St George’s, touching most specialties acrossthe Trust and accounting for almost one in sixoperations carried out here. We are one ofonly two designated children's cancer centresin London (in partnership with the RoyalMarsden, with all surgery undertaken at StGeorge’s), the second largest provider of braincancer services in London, the second largestcentre for skin cancer in the country after theChristie NHS Foundation Trust, and the largestcentre in the country for penile cancer.

The NHS Long Term Plan sets out ambitiousplans for improving the treatment of cancer.At St George’s, we share those ambitions, andso we will make development of our servicesas a cancer centre a key priority for thecoming five years, making available additionaltreatments and working closely with ourpartners such as the Royal Marsden, the WestLondon Cancer Alliance, and our local GPs. Akey part of our ambitions for the comingyears will be the development of a rapiddiagnostic centre, co-located with some ofour existing cancer services, enabling us todiagnose more cancers at an early stage, andsupporting hundreds of our patients to livelonger lives.

5 NHS Long Term Plan (2019), 6 Wandsworth Joint Strategic Needs Assessment (2017),7 Research by Cancer Research, accessible at www.cancerresearchuk.org

LEADING SPECIALISTHEALTHCARE


Delivery Network, building our reputation asone of London’s major children’s hospitalsand delivering outstanding care for childrenacross south west London, Surrey, Sussexand beyond.

Neurosciences Neurological conditions are among theleading causes of death and disabilitynationally: stroke is the fourth single leadingcause of death in the UK and the singlelargest cause of complex disability, affectingaround one in six men and one in fivewomen;9 one in three people born in the UKthis year will develop dementia in theirlifetime.10

Neurosciences accounts for 12% of all activityat St Georges, and we are one of the largestneuroscience centres in London – the secondlargest in neurology, and third largest inneurosurgery11. St George’s offers a widerange of innovative services, from leadingnational services relating to treatment offunctional disorders and Tourette’s syndrome,to being the only 24/7 thrombectomy servicein the UK (surgically removing clots from thebrain for stroke patients).

The NHS Long Term Plan commits the NHS toa range of actions that would result in theNHS having the best performance in Europefor people with stroke.

Locally, we also know that better access toneurorehabilitation in south west Londonwould have a significant positive impact onpatient outcomes and experience, and helphospitals across the region to treat anddischarge patients with neurological or spinalinjuries more quickly, thereby improvingaccess to hospital beds and A&E waitingtimes for other patients.

8 ONS population estimates (2017), 9 Stroke Association, State of the Nation: Stroke Statistics (2018),10 Research for Alzheimer’s UK, accessible at www.alzheimersresearchuk.org, 11 Dr Foster, 2017/18 data

Children’s services Across south west London, children underthe age of 16 account for one in five of thelocal population.8 Paediatric patients accountfor approximately 20% of the Trust’sadmissions, touching specialties across thehospital.

St George’s provides a range of specialistpaediatric services, operating at the centre ofa network covering south west London,Surrey and Sussex. This includes being oneof London’s four paediatric major traumacentres; providing a paediatric intensive careunit and high dependency unit; offeringtertiary specialties such as neurology,respiratory, endocrinology, infectiousdiseases, haematology and gastroenterology;being one of London’s two paediatriconcology centres (in partnership with theRoyal Marsden); offering a neonatal unit forthe most unwell babies, along with neonatalsurgery and fetal medicine. We also provide arange of surgical services catering to childrenfrom across south west London, Surrey andSussex, and are in the top three centres inLondon for specialist paediatric surgery. Thismakes us one of the largest children’shospitals in London.

One of the national priorities in the NHSLong Term Plan is to give children and youngpeople a strong start in life, includingthrough improvements to neonatal care, carefor children with long term conditions suchas asthma, epilepsy and diabetes, paediatriccritical care and surgical services.

St George’s will therefore makeimprovements to our services for children akey priority for the coming years, workingclosely with our partners such as the RoyalMarsden and the South London Operational


St George’s will make development of ourneurosciences services a key priority for thecoming years, working closely with ourpartners such as district general hospitalsacross south west London and the SouthLondon Neurosciences Operational DeliveryNetwork, cementing our reputation as one ofLondon’s major centres for neurosciencesand delivering outstanding care for patientsacross south west London, Surrey, Sussexand beyond.

In pursuing all of these ambitions we will alsoinvest appropriately in relevant supportservices.

We will pursue commercialopportunities that enable us to invest more in NHS patient care Our position as a provider of leadingspecialist services, developing innovative newtreatments for patients, presents St George’swith commercial opportunities that couldenable us to spend more money on patientcare. We have strengths in training andeducation, clinical support services (such aspharmacy), and clinical tools (such assoftware developed by St George’s cliniciansto support them in their work), which otherparts of the NHS could benefit from.

We will seek to continue developing thesestrengths not just for St George’s patients,but as a commercial offering for other partsof the NHS, thereby enabling us to spendmore funding on patient care.

We will develop tomorrow’streatments today, throughinnovation, research andtraining St George’s has a proud history of being at theforefront of developing new treatments for thebenefit of patients. Our key partnership withSt George’s, University of London, enables usto work together on fundamental,translational and clinical research, where wehave a growing role. More than 10,000patients were recruited into clinical researchtrials in 2018/19, more than ever before, andwe featured amongst the top ten Trusts inEngland for participation in life scienceindustry research in 2017/18.

As one of London’s teaching hospitals, wealso work together with the university to helptrain the clinicians of the future and offerinnovative education.

Over the coming five years, we will:

• continue to build on our partnershipwith St George’s, University of Londonto increase our impact throughresearch, setting out our priorities inmore detail in our forthcomingresearch strategy

• continue to apply the latest clinicalinnovations to the services we offer toour patients, from the latest in medicalscience (such as genetically targetedtreatment) to the latest technologicaladvances (from robotic surgery to theuse of artificial intelligence inhealthcare)

• continue to develop the nextgeneration of clinicians, setting out ourplans in more detail in our forthcomingtraining strategy.

LEADING SPECIALISTHEALTHCARE


Implementing our strategy

This strategy was approved by the TrustBoard at St George’s in March 2019, andpublished on 23 April.

We are committed to our vision of deliveringoutstanding care, every time for our patients –and this strategy will help make this a reality.

The delivery of this five year strategy will bedriven through annual business planning andpriority setting, with all decisions – be theyquality, operational, financial, or strategic –linked to the four over-arching priorities setout in this document.

The Trust Board will track progress againstthe strategy on a regular basis, withdeliverables clearly set for individualdirectors, clinicians and managerial teams.

We are determined that the strategy willdrive everything we do, and the Trust willmonitor and track progress to ensuredelivery.

We will continue to listen and engage withpatients and staff about our strategy throughexisting forums and meetings, so it becomesan integral part of decision making and dayto day service delivery.

We will also clearly communicate theprogress we are making, and ensure thatboth successes and challenges are sharedand widely publicised.


What this means for individual services

Acute and general medicine,emergency department, and senior health services at St George's Acute and general medicine, emergencydepartment, and senior health services at St George’s support patients presenting tohospital in an emergency; deliver diagnosis,management and non surgical treatment ofdiseases; and work with services across theTrust to ensure older patients get the carethey need. St George’s is one of four majortrauma centres in London, receiving patientsby ambulance and by helicopter.

For our acute and general medicine,emergency department and senior healthservices, this strategy means:

• strong foundations: continuing todeliver improvements in financial andoperational performance and in thequality and safety of our services andcontinuing to improve our digital offerand IT infrastructure, our estate andinvesting in our workforce

• excellent local services: offeringplanned care designed around ourpatients’ lives (for instance with newmodels of outpatient care, particularlyfor frail older patients), and continuingto develop our same day emergencycare offer for patients with a wide rangeof conditions

• closer collaboration: helping GPs tosupport patients with a range ofconditions in the community, avoidingunnecessary trips to hospital; workingwith a range of partner organisations toensure patients with additional needs(such as mental illness) get the care theyneed in our emergency department;and working with partners across thehealth and care system to respond tothe changing needs of our ageingpopulation

• leading specialist healthcare:continuing to act as the major traumacentre for south west London, Surreyand Sussex, and continuing to developour strengths in research and training.


Cancer services at St George’s Cancer accounts for 10% of all activity at St George’s, touching most specialties acrossthe Trust and accounting for almost one insix operations carried out here. We are oneof only two designated children's cancercentres in London (in partnership with theRoyal Marsden, with all surgery undertakenat St George's), the second largest providerof brain cancer services in London, thesecond largest centre for skin cancer in thecountry after the Christie, and the largestcentre in the country for penile cancer.

For our cancer directorate, this strategymeans:

• strong foundations: continuing todeliver improvements in financial andoperational performance and in thequality and safety of our services andcontinuing to improve our digital offerand IT infrastructure, our estate andinvest in our workforce

• excellent local services: delivering andfocusing on person centred care inoutpatients and planned care, forexample delivering more one stop andvirtual clinics

• closer collaboration: working closelywith primary care to improve earlydiagnosis of cancer through thedevelopment of a rapid diagnosticcentre, and continuing to develop ourpartnerships with other Trusts in southwest London so that patients canaccess the right care, in the right place,at the right time

• leading specialist healthcare:continuing to develop our specialistcancer services as a key priority for thecoming five years, working closely withour partners such as the RoyalMarsden.


Cardiac, vascular and thoracicsurgery at St George’s Patients come to St George’s from acrosssouth west London, Surrey, Sussex andbeyond for specialist cardiac, thoracic andvascular surgery. We are one of eightdesignated heart attack centres in London,one of the largest aortic practices in Europe,and one of only 31 thoracic centres in the UK.

The cardiac, vascular and thoracic surgerydirectorate is also integral to both our cancerservices and also our major trauma centrestatus.

For our cardiac, vascular and thoracicsurgery directorate, this strategy means:


• excellent local services: deliveringperson centred care in outpatients andplanned care, for example byexpanding our offer of one stop andvirtual clinics, or providing more daysurgery

• closer collaboration: working withother acute Trusts across south westLondon and beyond to ensure a highquality, financially sustainable set ofcardiac, vascular and thoracic surgeryservices across the region

• leading specialist healthcare:continuing to develop specialisttreatments, working in a network withother acute Trusts across south westLondon, Surrey and Sussex; anddeveloping our growing strength inresearch and training in these fields.


Cardiology at St George’sThe Cardiology Clinical Academic Group(CAG) enables St George’s to be one of eightdesignated heart attack centres in London,and patients come to St George’s fromacross south west London for specialistcardiology services.

We are credited with an internationallyrecognised portfolio of services includinginherited cardiac conditions, sportscardiology, complex angioplasty andtranscatheter aortic valve implantation (TAVI).

The cardiology CAG is also integral to ourmajor trauma centre status.

For our cardiology CAG, this strategy means:


• excellent local services: delivering andfocusing on person centred care inoutpatients and planned care, forexample, developing and expandingmulti-disciplinary teams, improvingoperational processes and patientpathways, e.g. expanding the currentoffer of onestop and virtual clinics, anddeveloping GP direct accessdiagnostics

• closer collaboration: supportingprimary and community healthservices to deliver care closer to home,avoiding unnecessary admissions ortrips to hospital, consolidatingnetworks with our partner Trusts, andimproving our services in south westLondon together

• leading specialist healthcare:continuing to develop specialisttreatments, working in a network withother acute Trusts across south westLondon, Surrey and Sussex, anddeveloping our growing strength inresearch and training in these fields.


Children’s services at St George’sThe children’s directorate comprisespaediatric acute medicine, paediatric medicalspecialities, community services, critical care,paediatric oncology, paediatric surgery andurology, as well as newborn services includingnewborn critical care.

The directorate at St George’s is one of thelargest in London. We are one of only twodesignated cancer centres for children inLondon in partnership with the Royal Marsden,and one of four paediatric trauma units inLondon, with the only paediatric and newbornintensive care units in south west London.

We are also credited with a recognisedportfolio of services in London, Surrey andSussex including infectious diseases,paediatric neurology, neonatal surgery,paediatric oncology and paediatric surgery.

The children’s directorate is integral to bothour cancer services and also our majortrauma centre status; which we could notdeliver without the range and depth ofpaediatric services provided at St George’s.

For our children’s directorate, this strategymeans:

• strong foundations: continuing to deliverimprovements in financial andoperational performance while assuringand improving the quality and safety ofour services. We will continue to improveour digital offer and IT infrastructure, ourestate and invest in our workforce

• excellent local services: deliveringimprovements and innovations inambulatory and community care forchildren. We will also improve ouroperational processes, patientpathways and services

• closer collaboration: avoidingadmissions and delivering care closer to home in partnership with primaryand community health colleagues,developing further networks with ourpartner Trusts and improving ourservices in south west London together

• leading specialist healthcare:branding our children’s hospital anddeveloping our range of services whereit makes sense to do so, continuing toinvest in and deliver our existing local,national and regional specialistservices, plus working in a networkwith other Trusts across south London,Surrey and Sussex. We will alsocontinue driving forward furtherinnovation and research throughcollaboration with regional andnational partnerships.


Critical care services at St George’sThe critical care directorate includes acutedependency, cardiothoracic intensive care,general intensive care unit, high-dependencyand neuro-intensive care services.

We are one of four major trauma centres inLondon with the largest critical care unit insouth west London and host the SouthLondon Adult Critical Care Network. Thecritical care directorate is integral to almostall the services in the Trust, including ourcancer services and our major trauma centrestatus, which we could not deliver withoutour critical care services.

For our critical care directorate, this strategymeans:


• excellent local services: improvingaccess to critical care at an appropriatelevel for our partners and patients, anddelivering improvements in ouroperational processes, patientpathways and services

• closer collaboration: developingfurther network links with our partnerTrusts, improving our processes forworking together, and improvingservices across south west Londontogether

• leading specialist healthcare:continuing to deliver our existing local,national and regional specialistservices, driving forward furtherinnovation and research andincreasing our range of services whereit makes sense to do so.


Diagnostic services at St George’sThe diagnostics directorate includesdiagnostic and interventional radiology, breastservices, clinical genetics and the mortuary.

We are one of 24 clinical genetics services inthe UK and one of four based in London. Weare also one of 13 genomic medicine centresin England, delivering the 100,000 GenomesProject in partnership with King’s HealthPartners, and in 2018 became one of sevengenomic laboratory hubs in England.

We are also credited with a recognisedportfolio of high quality services in London,Surrey and Sussex that includes breastscreening, diagnostic radiology, interventionalradiology and nuclear medicine.

The diagnostics directorate is integral to bothour cancer services and also to our majortrauma centre status which we could notdeliver without our diagnostic services.

For our diagnostics directorate, this strategymeans:

• strong foundations: continuing todeliver improvements in financial andoperational performance and in thequality and safety of our services andcontinuing to improve our digital offerand IT infrastructure, our estate and toinvest in our workforce

• excellent local services: access todiagnostics services for our GPs andpatients in outpatients, planned careand urgent and emergency care –delivering and focusing on personcentred care with results on the sameday, aiming for day surgery to be thedefault for an increasing number ofplanned procedures on the same day,and improving our operationalprocesses, patient pathways andservices

• closer collaboration: making access todiagnostics easier, faster and sevendays a week, delivered in partnershipwith primary and community healthservices, collaborating on a diagnosticimaging network (including PACS) withour partner Trusts, developing furthernetworks with our partner Trusts, andimproving our services in south westLondon together

• leading specialist healthcare:continuing to deliver our existing local,national and regional specialistservices, developing a rapid cancerdiagnostic centre, driving forwardfurther innovation and research andincreasing our range of services whereit makes sense to do so.


Neurosciences at St George’s Neuroscience services at St George’s supportpatients who have suffered disease or injuryto their nervous system, and includeneurosurgery, neurology, stroke services,pain clinics, neurorehabilitation andneuroradiology. The department is the thirdlargest centre in London for neurosurgery,and the second largest centre in London forneurology, offering specialist treatment topatients from across south west London,Surrey, Sussex and beyond.12

It is also home to one of London’s eighthyper acute stroke units, offering the UK’sfirst 24/7 mechanical thrombectomy service,and offers the only specialist inpatientservice for traumatic brain injury in London.Our neuroscience services are also integralto both our ambitions on cancer and ourcommitment to remaining a major traumacentre.

For our neuroscience services this strategymeans:


• excellent local services: offeringplanned care designed around ourpatients’ lives (for instance with newmodels of outpatient care), andcontinuing to develop our same dayemergency care offer for patients withneurological conditions

• closer collaboration: helping GPs tosupport patients with neurologicalconditions in the community, avoidingunnecessary trips to hospital; workingwith other acute Trusts across southwest London to ensure a high quality,financially sustainable set ofneuroscience services across theregion; and continuing to strengthenour care for older patients who havedementia

• leading specialist healthcare:continuing to develop specialisttreatments across the patient pathway,from acute presentation torehabilitation; working in a networkwith other acute Trusts across southwest London, Surrey and Sussex; anddeveloping our growing strength inresearch and training in neurosciences.

12 2017/18, volume of neurosurgery admissions, volume of neurology admissions, volume of neurology outpatient appointments


Renal, haematologyand oncology services at St George’s The renal, haematology and oncologydepartment at St George’s supports patientswith kidney or blood related conditions, andcancer. The department is the centre forspecialist renal and haematology services insouth west London, such as kidney and stemcell transplantation, while its oncologyservices such as chemotherapy form part ofSt George’s major cancer offering (see cancersection on page 36).

For our renal, haematology and oncologydepartment this strategy means:


• excellent local services: offeringplanned care designed around ourpatients’ lives (for instance with newmodels of outpatient care), andcontinuing to develop our same dayemergency care offer for patients withrenal or haematological conditions orthose living with cancer

• closer collaboration: helping GPs tosupport patients with blood/kidneyconditions or cancer in the community,avoiding unnecessary trips to hospital;and working with other acute Trustsacross south west London to ensure ahigh quality, financially sustainable setof renal, haematological and cancerservices across the region

• leading specialist healthcare:continuing to develop specialisttreatments for the population of southwest London, working in partnershipwith other acute Trusts across theregion, and developing our growingstrength in research and training inrenal conditions, haematology andoncology.


Specialist medicineThe specialist medicine directorate at St George’s supports patients withdermatological conditions, respiratoryconditions, diabetes and endocrineconditions, infectious diseases,rheumatological conditions andgastroenterological conditions. St George’s isthe largest infection unit in south London, thelargest skin cancer unit in London and one ofonly two lymphoedema tertiary units in thecountry, and offers the largest service in southwest London for diabetes, rheumatology,gastroenterology and respiratory medicine.Our specialist medicine services are integralto both our ambitions for cancer services andour commitment to remaining a major traumacentre.

For our specialist medicine services, thisstrategy means:


• excellent local services: offeringplanned care designed around ourpatients’ lives (for instance with newmodels of outpatient care), andcontinuing to develop our same dayemergency care offer for patients witha wide range of conditions

• closer collaboration: helping GPs tosupport patients with a range ofconditions (in diabetes, dermatology,gastroenterology, rheumatology andchest medicine) in the community,avoiding unnecessary trips to hospital;and working with our emergencydepartment, and acute and generalmedicine services to further developour same day emergency care offer forpatients with a range of medicalconditions

• leading specialist healthcare:continuing to act as the centre forspecialist services for south westLondon and beyond in a range ofareas, from lymphedema totuberculosis.


Surgical services at St George’s The surgical directorate includes audiologyand audiological medicine, dental, ear, noseand throat (ENT), general surgery, maxillofacial,plastics and trauma and orthopaedics andurology services.

We are one of four major trauma centres inLondon with the largest critical care unit insouth west London. We are also credited withan internationally recognised portfolio ofservices including melanoma (skin cancer) andpenile cancer treatment as well as arecognised portfolio of services in London,Surrey and Sussex.

The surgery directorate is integral to almost allthe servicers in the Trust, including our cancerservices and also our major trauma centrestatus which we could not deliver without oursurgical specialties.

Along with other Trusts in south west Londonwe are a founding partner in the South WestLondon Elective Orthopaedic Centre(SWLEOC) and the Joint Referral Unit ( JRU),which have improved access to services andoutcomes for patients.

For our surgical directorate, this strategy means:


• excellent local services: deliveringimprovements in outpatients andplanned care including accessibility toclinics both physically and virtually,aiming for day surgery to be the defaultfor an increasing number of plannedprocedures and improving ouroperational processes, patientpathways and services

• closer collaboration: agreeing changeswith commissioners to improve patientpathways, avoiding admissions anddelivering care closer to home inpartnership with primary andcommunity health services, collaboratingon facilities optimisation, developingfurther networks with our partner Trusts(for instance through the Joint ReferralUnit or building on the SWLEOC model)and improving our services in south westLondon together

• leading specialist healthcare:continuing to deliver our existing local,national and regional specialist services,driving forward further innovation andresearch and increasing our range ofservices where it makes sense to do so.


Theatre and anaestheticservices at St George’sThe theatres and anaesthetics directorateincludes anaesthetics, decontamination(sterilisation) inpatient pain, pre-operativecare, resuscitation, and theatres services. Weoversee 29 different operating theatres (sixthlargest in London) with more than 13,000operations a year carried out for patients inthe south of England by our surgical teams atSt George’s. The theatres and anaestheticdirectorate is integral to both our cancerservices and also our major trauma centrestatus which we could not deliver withoutthese services. In addition, anaestheticscover is also provided at the South WestLondon Elective Orthopaedic Centre(SWLEOC) and South West London and StGeorge’s Mental Health NHS Trust.

For our theatre and anaesthetic directorate,this strategy means:

• strong foundations: continuing todeliver improvements in financial andoperational performance and in thequality and safety of our services andcontinuing to improve our digital offerand IT infrastructure, our estates andequipment, and invest in ourworkforce

• excellent local services: deliveringimprovements in peri-operative care(e.g. by building on initiatives likesurgery school) and improving ouroperational processes, patientpathways and services

• closer collaboration: continuing tocollaborate with our partner Trusts andimproving our services in south westLondon together

• leading specialist healthcare:continuing to deliver our existing local,national and regional specialistservices, driving forward furtherinnovation and research andincreasing our range of services whereit makes sense to do so.


Women’s services at St George’sThe women’s directorate includesgynaecology, maternity and obstetricservices. We are credited with aninternationally recognised portfolio ofservices, particularly within fetal medicine,fetal surveillance during labour, and care forwomen with serious conditions relating tothe growth of the placenta. In addition, wehave a thriving research department.

For our women’s directorate, this strategymeans:


• excellent local services: achieving theaims of the Better Births forward view(better continuity of carer, perinatalmental health, personalised care andsafer care), and improving ouroperational processes, patientpathways and services

• closer collaboration: avoidingadmissions and delivering care closerto home in partnership with primaryand community health services,developing further networks with ourpartner Trusts and improving ourservices in south west Londontogether

• leading specialist healthcare:continuing to deliver our existing local,national and regional specialistservices, driving forward furtherinnovation and research andincreasing our range of services whereit makes sense to do so, such as infetal medicine.

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