Having founded the oldest hospital in England in 1123, Barts has a proud history of leading innovation in the NHS.
Alice Roberts' recent Channel 5 biography Barts: Our Hospital Through Time, showcases this pioneering spirit through time from 17th century bladder stone operations and the earliest x-rays to AI assisted diabetes prediction and diagnostics, and robotic assisted surgery.
DeGaris said: ‘We're really trying to make sure that innovation, clinical improvement, innovation and doing things differently is part of our strategy going forward.
‘Just doing the same thing and expecting different results is just not going to happen.
‘We're really trying to encourage innovation at a grass roots clinical level, in particular, by enabling clinical interventions, alongside adopting new ways of working with innovations that are already in the market.'
DeGaris said Barts was trying to be much quicker at adopting cutting edge innovations.
The hospital group uses its life sciences arm as its main vehicle to translate research into practical applications through partnerships with industry on new drugs and devices.
Barts is currently collaborating with major companies looking to invest in land next to The Royal London Hospital in order to create laboratories for commercial tenants and build its research capability.
DeGaris revealed a major new clinical research centre will be opening soon at The Royal London.
Research will be complemented by the Barts' single data platform that the trust is seeking to extend across London so that people can easily access their records.
Barts also leads innovation as a member of UCLPartners in London and by working closely with the Association of British HealthTech Industries to get health tech inventions adopted and to support UK PLC in terms of business overseas.
Core to all this is making sure innovation benefits Barts' local population where two-thirds of residents live in some of the most disadvantaged areas in England.
It is this history of innovation that makes Barts well-placed to lead adoption of the Government's three shifts.
Shift 1: Analogue to digital
DeGaris cited Barts' outpatients' transformation programme as a primary example of how it is leading on digital adoption.
With patients already receiving appointment reminders by text, the goal is to shift to a portal where they can directly message about their care and self-manage their pathway so they receive updates while they are waiting.
All clinical letters have been shifted to digital and the trust is in the process of establishing a patient contact centre to support AI and automation so patients can self-schedule appointments.
‘Our DNA rates could be reduced significantly by giving patients more power,' DeGaris observed.
DeGaris said Barts had just published a board paper on the ethics and governance of AI as the pace of roll-out ramps up.
‘The other bits - the governance, the regulations - have not caught up with AI adoption,' he observed.
‘We've recognised that and have said, ‘right, how about we just get some control?' I'm also quite keen that we don't stifle innovation and create a bureaucracy, because the NHS loves that. We don't want to slow everything down.'
The trust is already beginning to reap the rewards of digital adoption in terms of increasing productivity and reducing waiting times.
‘As soon as we started to move to more digital interactions the did not attend (DNA) rate dropped 2 or 3%,' DeGaris noted.
‘There's no doubt digital will improve productivity and, therefore, make it far easier to book more patients into constrained capacity and, of course, there's a financial benefit around additional clinics we might not have to run if we can use our capacity better.'
The chief executive said elective waiting times and outpatients were ‘the two big opportunities' where improvements can be made on reducing the number of patients returning to hospital for follow up.
DeGaris said he was confident the Government would hit its interim target of 65% people waiting 18 weeks for elective treatment by the end of March.
‘We're already meeting all the cancer headline targets, faster diagnosis and 62-day treatments, and we've been doing that for quite a while,' he noted.
‘Last year we were the second most improved trust in the country on waiting times.'
The chief executive said Barts had received a ‘seven-figure sum' from the Government to expedite its ‘quarter-four sprint' towards hitting the interim national elective target.
Barts is also one of 10 trusts that are part of a national outpatient transformation programme to accelerate performance and productivity.
The trust is also working on trying to make emergency pathways easier to navigate for patients.
‘There's a bewildering set of patient choices,' DeGaris said. ‘You've got your GP, your urgent care centre, your pharmacist, your A&E, and people tend to default to the A&E if they don't really know what to do.
‘Being more open and available about the other options and working with system partners is something happening right around the country to better manage demand.'
Shift 2: Hospital to community
DeGaris said acute hospitals had a really important role as a system partner in the shift to community.
Speaking to me from The Royal London Hospital in Tower Hamlets he observed how it was located next to the town hall and was very much part of the local community.
DeGaris said hospitals were places where specialist expertise was brought together to try to prevent admissions as well as deal with patients swiftly and smoothly when necessary.
He also highlighted how some hospitals managed long-terms conditions such as diabetes and renal failure.
The trust leader also identified a programme at Barts Heart Centre where consultants go out into the community to prevent premature cardiovascular disease.
‘Each hospital is already part of the community,' De Garis emphasised.
‘It works closely with local partners to develop these local care models through integrated neighbourhood services.'
He also spotlighted Barts' community partnership services such as Tower Hamlets Together, led by chief executive of The Royal London, Neil Ashman, which seeks to deliver better health through working with social care.
‘Neil has done a great job and there's lots of interesting things going on there,' DeGaris said.
The Barts head said it would be interesting to see what role each partner can play as budgets shift from hospital to community.
‘It makes absolute sense for patients to be seen closer to where they are,' he said.
‘How the resources shift and what that transition arrangement is will be quite important so that we don't destabilise hospitals that are going to still have to deal with a very large number of patients.'
DeGaris said funding flows would automatically follow the shift from hospitals to communities, while also noting this could involve hospital clinical staff doing more work in the community.
He added some ‘pump priming' of funding would be required to accelerate the shift to communities.
‘We are having some good discussions in north east London about what that might look,' De Garis said.
‘No one's arguing about the start point, which says we can't carry on as we are. The discussions are mostly about ‘how do we actually make this happen in a sensible way that's sustainable for all parts of the system and in a way patients can understand.'
The trust boss said ICBs' shift to strategic commissioning would provide more opportunity to support place-based partnerships.
‘We're going to need someone to co-ordinate that across a wider patch,' he observed.
Addressing current system biases towards acute care, DeGaris said the days of payment mechanisms which incentivised hospital to carry out more procedures were ‘long gone'.
‘There's no incentive for a hospital to suck up work or patients on an emergency pathway,' he said. ‘In fact, the exact opposite is in place, whereas we're incentivised to work with our partners to give patients opportunity not to have to come in.'
He admitted the boundaries were a ‘bit more murky' in elective care, however, in terms of paying people properly to improve productivity on high volume, low complexity care.
‘As the "quarter four sprint" showed on electives, I have consultants and theatres that can do more work,' DeGaris noted.
‘I'm just one example around the country where we could accelerate that if there was more funding to support the elective programme.'
The chief executive said one of his objectives was to shift some of the resource being spent on private hospitals back into his hospitals provided he can guarantee capacity, improved productivity and quality.
He added the private sector still had a role to play in helping the Government meet its end of Parliament targets.
DeGaris said Barts also had a key role to play within an integrated health system.
‘The way our group model is designed and the role of our hospital leadership teams means I've got some space to operate at that system level across multiple boroughs,' he observed.
The trust boss is the lead chief executive for the North East London Acute Provider Collaborative with Barts chair Professor Ian Jacobs chairing the partnership.
‘We've already got a construct where we can work together as acute trusts and then I guess the real challenge is then how do we then work both horizontally with the other big providers in our patch to the mental health and community trusts and primary care, as well as vertically within the local community,' DeGaris said.
‘Alongside all the providers in our system, we've all got a collective role to embrace the 10-Year Health Plan, to make it work for our population and for our patients, and to have honest discussions about things we're worried about, or things we can work on together.'
He agreed with the sentiment that central performance metrics such as league tables focused on trust level performance could be a distraction from partnership working.
‘I was always the accountable officer for Barts Health and accountable for its performance, so that's not changed,' he noted.
‘But what has changed, I think, is there's a system wide financial control total and as long as the system hits that number, whatever that is, break even, or some other number, it's agnostic about the individual providers within that.
‘So there's still a system number, but basically every trust has got to do their number and their plan.'
DeGaris said there was a similar situation in electives and A&E.
‘I do agree there's a risk there, in the sense there's a potential to disincentivise us to work together, if I'm only really being held to account for what happens within my trust,' he added.
‘The system is very much "you deliver what you have to do in your trust", but they still encourage us to work together and, to be fair, we want to work together, because these things aren't mutually exclusive.
‘We would want to have patients having the most and quickest access, because the patient doesn't really care who runs the trust and how big the trust is.
‘What they're interested in is: "How quickly can I get seen? Will I get seen by someone that knows what they're doing? And will I get the outcome I need? So that's where we have to work together.'
DeGaris said his team would be scrutinising the neighbourhood health targets that were published on 17 March, adding some good discussions had begun with ICBs.
When asked whether acute trusts should lead on neighbourhood health, he said that would depend on the circumstances.
‘In certain circumstances, in certain boroughs, a multi-site, multi-borough trust like us is probably better placed to be operating in a leadership capacity,' he stressed.
‘If you're a much smaller provider, that might not be as easy, but regardless of who's leading it's all going to have to be done in partnership, and whether someone's hosting or leading or not, all those key partners are going to have to be involved if the neighbourhood model is to be effective and primary care clearly has to play an important part in this.
‘The GP at the end of the day is very central to the day-to-day patient experience and how access to various services is governed, and I think that's a really
important link.'
Shift 3: Prevention
DeGaris said Barts had a key role in outreach to deprived communities in local neighbourhoods, noting the trust had established a much more formal equity programme since Covid to identify disparities of service provision.
Equity scorecards are published for emergency care, cancer and maternity waiting times.
As an example, the trust recently flagged patients with learning disabilities were waiting two to three longer for treatment largely due to delays in restorative dentistry.
‘We're going to expand that analysis to cover disability, homelessness and neuro divergence,' he added.
‘Our equity dashboard data tells us that disproportionately high numbers of young black men don't attend hospital appointments. So there's recommendations that come from that to make services better and easier for people to access.'
In addition, DeGaris highlighted how the Barts patient experience and outreach team were embedded in each borough with partners, adding their feedback was crucial to how services are shaped and responded to.
Addressing children's inequities, DeGaris noted Barts had one of the biggest children's hospitals in the country as part of The Royal London, as well as important centres of paediatric medicine and award winning centres such as the Rainbow Centre in Newham and services at Whipps Cross.
Barts is seeking to improve the timeliness of children's assessments through its five-year clinical strategy and help prevent admissions where possible through expanding hospital-at-home facilities.
The way ahead
Looking ahead, DeGaris said Barts' innovation would continue to be driven by a combination of new innovations and ideas from clinical staff and adoption of innovations already in use.
The chief executive emphasised that innovation would also have to support the three shifts in the 10-Year Health Plan.
‘We have to make sure that what we're trying to do isn't being done in a bubble and it helps those shifts,' he stressed.
Secondly, DeGaris said he was really interested in pushing the digital agenda to make life easier for patients and staff.
Thirdly, he stressed the importance of innovation making a difference in addressing healthcare inequalities in the local population.
‘The good news is we have that sort of people who want to make a difference at Barts, which is why they work in East London,' De Garis concluded.
‘We've got the right ethos.'
