One of London's biggest NHS trusts is engaged in financial juggling its bosses describe as like “trying to land a jumbo jet on a pin-head”.

Imperial College Healthcare NHS Trust, which recently featured in the BBC documentary series Hospitals, was criticised by the care watchdog earlier this year for patients being treated on trolleys in Charing Cross Hospita l's corridors.

Now it is under pressure to reduce its A&E waiting times to get extra funding to help it overcome its planned £20.6m deficit, after achieving a £3m surplus in the last financial year.

The heavy demand its hospitals are facing is in part due to it being confronted with increasingly older and sicker patients, chief executive Professor Tim Orchard told the trust's annual general meeting.

Imperial also had the “dubious honour” of having one of the biggest capital maintenance backlogs in the NHS, he added.

The trust, under pressure to fix up its ageing estates, received £15m from its charity arm over the past three years to fund its projects.

Professor Orchard told the AGM major estate problems at St Mary’s Hospital put a whole ward out of action for several weeks during the winter.

However, he also highlighted Imperial's successes, including it having among the lowest patient mortality ratios in the UK, and strong performance against national cancer treatment waiting time standards.

Charing Cross Hospital

It has invested £10m in doubling the number of beds at the St Mary's children's intensive care unit.

The trust managed to achieve a surplus by reaping £43.1m in efficiency savings through measures including reducing the use of agency staff and tightening procurement, and boosting private patient income, and was able to finish the financial year with its underlying deficit reduced by £10m.

However, it is still staking its outlook on Sustainability and Transformation Funding (STF) from the NHS.

Falling short of the A&E four-hour waiting time target in 2017/18 cost it £6.2m of STF.

The STF criteria has been labelled “illogical” by the British Medical Association, which claims it fails to recognise that trusts struggle to meet targets due to under-investment, not financial mismanagement.

Imperial wants another £34.2m in STF. However, that is two-thirds contingent on it making £48m in savings, to overcome a £20.6m deficit in the next financial year, and one-third on it achieving the A&E targets 95 per cent of the time. It is presently achieving 87 per cent.

Imperial's chief financial officer Richard Alexander told the AGM staying in the black was heavily focused on the STF funding, which was “the line that we frankly can't rely upon, at all.”

He added: “It's a bit like trying to land a jumbo jet on a pin-head, really.”

However, Mr Alexander said the community should feel buoyed by Imperial's increasing numbers of permanent staff, and capital spending on Hammersmith and St Mary's hospitals' estates.

It had invested in adding 50 more beds across St Mary's and Charing Cross by this winter, he added.

St. Mary's Hospital in Paddington (stock image)
St Mary's Hospital in Paddington

“I am confident that we can continue to provide high-quality care throughout the winter this year,” he said.

A steady upward trend showed Imperial was heading in the “right direction,” he added.

Plans for an eventual axing of Charing Cross hospital services to transform it into a “local hospital,” downgrading its A&E to make way for an urgent care clinic, have attracted widespread protests.

The trust has insisted no moves can be made until at least 2021 as the demand on its beds remains high. It has invested £7.2m in upgrading its A&E in the meantime.

Save Our Hospitals campaigner Merrill Hammer sought Imperial's assurance that when demand eased it would seek fresh public consultation on the plans.

She said: “It would be nice to get a positive commitment from Imperial that they will pressurise the Clinical Commissioning Group publicly to withdraw the downgrading of Charing Cross from the plans.”

Professor Orchard responded that there was still no certainty on what position the hospital would be in beyond 2021, and the focus remained on caring for patients.

He added: “We absolutely think that, given the increasing demand, it's going to be many years before we are in a situation where those conditions are met.”