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A lifetime of specialist care Annual Review 2019 RBH annual review 2019-FINAL.qxp_Layout 1 24/01/2020 11:05 Page 2
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annual ReVIeW 2019 | Contents
Introduction from the chair and chief executive 04 About us 07 Professor Tim Evans – in memory 08 Our vision and values 09 CQC report 10 Performance and achievements 13 Evolution of Darwin 14 Our clinical expertise and specialist services 16 A dedicated service for children and young people 24 Rehabilitation and therapies 28 Research highlights 30 Sharing our expertise 32 Listening to our patients 34 The healing arts 36 Our charities 38 Our profile in the media 40 Governance 42 Royal Brompton & Harefield NHS Foundation Trust accounts 44
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| annual ReVIeW 2019 Introduction from the chair and chief executive
We are pleased to present this annual Royal Brompton Hospital and returning to work within four weeks. review. It reflects a year that has seen Professor of respiratory and sleep Traditional aortic valve surgery entails the Trust’s commitment to excellence medicine at Imperial College, was cutting through the chest with an in patient care recognised across elected President of the European incision of up to 30cm, and a recovery many platforms. Respiratory Society (ERS). ERS brings time of up to six months. together physicians, healthcare In its 2018 inspection of our services, professionals, scientists and other At Royal Brompton, doctors have the Care Quality Commission (CQC) experts working in respiratory treated the largest number of awarded a rating of ‘Good’ and medicine. It is the largest respiratory premature babies in Europe with identified several areas of outstanding society in the world – covering not pioneering catheter interventions. practice; recognising our “systematic only Europe, but forging strong global Babies with patent ductus arteriosus approach to continually improving the links, particularly across Asia and (PDA) – a life threatening congenital quality of services, and safeguarding Australasia. heart defect – have benefited from a high standards of care by creating an new procedure that takes just 20 environment in which excellence in Dr Nick Hopkinson, honorary minutes and avoids the need for open clinical care flourishes”. consultant chest physician at Royal heart surgery, a complex procedure in Brompton Hospital and reader in tiny babies. Babies were referred by 20 Commending our clinical teams for respiratory medicine at Imperial different neonatal intensive care units the compassion shown to patients, College, was appointed medical across the country, as the Trust is the the CQC reported that: “Feedback from director of the British Lung Foundation only centre in the UK to have a patients confirmed that staff treated (BLF). The Trust has close links with the specialist referral team. them well and with kindness…staff BLF – the leading national umbrella involved patients and those close to charity that funds research into, and Our experts joined forces with the west them in decisions about their care and supports people affected by, lung London cancer alliance, hosted by treatment…and provided emotional disease. cancer centre The Royal Marsden, to support to minimise their distress”. diagnose patients with lung cancer Dr Sonya Babu-Narayan, consultant earlier, by using mobile CT scanners in Three of the four core services cardiologist at the Trust and clinical the community. They recruited 2,284 inspected were rated good (Children’s senior lecturer at Imperial College, was patients to over 200 research and Young People’s Services, Critical appointed associate medical director programmes that will contribute Care and Surgery at Royal Brompton for the British Heart Foundation (BHF). towards better patient care and Hospital) and one, Surgery at Harefield The BHF funds over £100 million of outcomes. They were awarded funding Hospital, was rated outstanding. research each year into heart and from the National Institute for Health circulatory conditions. Research Invention Innovation (i4i) The Trust’s ECMO service for adults Programme to study how artificial with severe acute respiratory failure Many others were recognised by intelligence can diagnose a rare (SARF), was highly praised at the professional associations, medical inherited lung condition, and launched Extracorporeal Life Support colleges and national charities. the UK’s first international postgraduate Organisation (ELSO) awards for course in heart failure; and received a Excellence in Life Support. Harefield But our clinicians are not motivated by 95 per cent recommendation score in Hospital was presented with the silver accolades. Across both our sites, the annual Friends and Family Test. award, and Royal Brompton Hospital talented teams of doctors, nurses and received the prestigious platinum allied health professionals strive every So it is not news to us that we have award. This certification is the highest day to offer patients the very best some of the most talented, skilled and distinction given by ELSO, and Royal specialist care that is available, committed teams in the NHS within Brompton was the only centre in anywhere in the world. our Trust. We know that clinical England to achieve it. leadership is vital if we are to move This year saw pioneering innovation in forward and continue to break new Several of our talented colleagues minimally-invasive heart valve surgery ground in treatment and research, and were recognised for their expertise at Harefield Hospital transform the it is particularly encouraging to see the and clinical leadership. lives of patients. Using a small 6cm enthusiasm shown by clinical incision between the ribs, minimally- colleagues for our planned Professor Anita Simonds, consultant in invasive techniques mean a quicker collaboration with King’s Health respiratory and sleep medicine at recovery time with many patients Partners (Guy’s and St Thomas’ NHS
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our clinicians join teams from King’s Health partners to discuss how patients describe what they would like to see in a new partnership best to work together
FT, King’s College Hospital, South Being part of a wider network will Our plans will take time to develop London and Maudsley NHS FT, and provide the opportunity to do things and deliver; transformation on this King’s College London University). differently, to design new models of scale requires detailed planning and care using the best of the best from engagement. But whatever else We already work closely with each partner organisation. Working as changes in the environment around colleagues at Guy’s and St Thomas’ in one team, at scale, our combined us, it is patients who remain our focus, particular, and over the past 12 months capability will place us in the global and our commitment to them will it has become apparent that there is a top five for world-leading heart and continue to guide everything that very real appetite among clinical teams lung research and personalised care. we do. to investigate closer ways of working. Although central to our vision is the development of a new purpose-built clinical academic facility on the St Thomas’ Hospital and Evelina London Children’s Hospital site, which will take around 10 years to complete, clinical Baroness Sally morgan Bob Bell Chair Chief executive and research links with colleagues across King’s Health Partners are 22 January 2020 22 January 2020 growing stronger by the day, with joint clinics and services developing in several areas.
We are confident that the greatly enhanced opportunities that this collaboration offers, and the strength of our brand, will attract clinicians and researchers from other countries to this new hub of expertise and opportunity. Training and education opportunities, in particular, will be world-leading, supporting not only recruitment but retention.
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annual ReVIeW 2019 | About us
Royal Brompton & Harefield NHS Foundation Trust is the largest specialist heart and lung centre in the UK and one of the largest in Europe.
The Trust is a partnership of two life. Over the years our experts have hospitals – Royal Brompton in been responsible for major medical Chelsea, West London, and Harefield, breakthroughs including performing near Uxbridge – which are each the first successful heart/lung known throughout the world for their transplant in Britain, implanting the first Our values guide and expertise, standard of care, and coronary stent, founding the largest support every decision we influential research. centre for cystic fibrosis in the UK, and pioneering intricate heart surgery for make to ensure our care is We are a specialist trust, providing newborn infants. safe, of the highest quality treatment for people with heart and and available to everyone lung disease only. This means our We treat patients from all over the UK who needs it. doctors, nurses and other healthcare and other countries, many of whom staff are experts in their chosen field, are unique in their medical needs, and with many of them moving to us from demand for our services continues to around the world so that they can grow year-on-year. develop their skills even further. By recruiting the best clinical and non- We carry out some of the most clinical staff and investing in their complex surgery and offer some of development, we maintain our “ the most sophisticated treatment that position as the leading UK provider of medicine through research, and by is available anywhere in the world. respiratory care and a national leader sharing what we know through in the specialist areas of paediatric teaching, we can help patients Our fetal cardiologists can perform cardiorespiratory care, congenital everywhere. scans at just 12 weeks, when a baby’s heart disease and cystic fibrosis. heart valve is just over a millimetre in Our values (page 9) guide and support size, and our clinical teams regularly We work closely with academic and every decision we make to ensure our treat patients well into their 90s and industry partners to play a leading role care is safe, of the highest quality and help them maintain a good quality of in pushing forward the boundaries of available to everyone who needs it. Royal BRompton & HaRefIeld nHS foundatIon” tRuSt | 7 RBH annual review 2019-FINAL.qxp_Layout 1 24/01/2020 11:06 Page 8
| annual ReVIeW 2019 Professor Tim Evans
Professor Tim Evans, former medical director, deputy chief executive and director of research, passed away in November 2018. The news of his death was greeted with immense shock and sadness throughout the Trust.
Chief executive Bob Bell paid tribute Care Society, and more recently and to a greatly missed colleague who importantly in founding the Faculty of was also a mentor, an inspiration and Intensive Care Medicine. a friend to many. “A large number of doctors in critical “As a physician Professor Evans was care the world over have been respected throughout the world and influenced by him. Some rotated was a major driver in the maturation of through Royal Brompton’s adult critical care as an independent intensive care unit or respiratory specialty in the UK, through influences medicine division, some had the benefit at Royal College level, the Intensive of him as research supervisor. Many of them have gone on to have successful professor tim evans, former medical director, deputy careers in the UK and internationally, chief executive and director counting him as one of the most of research of the trust important influences in their lives.
“Professor Evans won many accolades and the reason why the Trust is now a Put simply, men like for his clinical expertise. His interest in major ECMO (extracorporeal Professor Tim Evans acute lung injury and acute respiratory membrane oxygenation) centre. come along once in a distress syndrome, ARDS, which generation. started in the mid-1980s, led to him “The respect of his peers pales into rapidly becoming a world authority in insignificance when compared to the ARDS. Research collaborations which regard in which Professor Evans was followed were the start of Royal held by his patients. The relationship Brompton’s role as a national referral he had with many of his ‘long-term’ centre for severe acute lung failure patients was the envy of colleagues.
“It was this genuine focus on patients that, in my view, made him such a brilliant medical director. Tim would never compromise on putting patients “ first and providing safe and high- quality care.
“It is difficult to summarise the immense contribution he made to the Trust: his clinical expertise and leadership, his passion for research and education, the significant contribution he made over several years on the Trust Board and other ” management bodies. He was also a highly valued and popular Trustee of the Royal Brompton & Harefield Hospitals Charity.
“Put simply, men like Professor Tim Evans come along once in a generation.”
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annual ReVIeW 2019 | Our vision and values
Our vision is to be the UK’s leading specialist centre for heart and lung disease, developing services through research and clinical practice to improve the health of people across the world.
The Trust will achieve this vision by:
½ improving patient safety and satisfaction ½ providing world class specialist treatments that others cannot offer
½ bringing innovation to clinical practice through our research partnerships
½ attracting, developing and retaining world class clinical leaders
½ investing in services, technologies and facilities to support new service models at both sites.
We are supported in this by active patient and community groups that enthusiastically encourage and challenge us to deliver our goals.
Our values
At the heart of any organisation are its values: belief systems that are reflected in thought and behaviour. When values are successfully integrated throughout an organisation, the result is a shared outlook and consequent strength, from performance through the style of communications to the behaviour of employees.
Our values were developed by staff for staff. We have three core patient-facing values and four others which support them. And the following values support us in achieving them: Our three core values are: We believe in our staff We care We believe our staff should feel valued and proud of their We believe our patients deserve the best possible work and know that we will attract and keep the best people specialist treatment for their heart and lung condition in a by understanding and supporting them. clean, safe place. We are responsible We respect We believe in being open about where our money goes, We believe that patients should be treated with respect, and in making our hospitals environmentally sustainable. dignity and courtesy, and that they should be well informed and involved in decisions about their care. We We discover always have time to listen. We believe it is our duty to find and develop new treatments for heart and lung disease, both for today’s We are inclusive patients and for future generations. We believe in making sure our specialist services can be used by everyone who needs them, and we will act on We share our knowledge any comments and suggestions which can help us We believe in sharing what we know through teaching, so improve the care we offer. that what we learn can help patients everywhere.
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| CQC RepoRt
CQC report: good overall with some excellent highlights
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The Trust won praise for excellence in clinical care and compassion for patients, in a report by the health regulator.
In its 2018 inspection of our services, “Feedback from patients confirmed the Care Quality Commission (CQC) that staff treated them well and with awarded the Trust a rating of ‘Good’ kindness…staff involved patients and and identified several areas of those close to them in decisions about outstanding practice. their care and treatment…and provided emotional support to minimise their The CQC recognised our “systematic distress.” The CQC recognised our approach to continually improving the “systematic approach to quality of its services and safeguarding Three of the four core services continually improving the high standards of care by creating an inspected were rated good (Children’s environment in which excellence in and Young People’s Services, Critical quality of its services and clinical care would flourish.” Care and Surgery at Royal Brompton safeguarding high Hospital) and one, Surgery at standards of care.” Commending clinical teams for the Harefield Hospital was rated quality of specialist care they provide outstanding. Overall, the Trust was and for the compassion shown to rated safe, effective, caring, responsive patients, the CQC reported that: and well-led. “ Trust chief executive Bob Bell welcomed the CQC report
“This remains an impressive and well- deserved achievement, especially for the surgery teams at Harefield Hospital which were commended for their approach to a number of issues around safety, culture and innovation. I am pleased that their continued ” commitment to providing exceptional care for patients was recognised in this way.
“‘Outstanding practice’ was also identified in Critical Care and Children’s and Young People’s services at Royal Brompton Hospital. Overall, the Critical Care team: ‘demonstrated excellent multidisciplinary working practices which enabled collaboration in improvement projects and enhanced patient care,’ and the accredited intensive care course for nurses was praised for enabling 63 per cent of nurses to gain the qualification, significantly exceeding national Surgery at Harefield Hospital was rated outstanding guidance.
“It was a similar story for Children’s and highly of the culture of the service and one thing above all else; delivering the Young People’s services: ‘The service the staff survey results were consistently best possible specialist care. Whatever went above and beyond for its patients high for workplace satisfaction.’ else changes in the environment and patient families; there was clear around us, patients will remain our evidence of research, innovative and “It was clear to the CQC that we are an focus, and our commitment to them outstanding practice; staff spoke very organisation that steadfastly prioritises will guide everything that we do.”
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ANNUAL REVIEW 2019 | Performance and achievements
During 2018/19 we:
Maintained one of the fastest arrival to Cared for more than Cared for nearly treatment times for UK 210,000 patients in our 40,000 patients of all heart attack patients – outpatient clinics. ages on our wards. 23 minutes compared with a national average of 56.
Received more than Received a 95% 1,000 patient referrals recommendation for our pulmonary score in the annual Friends rehabilitation programme at Harefield Hospital. and Family Test.
Reduced the average Received 100 per cent length of time children wait positive feedback about in outpatient clinics by Harefield's new day of surgery 15 per cent. unit in a patient survey.
Produced 889 peer-reviewed Recruited 2,284 patients publications, with our academic Welcomed a rating of onto over 200 research partner, Imperial College, London, programmes that will 'Good' in our Care Quality making the Trust a leading centre contribute towards better Commission inspection. for cardiovascular, critical care and patient care and outcomes. respiratory research.
Joined a new genetic testing network that is Attracted more than set to revolutionise the way £10 million in external rare genetic diseases are grants for research. identified across South London and the South-East.
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| eVolutIon of daRWIn
Evolution of Darwin
During 2018/19 a Trust-wide transformation programme, Darwin, continued to make progress.
The programme has ambitious goals ensuring that resources were going into DARWIN to transform the productivity and the things that matter most for patients: PROGRAMME efficiency of clinical services and this FIT FOR THE year results were encouraging. ½ In surgery, reorganising pathways to reduce the length of stay in our FUTURE As a global leader in cardiothoracic hospitals saved £2 million, and and respiratory care, clinical teams at resulted in very encouraging the Trust deliver excellent patient feedback from patients. outcomes, while also investing in cutting-edge innovations and ½ In theatres, overhauling the infrastructure. It became apparent in approach to scheduling surgery 2015/16, that without transformational saved money but also ensured change to make operational patients were seen faster. improvements and stabilise the Trust’s For non-patient facing functions, such financial base, this position was at risk. By the end of March 2019 – two years as a procurement review and after the launch of Darwin, the Trust modernising back office services, a Transforming patient-facing clinical had over 50 improvement initiatives saving of £6 million was achieved by services has clearly focused on underway. the end of 2018/19.
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Some examples of initiatives delivered under Darwin:
½ Two new day case facilities were set up in cardiology at both hospitals which between them have allowed patients to spend 4,350 more days a year at home with their families – rather than in hospital.
½ New one-stop lung clinics are improving patient care. Interstitial lung disease and asthma patients can now get all their care in one visit meaning patients spend 1,950 fewer days in hospital each year.
As one patient explained: “I used to have to stay on the ward once every month. Now I stay for a couple of hours and go home… it really does make a difference.”
½ Implementing new theatres software has increased capacity to enable 65 more major cardiac cases to be undertaken. Clare denny, senior sister outpatients, talks to a patient at one of the trust's new cardiology day case facilities ½ Reviewing bed capacity in intensive care helped grow our ECMO service (extracorporeal membrane oxygenation) – a highly specialised service for critically ill patients. The Trust is one of only five commissioned ECMO centres in the UK (read more about our ECMO service on page 17).
½ A review of bed capacity in intensive care increased bed utilisation from 66 per cent to 80 per cent, meaning 1,200 more critically ill patients can be supported each year.
½ Re-designing cardiac surgery processes has meant that:
• over half of patients now come in on the day of surgery
• £1 million has been saved. patient George Coldrake at one of the new one-stop lung clinics Once again patient feedback has been positive.
This is a really good new service provided by the hospital – it helped with the process to prepare myself before the op. First class treatment fully explained. Nothing was a problem.
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Our clinical expertise and specialist services
Teams at Royal Brompton and Harefield are world-leaders in diagnosing and treating a range of conditions, and recently won two major awards for the Trust’s life-saving ECMO service (extracorporeal membrane oxygenation). ECMO supports recovery after major life-saving surgery or life-threatening illness by oxygenating blood outside the body and returning it – effectively doing the work of a patient’s lungs, or both heart and lungs, until theirs can resume to normal functioning.
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annual ReVIeW 2019 | ECMO (extracorporeal membrane oxygenation) service recognised as ‘platinum’ centre of excellence
Vicky Scollen, staff nurse on the adult intensive care unit, using the eCmo equipment
The Trust’s ECMO services were inform decision-making which, highly praised at the Extracorporeal ultimately, benefited patients. This led Life Support Organisation (ELSO) to a 60 per cent increase in referrals awards for Excellence in Life Support. within the first year alone, offering It’s fantastic news that our highly specialised life support Harefield Hospital was presented with techniques to more patients than ever ECMO programme has the silver award, and Royal Brompton before. been recognised with this Hospital received the prestigious award. This is thanks to the platinum award. This certification is Having gone from strength to team’s hard work the highest distinction given by ELSO, strength, the service has expanded with Royal Brompton being the only even further to provide more cardiac developing our services commissioned centre in England to ECMO for patients suffering over the last few years to achieve it. cardiogenic shock (a condition where deliver the best possible the heart is suddenly unable to pump care for our patients. The Trust’s ECMO service, one of only enough blood to meet the body’s five ECMO centres for adult severe needs). acute respiratory failure (SARF) in England, also provides paediatric care Dr Stéphane Ledot, consultant in “ and both were recognised as critical care and anaesthetics, and outstanding by ELSO. Royal Brompton’s severe acute respiratory failure and ECMO lead, A redesign of the service in 2016/17, said: “It’s fantastic news that our supported by colleagues at Guys and ECMO programme has been St Thomas’ NHS Foundation Trust, recognised with this award. This is increased capacity and encouraged thanks to the team’s hard work greater multi-disciplinary collaboration developing our services over the last across sites. Such a range of expertise few years to deliver the best possible and streamlined planning helped to care for our patients.” ” Royal BRompton & HaRefIeld nHS foundatIon tRuSt | 17 RBH annual review 2019-FINAL.qxp_Layout 1 24/01/2020 11:06 Page 18
| ouR ClInICal eXpeRtISe and SpeCIalISt SeRVICeS Bringing services to patients
Trust experts lead the way in alliance hosted by leading cancer the lowest one-year lung cancer diagnosing and treating diseases of centre The Royal Marsden, to survival rate. the lungs. Patients from the UK as diagnose patients with lung cancer well as overseas are treated for the earlier. Under the initiative, people in full range of respiratory conditions Hammersmith & Fulham are invited to including: asthma and allergy, cancer The initiative, which includes patients a lung health check at Royal Brompton services, lung inflammation and having access to a mobile CT scanner, Hospital, while those in Hillingdon are cystic fibrosis, lung infection and is the first of its kind in London and invited to a mobile CT scanning unit in immunity, lung failure (including means people in Hillingdon and in Tesco or Sainsbury’s car parks. The transplant, COPD – chronic Hammersmith & Fulham who have mobile CT unit uses a novel wireless obstructive pulmonary disease – and been identified as being at increased technology developed in the UK sleep and ventilation), and lung risk of lung cancer will be invited for a which, for the first time, allows scans assessment (including sleep studies, lung health check. If appropriate, they to be transmitted for remote diagnosis lung function and physiology). will then be offered a CT scan in a within minutes, rather than being convenient place on the same day. couriered on CDs. Our teams run the largest interstitial lung disease clinic in the UK, the Lung cancer is by far the most Professor Anand Devaraj, consultant largest asthma clinic in London and common cause of deaths from cancer thoracic radiologist at Royal the south east, and the biggest in the UK because the majority of Brompton, is leading the work. He occupational lung disease service in people are diagnosed in its late stages, said: “Early detection of lung cancer the UK. We are also home to the when treatment has a more limited saves lives, but often people are largest cystic fibrosis clinic in the UK, impact. diagnosed at a late stage of the and the largest centre for surgical disease, having been unaware of any treatment of lung cancer. Twenty GP surgeries across the two signs or symptoms in the earlier London boroughs are taking part in stages. The earlier someone is Our specialists joined forces with RM the pilot and over 7,000 current or ex- diagnosed, the more effective the Partners, the west London cancer smokers between 60 and 75, are being treatment they can be offered. invited for a lung health check. Hammersmith & Fulham has the “This pilot is a real opportunity to help highest lung cancer improve people’s lung health. Those incidence and mortality who smoke will be offered help to across west London, stop and, where we find people who and Hillingdon has do not have lung cancer but a different condition, we can make sure they are referred for the appropriate treatment.”
The initial pilot ran for a year, with the study into the outcomes and results for patients ongoing for a further year.
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annual ReVIeW 2019 | National recognition for Trust experts
Many of our specialists hold research and training the society Dr Hopkinson said: “Lung disease is the important positions in professional focuses on. third biggest killer in the UK, so it is organisations and win national and important that we are able to support international recognition for their “We want to see the society become the delivery of the best possible care, work. During 2018/19 examples even more international, fostering links ensure timely diagnosis, and take the include: with low-income necessary preventative steps to deliver countries, for example, and good lung health – cutting smoking Professor Anita running international rates further, addressing air quality and Simonds, exchange programmes for challenging child poverty.” consultant in clinicians and researchers. respiratory and Welcoming Dr Hopkinson as medical sleep medicine at “I’m also very keen to director, Dr Penny Woods, chief Royal Brompton encourage executive of the British Lung Hospital and multidisciplinary team Foundation said: “Nick has supported professor of members to take active the BLF as an honorary medical respiratory and roles in the society: nurses, adviser, health information expert and sleep medicine at clinical scientists, media spokesperson for many years. Imperial College’s physiotherapists and We are very glad that he is joining our National Heart and speech and language team on a formal basis, to continue his Lung Institute, was therapists, have such vital tireless work on behalf of the people elected president of professor anita Simonds roles in affected by lung the European treating disease that he sees Respiratory Society (ERS). patients with respiratory every day.” ERS brings together physicians, conditions and carrying healthcare professionals, scientists and out research.” Dr Sonya Babu- other experts working in respiratory Narayan, consultant medicine. Its mission is to promote Professor Simonds has cardiologist at the lung health to alleviate suffering from been instrumental in Trust and clinical disease and drive standards for developing respiratory senior lecturer at respiratory medicine globally. and sleep medicine at Imperial College, has Royal Brompton since been appointed It is the largest respiratory society in the she joined in the 1990s, associate medical world – covering not only Europe, but including leading the director for the British forging strong global links, particularly first team in the UK to Heart Foundation across Asia and Australasia. use non-invasive (BHF). The BHF funds ventilation in children over £100 million of Professor Simonds said: “I see this as a and young people with dr Sonya Babu-narayan research each year real opportunity to forge closer ties inherited neuromuscular into heart and with our respiratory colleagues in disorders, in turn influencing the care circulatory conditions. Europe, at a time when many delivered to patients all over the world. conversations seem to be about the Dr Babu-Narayan said: “It’s a real UK going in the opposite direction. It is Dr Nick Hopkinson, honorary honour to be joining the BHF. I know critically important to maintain our EU consultant chest physician at Royal how the charity is trusted and valued research links, which are hugely Brompton Hospital and reader in by the heart and circulatory disease productive. respiratory medicine at Imperial research community, as well as College, was patients and their families’, who are at “The ERS genuinely effects appointed medical the very centre of everything we do.” change – it has a director of the compelling voice on the British Lung Dr Babu-Narayan is internationally environment, on smoking Foundation (BLF). recognised for her research to improve and chronic respiratory the care and quality of life of adults disorders for example, The Trust has who were born with congenital heart which has acted as an close links with the disease. Associate medical directors important lever on EU BLF – the leading provide leadership and strategic policy-makers. It works national umbrella direction to the vital research mission closely with the European charity that funds of the BHF, helping to ensure every Lung Foundation and has research into, and pound donated is used to support strong engagement with supports people research with the potential to make the patients, working alongside affected by, lung maximum impact for those affected by them to prioritise the disease. heart and circulatory diseases. dr nick Hopkinson Royal BRompton & HaRefIeld nHS foundatIon tRuSt | 19 RBH annual review 2019-FINAL.qxp_Layout 1 24/01/2020 11:07 Page 20
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Transplant patient hits the high notes on national TV
Harefield Hospital transplant patient after his lung collapsed while he was Charles Michael Duke debuted his on stage performing in a Christmas new lungs on BBC1 – by singing a show in 2014. spellbinding version of Ella Henderson’s Yours. Charles said: “I was still recovering at I’ve met people who have the time of recording the song, but had heart transplants over The 23-year-old, who has cystic considering it was only 12 weeks 30 years ago. fibrosis (CF), starred on This Is My post-transplant, I’m really happy with Song, a two-part TV series that gives the way it turned out. And, it was members of the public a chance to more about marking the end of this It makes me think if these make a record of a song that’s special journey for me than sounding like people have managed to to them. Beyoncé.” keep going over three decades with a transplant, I At the time of filming, Charles had just He added: “Singing with my new should feel optimistic. received a double lung transplant at lungs was amazing, I could reach the Harefield after three years on the end of sentences and hit notes I waiting list. couldn’t before.” He learned to play the song Yours on Charles continues to visit Harefield “ his guitar while recovering in hospital. Hospital for regular check-ups. He Charles wanted to record his own commented: “I’ve met people who version to celebrate the moment he have had heart transplants over 30 was given a new lease of life. years ago.
The Southampton-based singer and “It makes me think if these people actor has always tried to live life to the have managed to keep going over full despite having CF. But he three decades with a transplant, I accepted that he needed a transplant should feel optimistic.” 20 | Royal BRompton & HaRefIeld nHS foundatIon tRuSt ” RBH annual review 2019-FINAL.qxp_Layout 1 24/01/2020 11:07 Page 21
annual ReVIeW 2019 | Innovative surgery attracts national attention
Experts at Royal Brompton and recovery time, because the 6cm 6cm incision. Because the new Harefield hospitals care for patients incision goes between the ribs. With Edwards Intuity valve doesn’t need with a wide range of complex cardiac the new valve, no stitches are required suturing, patients spend just 15 to 20 conditions, both congenital (present and many patients are back to work minutes on a heart-lung machine, so at birth), inherited and acquired later within four weeks. the risks are lower.” in life. The operation takes 90 minutes to two Mike said: “Three weeks after the Pioneering innovation in minimally- hours, around an hour faster than the surgery I could walk 15km and by four invasive surgery was highlighted in the usual procedure. weeks, I was able to go for my first national media this year. gentle jog, which was amazing. Now Mr Bahrami told the Daily Mail: “At just three months after the operation I Secondary school teacher Mike Harefield we now implant most valves, can run 10km non-stop with no ill- Adamson, 62, enjoyed an active including mechanical ones, minimally effects — and I was back at work after lifestyle of cycling and jogging, but invasively — usually we only need a six weeks.” sought medical advice after he experienced breathlessness and a dull ache when out running.
Doctors discovered Mike’s aortic valve had stiffened due to a build-up of calcium. Not enough oxygenated blood was being pumped around the body – hence the shortness of breath. The valve would need replacing, or Mike would risk heart failure.
Traditional aortic valve surgery entails cutting through the chest with an incision of up to 30cm, and a recovery time of up to six months. Minimally- invasive techniques mean a quicker the theatre team at Harefield Royal Brompton hosts heart charity conference
Congenital heart charity The by Professor Michael Gatzoulis and of my 50 years. I’ve benefited from the Somerville Foundation held its included talks by Drs Natali Chung and fantastic care they provide and their annual conference at Royal Harith Alam, consultant cardiologists at adult congenital heart disease (ACHD) Brompton Hospital. Guy’s and St Thomas’. unit is cited as the most influential in the world.” More than 120 delegates from across Opening the conference, new Trust the UK attended the event and one patient governor Paul Murray, said: Speakers from Royal Brompton travelled from Canada. The event was “Having The Somerville Foundation at Hospital included Professor Gatzoulis, designed to bring people with Royal Brompton Hospital brings two Dr Kostas Dimopoulos, consultant congenital heart conditions together organisations that are so close to my cardiologist, Richard Grocott-Mason, to share their experiences and provide heart, metaphorically and literally, medical director and consultant them with a range of expert together. cardiologist, Lynda Shaughnessy, information, including treatments and clinical nurse specialist in ACHD, future models of care. “If you’re able to meet people with the Professor Wei Li, consultant in same conditions, or who face similar echocardiography, and Professor Alain It was supported by leading members issues, it’s beneficial. I have attended Fraisse, consultant and director of of the Trust’s congenital heart team led Harefield and Royal Brompton for 47 paediatric cardiology.
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| ouR ClInICal eXpeRtISe and SpeCIalISt SeRVICeS Harefield team shortlisted
for leadership award Genetic testing for FH was almost unknown in A prevention programme that involves GP practices and hospitals England before we started identifies people at high risk of across Hillingdon and Slough. this programme. We coronary heart disease and Programme lead, consultant couldn’t have got to where intervenes early to save lives, cardiologist Dr Mahmoud Barbir, said: we are without the support was a finalist in the UK’s leading “Early prevention is by far the best way medical awards. to manage this condition – treating the we had from management underlying problem before the person – who also encouraged us Familial hypercholesterolemia (FH) is a experiences a serious cardiac event, to put ourselves forward for common genetic condition that and preventing premature deaths. Yet this award. causes an increase in harmful LDL FH is vastly under-diagnosed and cholesterol in the blood, causing under-treated. narrowing of the arteries – even in healthy and active people. It is one of “When someone comes to us with a “ the major causes of cardiac events, heart attack that we treat, we offer and it is estimated that more than a their siblings and other family the Trust decided to make it a quarter of a million people in England members a test to see if they have FH, permanent service, with FH clinics at are living with the condition but this is the tip of the iceberg. We Royal Brompton as well as Harefield, undiagnosed. knew we could identify and treat more and various community hospitals. people by getting out into the Jane Breen, clinical nurse specialist in Celebrating its 10th anniversary this community.” FH cascade, said: “Genetic testing for year, Harefield’s FH team spearheads a FH was almost unknown in England prevention programme using a The team works closely with GPs to before we started this programme. combination of detective work and identify, from blood tests and other We couldn’t have got to where we are genetic testing technology, to find evidence, people who could be at risk without the support we had from people who are at risk, test them and of FH and offer them genetic testing. management – who also encouraged their family, and get treatment started When someone is found to have the us to put ourselves forward for early to reduce the chance of condition, their siblings and children this award. premature cardiovascular disease in are offered a test. This “cascade” later years. approach has enabled the team to “It’s especially rewarding” when you see identify young children with FH and three generations of the same family The project, which was shortlisted as a start their treatment as early as coming to clinic: we’ve identified finalist in the BMJ awards’ “clinical possible. something that could have had a leadership team” category, started by serious impact on these families offering testing to heart attack patients The programme first expanded into across the years, but with the right and their families, but has since the community in 2014 with British treatment they can all expect to live expanded into the community and Heart Foundation funding, after which longer and healthier lives.”
members of the familial hypercholesterolaemia team whose project was shortlisted in the BmJ awards
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annual ReVIeW 2019 |
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| a dedICated SeRVICe foR CHIldRen and younG people
A dedicated service for children and young people
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annual ReVIeW 2019 | Royal Brompton doctors treat the largest number of premature babies in Europe with pioneering catheter interventions
More than 80 premature babies The large number of babies treated with patent ductus arteriosus at the centre has been facilitated (PDA) – a life threatening with help from Royal Brompton & congenital heart defect which Harefield Hospitals Charity, which causes a leak between blood funded the purchase of a new Our success has been a real vessels from an opening in the incubator, allowing the team to team effort, combining the heart – have been treated at treat twice as many babies. talents and expertise of Royal Brompton Hospital using a cardiologists, anaesthetists pioneering catheter procedure. Gill Raikes, chief executive of the and nurses. It’s thanks to this charity, said: “It’s wonderful to be Professor Alain Fraisse, consultant able to support the work Professor that we have been able to use paediatric cardiologist, carried out Fraisse and his team are doing for this pioneering procedure to the first of this type of catheter premature babies and their treat the largest number of intervention at the Trust. families, as without their premature babies in Europe.” interventions many of these infants The procedure involves inserting a would not survive.” small device made from wire mesh into the heart (through a catheter Professor Fraisse added: “We’re inserted via a vein in the baby’s leg) extremely grateful to the charity for “ to block the opening in the heart to stop the leak. It is guided into place using echocardiography imaging, More than 80 which uses sound waves to capture moving images and is the most premature babies with widely used technique for non- patent ductus invasive imaging of the heart. arteriosus (PDA) have been treated at Royal The procedure takes just 20 minutes and avoids the need for Brompton Hospital open heart surgery – a complex using a pioneering procedure in tiny babies. catheter procedure to treat the largest Professor Fraisse said: “This procedure offers young paediatric number of premature patients and their families hope babies in Europe. ” through a less invasive treatment than surgery, with a shorter hospital stay with no chest scar.” providing funds for another Babies sent to Royal Brompton for incubator, allowing us to treat treatment were referred by 20 more babies. different neonatal intensive care units across the country, as the “Our success has been a real team Trust is the only centre in the UK to effort, combining the talents and have a PDA referral team, which expertise of cardiologists, was set up and is led by paediatrics anaesthetists and nurses. It’s thanks matron Claire Buckle. to this that we have been able to use this pioneering procedure to Claire said: “The numbers show treat the largest number of that we really are leading the way premature babies in Europe.” for the treatment of patent ductus arteriosus and we have professor alain fraisse, consultant paediatric successfully treated infants cardiologist, examining the small device weighing as little as 800g.” inserted into a baby’s heart to stop a leak
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| a dedICated SeRVICe foR CHIldRen and younG people
Using artificial intelligence professor Claire Hogg (right) and research associate andreia pinto with to diagnose rare conditions CoSmonio nouS
Professor Claire Hogg, paediatric prevent lung damage in childhood and technology, known as COSMONiO respiratory consultant, is leading a to keep the lungs working as well as NOUS, that allows clinical experts to study to enable artificial intelligence possible. train the self-learning systems in real- to diagnose primary ciliary dyskinesia time. If successful, such technology (PCD), a rare, inherited condition. Diagnosis of the disease is complex could revolutionise diagnosis and and relies on expert scientists looking medical research. The Trust has been awarded funding at cilia with a powerful electron for the project from the National microscope, together with other tests. Professor Hogg said: “We hope that the Institute for Health Research Invention Professor Hogg’s study aims to use technology will enable us to confirm or Innovation (i4i) Programme, which artificial intelligence computing exclude a diagnosis of PCD in the vast aims to cultivate new techniques or techniques to identify both healthy majority of patients who are referred to technologies into innovative and abnormal cilia from electron within one month – it currently takes interventions for the NHS. microscopy images to provide a faster, around three or four months for a more accurate diagnosis. diagnosis. As well as producing more In patients with PCD, the microscopic rapid diagnosis, our aim is to create a hairs found in the nose and airways – Artificial intelligence is increasingly more accurate system. cilia – fail to adequately remove used in medicine and self-learning bacteria and particles from the systems and has already been trained “PCD is an excellent model disease for respiratory tract. to recognise a range of medical testing this technology and success in conditions. this field may pave the way for other This leads to recurrent infections in the rare diseases where time-consuming nose, ears, sinuses and lungs which, if Professor Hogg and her team hope to and expensive diagnostic pathways left untreated, can cause lung damage. be among the first in the world to use often lead to delays in starting Early diagnosis is important to help a new interactive machine learning treatments."
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annual ReVIeW 2019 | First information day for young heart patients
Young patients with inherited cardiac from the charity Hope UK, which conditions (ICC) face greater provides drug and alcohol education, challenges than many other teenagers explained the effects of legal and during adolescence. Among them are illegal substances, and led a group moving from children’s to adult There is a lot of pressure discussion on why people use alcohol services and taking greater from peer groups and and drugs. responsibility for their own health and wider society to drink, or wellbeing. Rachael said: “There is a lot of pressure even try drugs. We try and from peer groups and wider society to Recognising this, our specialist ICC give young people the right drink, or even try drugs. We try and nurses help young people to plan and information to equip and give young people the right prepare for the move to adult services, empower them to make information to equip and empower and for the first time this year (2018), them to make the right decision.” held an information day offering them the right decision. support and breakout sessions for Sessions included exercise and lifestyle family members or guardians. advice, and an opportunity for young people attending to separate from The goal of event held at Chelsea their parents and carers to quiz experts Football Club with the support of The “ on topics such as mental and sexual Brompton Fountain charity was to health. educate and inform young people aged that wasn’t too formal, where they between 14 and 19 years old about would get to meet other people facing Anita Kolawole, 17, was among those how lifestyle choices can affect heart similar issues. We thought we’d make it who attended. She said: “It’s been a health. feel less hospital-like by getting out of fantastic day. I have a dilated the clinic and into a more fun setting.” cardiomyopathy (a condition where Lucy Green, paediatric ICC nurse the heart is enlarged and function is specialist, explained: “The idea came After a talk on the ‘normal heart’ by impaired) and it’s not always easy as out of a research project I did. Patients paediatric clinical educator Dan my friends don’t have to think about with inherited heart conditions – such Fossey, which gave everyone an their health in the same way as I do. as cardiomyopathy and arrhythmias – insight into the workings of the Meeting people with similar issues said they would really appreciate a day cardiovascular system, Rachael” Duthie is great.”
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| ReHaBIlItatIon and tHeRapIeS
Rehabilitation and therapies
Daily activities can prove challenging for people with heart and lung conditions. As well as helping with recovery after a procedure, our expert therapists support patients to manage long-term conditions, cope with their symptoms and boost their independence and confidence.
Our rehabilitation and therapies The Trust’s experts in recovery and Working collaboratively as multi- services are designed to provide care therapy include physiotherapists, professional teams, our experts are for the ‘whole’ patient, from exercise occupational therapists, dietitians, able to consider all the needs of rehabilitation to psychological speech and language therapists and patients as they recover from therapies and dietetics. clinical psychologists. treatment and tackle daily life.
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annual ReVIeW 2019 | Patients with persistent Harefield coughs find support at cardiac Royal Brompton Hospital rehabilitation programme ranks highly in national audit
An independent national audit awarded Harefield’s cardiac rehabilitation (CR) programme a coveted ‘green’ certification, placing it in the top 20 per cent of services in the UK.
Cardiac rehabilitation is a comprehensive exercise, education and behavioural development programme. Introduced to patients at an appropriate stage of their recovery, it aims to improve not only their physical, but also their social and psychological the Voice of upper airway’ group meets several times a year to hear the about the latest treatments and advice on managing conditions condition.
The National Audit of CR is an A new support group was launched “GPs can often misdiagnose these annual joint project between the at Royal Brompton Hospital this year patients’ conditions as they can vary British Heart Foundation and the for patients with conditions that so much. Patients can end up feeling British Association for affect the upper airways – such as confused, and isolated or alone with Cardiovascular Prevention and persistent coughs. their condition. To be able to meet up Rehabilitation. For the first time, and discuss their experiences with the audit adopted a new Hosted by Dr Julia Selby, clinical lead others is hugely beneficial. approach to give a national speech and language therapist for the picture on the quality of CR upper airway service, and speech and “I am hugely pleased that we’ve been delivery for 229 UK programmes. language therapists Beth Tidmarsh and able to get this project off the ground: Emma Bailey, ‘The Voice of Upper these patients are central to our care, National standards of care were Airway’ group meets several times a and it’s been amazing because we’ve analysed under seven key year to hear the about the latest been able to include them in shaping performance indicators (KPIs), treatments and advice on managing how the group is run.” including how quickly the service conditions. gets patients into rehabilitation Group member Florest Cambran from after their cardiac event, how Members are also able to share and Wallington, South London, said: “I find thorough the assessments are potentially learn from each other’s myself gasping for breath and I’ve and the length of time spent personal experiences, and provide ended up hospitalised on numerous using the service. To achieve feedback about their care. occasions. Even though I am an green status, services must meet intensive care nurse and used to all seven KPIs. Dr Selby said: “Most of the patients in helping others, when you can’t the group have incredibly debilitating breathe yourself it is absolutely Heather Probert, specialist coughing fits on a regular basis. These terrifying. physiotherapist in cardiac can make it hard to carry out even the rehabilitation, said: “The team is most basic daily tasks. Some even end “I have been following prescribed incredibly proud. This certification up in hospital requiring urgent care – speech and language exercises, which is proof that our patients are with clinicians unsure about the have really helped, but I’m looking receiving the best possible level of proper method of treatment for their forward to getting more support from cardiac rehabilitation.” condition. this group.”
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| ReSeaRCH HIGHlIGHtS
Research highlights
Ground-breaking research plays a crucial role in providing world class specialist heart and lung care for patients.
The Trust’s world class research is by a consultant cardiologist and Consultant cardiologist professor made possible by the support of electrophysiologist, dr tom Wong, to martin Cowie is chair of the digital patients and volunteers who compare ablation techniques in Cardiology Committee for the participate in our trials. In total 2,200 patients with atrial fibrillation. european Society of Cardiology and participants were recruited for associate editor of JaCC: Heart research, an increase of over 20 per our staff continue to be recognised failure, a publication from the cent from the previous year. internationally for their expertise and american College of Cardiology. achievements. professor anita our clinical teams continue to lead on Simonds, consultant in respiratory and Close research ties exist with our recruitment to clinical trials. for sleep medicine was elected president partners at Imperial College london, example, this year we recruited the first of the european Respiratory Society Imperial College Healthcare trust and patient for a global study into a new (eRS) and professor michael polkey, the Royal marsden Hospital on device for people with heart failure, run consultant chest physician, was collaborative research and education by Harefield-based consultant awarded the european Respiratory activities, facilitated through the cardiologist dr Rebecca lane. We also Society Gold medal in chronic Imperial College academic Health recruited ahead of schedule for a study obstructive pulmonary disease. Science Centre (aHSC).
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Research highlights over the year include:
Trust researchers and their Dr Elisabetta Renzoni, collaborators were awarded consultant respiratory over £10m funding by a physician, and her variety of organisations collaborators have shown that including the National Institute the use of portable oxygen for Health Research (NIHR), (ambulatory oxygen) improves the British Lung Foundation the quality of life of and the British Heart patients suffering from Foundation. pulmonary fibrosis.
A national research An international clinical collaboration led by Dr John trial on a new drug, led by Wort, consultant in pulmonary Professor Toby Maher, hypertension and intensive consultant respiratory care medicine, helped identify physician, has shown some four novel genes promising results for associated with heritable patients with idiopathic pulmonary arterial pulmonary fibrosis. hypertension.
professor toby maher Our researchers produced The Trust was awarded funding 889 peer-reviewed from the National Institute for publications (including letters Health Research Invention and abstracts) with academic Innovation (i4i) Programme for the partner Imperial College London first time. Professor Claire Hogg – highlighting the Trust’s role as and her team will now study the a leading centre for role of artificial intelligence in cardiovascular, critical care and the diagnosis of primary ciliary respiratory research. dyskinesia (see page 26).
A major trial, led by Researchers at the Trust have Professor Sanjay Prasad, discovered a new link consultant in cardiology and between alcohol, genes and cardiovascular magnetic cardiac health, which may resonance, demonstrated lead to better treatment and the need for lifelong monitoring for those at risk of medication for dilated heart failure. cardiomyopathy.
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| SHaRInG ouR eXpeRtISe
Sharing our expertise
We believe in sharing what we know hospitals to give clinical staff easy around the world. We continually through teaching, so that what we access to the most up-to-date develop training for our teams to learn can help patients everywhere. training and teaching. Our ensure they are equipped with the programmes are world renowned, latest skills to deal with complex Training is a vital part of our work and with teaching provided by experts in procedures, crisis management and we have training facilities at both our their fields, attracting delegates from to enable better team working.
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annual ReVIeW 2019 | UK’s first international postgraduate course in heart failure begins in London
Over 60 participants from more than and considerable costs for healthcare 30 countries gathered at the Royal systems and societies. Society of Medicine for the start of the Trust-run UK first Postgraduate “Recent developments have markedly Course in Heart Failure this year. increased the life expectancy of people at risk of heart failure, and Designed for cardiologists at an reduced the amount of time they advanced stage in their training or need to spend in hospital. early in their consultant career and with an interest in treating patients “This medical progress has meant that with heart failure, the new course was the cardiologists of today, not to SPRinT team developed by experts at the Trust and mention tomorrow, have many the Institute of Cardiovascular options for their patients – from celebrates Medicine and Science (a partnership recommending lifestyle changes, to with Liverpool Heart and Chest new drugs, brand new catheter 10 years of Hospital NHS Foundation Trust), with procedures to ground-breaking support from the British surgery, as well as pacemakers and teaching Cardiovascular Society, the British defibrillators, all the way through to Society for Heart Failure and Zurich assist devices and, of course in some Our specialist SPRinT team Heart House. cases, a heart transplant. celebrated 10 years of providing expert training to clinical teams Attendees came from all over the “This means that doctors treating by holding a day of lectures, world – mainly from Europe, but also patients with heart failure need truly demonstrations and panel including the Far East, South Africa excellent training across the full range discussions for staff and external and the United States – and were of diagnostic and treatment options to partners. selected from nearly 200 applicants. give their patients the best possible care. This new programme offers SPRinT – which stands for Professor Thomas Lüscher, consultant education at the very highest Simulated interPRofessional Team cardiologist and director of research, academic and medical levels.” Training – uses state-of-the-art education and development, said: models and highly immersive “Heart failure is a true medical The full course takes place over two situations to prepare teams for a epidemic, it leads to serious illness, years and includes six modules of four variety of clinical emergency significantly impaired quality of life, days each. scenarios.
a live demonstration at the trust-run uK first postgraduate Course in Heart failure Programme director Dr Margarita Burmester said: “We work in an environment which is highly intense and involves fast decision making. Patient care is never done in isolation, it involves teams of people, so we wanted to improve team working skills to drive a culture of safety.
“It has been a long process, with a lot of learning along the way, but today we are conducting research that we are publishing and presenting internationally. We have trained more than 1,500 participants to date, and people from other institutions are wanting to come on our courses.”
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| lIStenInG to ouR patIentS
Views of our patients
Harefield acorn ward (acute cardiac care) “Harefield is a fantastic hospital. There is a feeling there that you are in the hands of the very best people. There is a mix of quiet and confident efficiency coupled with a nursing team who “demonstrate that they genuinely Listening to seem to care.” Royal Brompton Victoria ward (acute and chronic respiratory) our patients “There was an outstandingly good patient experience for which I am extremely grateful. Staff throughout Royal Brompton were professional, kind, We make time to listen and act on ½ 92% had confidence in the courteous and clearly team feedback from our patients. One of decisions being made about their players. An exemplary hospital. the Trust’s core valves is treating care or treatment. Many thanks. Staff took endless patients with respect, dignity and time to explain simply what was courtesy, and making sure they are In the National Cancer Patient going on.” well informed and involved in Experience Survey, when asked how decisions about their care. they would rate their care on a scale Harefield of zero (very poor) to 10 (very good) – Cherry tree ward (day case) Feedback comes from a variety of patients at the Trust gave an average “I consider the attitude of the staff sources and we use it to continually score of nine out of 10. was exemplary, the clinical improve patient care. We are proud to treatment was exemplary. I felt have scored highly in the Care Quality In the Friends and Family Test – a very reassured and safe in the Commission’s (CQC’s) 2018 Adult mandatory score based on comment hands of the staff and the clinical Inpatient Survey. forms NHS patients complete when staff and would thoroughly they are discharged – 95 per cent of recommend them to anybody. The CQC looked at the experiences of patients said they would recommend Thank you very much.” more than 450 patients from our our services to their friends and hospitals. In nine out of ten overall family. Royal Brompton areas – ranging from ‘doctors’, ‘nurses’ york ward (cardiac care) to ‘waiting lists’ and ‘care and Actions taken as a result of feedback “The staff were excellent, from treatment’ – the Trust was named include: the paramedics to the nurses to better than other trusts. the surgeons. The hospital was ½ Developing a garden for patients clean. The hospital looked well Highlights included: on transplant wards and creating maintained. The food was high an outdoor garden for respiratory quality. The staff went above ½ 96% of patients overall felt they were patients. and beyond to explain the treated with dignity and respect procedure to me. I felt very safe ½ Producing new materials with site and cared for.” ½ 96% had confidence and trust in maps to help patients find their the doctors treating them way around more easily.
½ 94% had confidence and trust in ½ Introducing staggered hospital the nurses and other clinical staff admissions to reduce patient treating them waiting times.
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Sister Fernandes said: “Some of our patients can be on the ward for up to 12 months and some are in isolation, so it can be hard for them to get outside. The new garden serves as a convenient space to get some fresh air and will help contribute to their rehabilitation and wellbeing.” Bringing the She and the rest of the ward team spent a year on the project to establish the garden in a small outdoors in outdoor space leading out from an area on the ward. The garden has been warmly welcomed by patients on the ward.
Johanna Callas, who has chronic asthma, said: “The garden is amazing. I’ve been coming to Victoria ward for 10 years and spend up to two weeks at a time here. It’s something patients Patients on Royal Brompton’s Victoria for patients with acute respiratory really needed because it can feel very ward can now relax in a secluded conditions. The project was inspired by claustrophobic on the ward. I find it outdoor garden area, thanks to a two patients who told staff about how calming. It’s peaceful and quiet which project led by sister Tasmin Fernandes. they missed being outdoors during I find relaxing, and it’s nice to be able inpatient stays. It aims to provide a space to go somewhere away from Clinical teams on the ward treat and care that enhances wellbeing and experience. everyone else.”
Online feedback about our care
Care Opinion “I want to give the utmost praise and positive recognition “I was referred to Harefield for the surgical removal of an to all the staff at Harefield who cared for my gran for all unidentified growth in my right lung. From the moment I the years she came here. She continued after her heart was admitted, I was impressed by the efficient, friendly transplant in 1996, to give the family many more years of care from the nursing staff on Cedar ward. They were memories. Thank you all so much.” attentive and always quick to respond to a call for assistance. The surgical care was also top class and the “The staff on Cherry Tree ward could not have been operation was successful.” better. I was kept informed of everything that was happening and the nurses were always very professional. “My mum was admitted to Royal Brompton after a heart The overall experience couldn’t be faulted and all the staff attack. The staff on York ward and in the HDU (high were superb at putting me at ease.” dependency unit) were completely professional and out of “this world. I would recommend every single one of them Twitter and thank them from the bottom of my heart.” “My husband had a double lung transplant at Harefield Hospital. From the very first appointment we were well “The care from everyone from the porters to the surgeons looked after and never felt as though we were on our [at Harefield] was exemplary. The compassion and care own. The support we have had and are still getting is shown by the nursing staff was beyond all expectations fantastic.” and I was so humbled and grateful.” “I am absolutely in awe of the amazing cardiac team [at NHS.uk Royal Brompton]. Thank you to @RBandH from the “From the delightful nurse who weighed me, to the bottom of my heart for saving my soulmate’s heart.” humour and kindness in the blood test room, to the superb doctor, I was very impressed by the patient care approach [at Royal Brompton]. I felt very much at ease To follow the Trust on Twitter, and cared for and I highly recommend this hospital.” search @RBandH
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| tHe HealInG aRtS
the rb&harts team is piloting virtual reality creative sessions for older inactive and less mobile people. photo by elam The healing arts forrester
The Trust’s arts programme rb&hArts delivers a range of vibrant creative arts designed to improve wellbeing and enhance our buildings for patients, visitors and staff.
Mainly funded by the Royal two musicians in residence playing As well as running projects for older Brompton & Harefield Hospitals live music for adult inpatients six people, rb&hArts runs Vocal Beats – Charity, this year the rb&hArts team hours per week, temporary a project that brings creative music- organised more than 500 workshops exhibitions, and arts and crafts making skills and beatboxing to working with 30 artists and curated workshops called Crafternoons for younger patients. Since starting the the Trust’s valuable permanent 10 hours a month. project in 2015, it has supported over collection of over 1,000 artworks. 600 children aged 0-16 years. The rb&hArts team also co-delivers Singing for Breathing, rb&hArts’ cultural programmes for health with The programme expanded this year flagship project for older adults living older people in and outside the to include 17 to 25-year-olds, with with chronic respiratory conditions, hospitals, including Akademi’s dance musicians delivering one-to-one celebrated its 10th anniversary (see workshops in Uxbridge, and is piloting sessions for cystic fibrosis and separate piece on page 37). virtual reality creative sessions for transplant patients. older inactive and less mobile people The core arts programme includes with digital art studio SDNA.
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annual ReVIeW 2019 | Celebrating 10 years of Singing for Breathing
The benefits of Singing for Breathing were celebrated this year as the project reached its 10th anniversary. Singing for Breathing supports people living with chronic lung and heart conditions or who experience breathlessness. People are invited to discover and tackle their health issues by singing.
Victoria Hume, founder of rb&hArts, was commissioned to revisit the project which she first established and co-create a choral work called The Singing Hospital. She was inspired by her interviews and audio recordings of people experiencing breathlessness.
The Singing for Breathing groups at the Trust are now the longest continually running hospital-based workshops in Britain for people with respiratory conditions.
Tia Thomas, who has a number of respiratory conditions, said: “I think it’s great. First, I noticed how much more lively it made me feel, then how much easier my breathing got during the classes.” Art commissioned to celebrate the NHS
The 70th anniversary of the NHS was Each individual ceramic heart contains celebrated in NHS70 Thanks for a personalised message about the Everything, a Trust-wide Trust, either from a member of staff programme of events themed on reminiscing about its history, or a gratitude. patient.
To mark the end of the year’s Sally Morgan, Baroness Morgan of celebrations, the rb&hArts team Huyton and Trust chair, said: “These unveiled new permanent artworks at artworks are both a symbol and a both hospitals. recognition of the importance of the NHS, but also the importance of Royal The two large mosaics, titled NHS70: Brompton and Harefield as well. It’s Thanks for Everything, feature artwork good to have something strong and by artist Carrie Reichardt, containing visual in both hospitals to symbolise imagery taken from hospital archives the strength of care and compassion and personalised ceramic hearts that happens in this Trust, and painted by patients and staff. throughout the NHS."
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| ouR CHaRItIeS Our charities
Our hospitals are supported by a number of charities which raise money to support projects that lie outside NHS budgets, but are often vital to enhancing patients’ health, wellbeing and experience. Royal Brompton & Harefield Hospitals Charity
The charity supports initiatives across the best possible treatment for patients both hospital sites, raising money for and enables them to return to their innovative treatment, equipment and normal lives, families and friends, far research. sooner.
Harefield Transplant Appeal Harefield healing garden Raising over £550,000 for organ care Securing £54,000 to create a calming systems at Harefield Hospital outdoor space at Harefield Hospital The charity exceeded its £500,000 With the support of Rosie Pope, the target, raising over £550,000 to charity successfully exceeded its target purchase organ care systems (OCS) and raised £54,000 for the Harefield for Harefield Hospital. OCSs, which are Healing Garden Appeal. The garden not currently funded by the NHS, keep has been designed to provide a donated organs viable for up to four calming, restorative space to promote times longer than the traditional on-ice physical and mental wellbeing for method. This means organs can come patients, their families and staff. from hospitals further away and arrive hospitals. Staff are invited to submit in better condition. As the UK's largest Rosie’s son Will had a heart transplant projects that they believe will enhance and most experienced centre for heart at Harefield Hospital when he was just the lives of the patients. In the past and lung transplants, this funding will 17, after contracting a virus that year, the fund has provided portable enable Harefield’s transplant team to attacked his heart, resulting in end- intravenous (IV) pumps to enable offer life-saving surgery to more stage heart failure. During her son’s patients on the urgent transplant list to patients, with OCSs now being used long stay at Harefield, Rosie was remain mobile while in hospital, and for all heart transplants at the hospital. inspired to create a ‘healing garden’ to six hours of live music across both support patients in their recovery. sites to provide relief from boredom, Nick Culshaw had a successful heart stress and loneliness. NHS funding transplant at Harefield in 2018, which, The Patients’ Fund cannot fund many of these projects in his own words, has transformed his enhancing the lives of patients at Royal because they are not deemed life. He said: “Thanks to the organ care Brompton and Harefield Hospitals “essential,” but staff, patients and their system, I was given a better chance at Each year, the charity gives £100,000 loved ones testify to the huge different life by making sure the donated heart to support various projects around the these projects make. was the right match and could be kept in the best possible condition.”
#ManyMoreHearts catheter laboratory appeal Helping to transform Royal Brompton's catheter laboratory Each year, hundreds of patients undergo life-saving procedures in Royal Brompton’s catheter laboratory. As part of a refurbishment, funds were urgently needed for equipment. Thanks to the generosity of its supporters the charity raised over £356,000, meaning Royal Brompton’s heart patients will benefit from innovative equipment and state-of-the- art facilities. This supports provision of an artist’s impression of the Harefield healing garden 38 | Royal BRompton & HaRefIeld nHS foundatIon tRuSt RBH annual review 2019-FINAL.qxp_Layout 1 24/01/2020 11:09 Page 39
annual ReVIeW 2019 | The Brompton Fountain
The Brompton Fountain provides vital workshops and Christmas parties. support for children who are being These events are a chance for cared for by the Trust. It aims to children to relax and have fun. They improve the quality of life for our also provide families with the young patients and their families. The chance to enjoy time together and charity works closely with paediatric meet others who have been teams to provide activities, medical through similar experiences. equipment and services that are not normally supplied by the NHS. ½ Raised funds for numerous projects including an appeal to During the 2018/19 financial year, the buy new state-of-the-art heart charity has: monitors which will provide individually tailored, second-by- ½ Run numerous events and activities second statistics for each child for children and their families being cared for on our paediatric State-of-the-art heart rate monitors funded including a barbecue, art Rose ward. by the Brompton fountain Friends of Royal Brompton
The Friends of Royal Brompton has interPRofessional Team Training). been supporting the hospital for Staff use the mannequin to practise almost 60 years, relying on a strong the emergency re-opening of the network of volunteers and one part- chest of a child following a heart time member of staff. The charity operation. runs two shops, operates trolley services for patients and their families ½ Raising £10,000 to buy a cycle on the wards, and hosts fundraising ergometer (bike) for the pulmonary events throughout the year. hypertension unit. The equipment is used to measure vital signs such as During the 2018/2019 financial year blood pressure and heart rate during the charity funded a variety of projects, invasive cardiac catheterisation (a Centre day-case facility. This including: way of finding out detailed included patient procedure chairs, information about the heart). patient trolleys, blood pressure ½ Securing £20,500 to fund an machines, a television and updated simulation mannequin of a ½ Donating £23,245 to buy a variety computer, and furniture for the young child for SPRinT (Simulated of equipment for the new Squire discharge lounge. Friends of Harefield Hospital
Harefield has a sister charity – the Friends of Harefield Hospital – which offers refreshments in an on-site pavilion complete with a charity shop section.
The charity’s biggest highlight during the 2018/19 financial year was funding the purchase of a new £41,000 state-of-the-art mannequin for clinical simulation training.
Representatives from the charity were delighted to see the mannequin in action when they visited the hospital’s Simulation, Training and Resource (STaR) Centre.
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| ouR pRofIle In tHe medIa Our profile in the media
The Royal Brompton & Harefield brand features across a wide range of media channels each month. From fundraising sponsored walks to exciting new clinical procedures and research trials, our hospitals are celebrated for their ground-breaking work and commitment to patient care. Here are some examples from 2018-19.
May 2018 athletes, the project is an opportunity treatment pioneered at Royal to understand the issue and “help Brompton, was approved by the Joint research by Royal Brompton, athletes remain fully available for National Institute for Health and Care Imperial College London and MRC training and competition.” Excellence. Institute of Medical Sciences that discovered a new link between Bronchial thermoplasty uses a probe alcohol, genes and heart failure was which emits heat and shrinks scarred, featured in the daily mail, the Sun, thickened lung tissue. This means the and the i. Dr James Ware, consultant healthy parts of the lung can expand, cardiologist and study author, which helps patients breathe more explained: “Our research strongly easily. Professor Pallav Shah, consultant suggests that alcohol and genetics are respiratory physician, told the mail on interacting – and genetic Sunday: “Clinicians are seeing predisposition and alcohol incredible results; research has shown consumption can act together to lead that bronchial thermoplasty can almost to heart failure.” halve the number of severe asthma attacks and cut the average number of emergency hospitalisations in treated patients by over 80 per cent. Some of our patients had difficulty walking upstairs, and are now doing intensely physical things like rock-climbing.”
professor andrew menzies-Gow (left) and dr James Hull (right)
July 2018
As the NHS celebrated its 70th anniversary on 5 July, patients, their families, staff and colleagues shared their experiences of our hospitals June 2018 across broadcast media. A local GP, Dr professor pallav Shah, consultant respiratory Kumar, told the BBC: “Just three days physician The evening Standard featured a ago there was a patient who project to help some of Great Britain’s complained of chest pain at 6:30pm. October 2018 elite athletes achieve their potential in By 10pm he was in Royal Brompton time for the 2020 Summer Olympics having triple bypass surgery. Come on, In a feature headlined ‘Pioneering in Tokyo, by reducing the impact of you can’t get better than that!” implant that can revitalise failing breathing problems on training and hearts’, the mail on Sunday reported competition. Dr James Hull, September 2018 that the first British patient to be fitted consultant respiratory physician, with a pioneering electronic device – explained that, given respiratory illness ItV news and the mail on Sunday at Harefield Hospital – is now 'able to is the most prevalent health issue in reported that bronchial thermoplasty, a walk around the local store with his
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annual ReVIeW 2019 |
daughter, a simple task that the said: “I was out of hospital in a week extreme fatigue and breathlessness with very little pain and felt like I’d caused by his condition had left him made a full recovery just two weeks unable to manage before.' Dr Rebecca afterwards.” Lane, consultant cardiologist, explained: "This device is for patients December 2018 who have exhausted all other treatment options. A few months back, In a reflective piece, the BBC and daily we would simply have had to tell them mirror noted that 35 years ago, on 6 to accept a miserable life, often stuck December 1983, the first successful in their homes. Now there is heart and lung transplant operation in something which could help them feel Britain took place at Harefield Hospital. better, to walk around, and perhaps Swedish journalist Lars Ljungberg live longer.” received the organs and it took a team of 20 doctors and nurses more than November 2018 five hours to carry out the operation, led by the ‘world-renowned surgeon A BBC Children in need special Professor Sir Magdi Yacoub.’ episode of BBC television’s Bargain Hunt featured a segment on Vocal January 2019 Beats, a project which sees professional musicians visit the The daily mail reported on the benefits children’s ward for interactive sessions of patients using virtual reality (VR) with young patients. Casualty actor headsets to help distract from their Sunetra Sarker described Royal pain. The piece cited research at Royal Brompton as providing "specialist care Brompton Hospital, where a study is for children with serious heart and planned in which patients due for lung conditions,” adding that “beat major surgery will watch a VR film boxing and singing are great activities about the intensive care unit. for young patients with heart and lung conditions as they help to strengthen February 2019 those parts of the body.” Writing in the daily telegraph under The mail on Sunday reported that the headline ‘The healthy benefits of thousands of patients who suffer from holding a tune’, Dr James Le Fanu, multiple life-threatening heart columnist and retired GP, wrote about problems are to be offered ‘three-in- the therapeutic benefit of singing. Dr one’ surgery – three major procedures Fanu acknowledged the launch of carried out during a single keyhole Singing for Breathing at Royal operation. The new technique was Brompton just over 10 years ago pioneered at the Trust, and patient as: “…an alternative to conventional Vivian Ellis was one of the first to methods for improving lung function. undergo the pioneering heart Since then the idea has flourished and procedure. In July, Mr Ellis was there are now more than 70 similar referred to cardiac surgeon Mr Toufan groups in hospitals across the Bahrami, at Harefield Hospital. Mr Ellis country."
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| GoVeRnanCe Governance
As a foundation trust, we are governed by an elected council of governors and independently regulated by NHS Improvement. We have almost 11,000 members who we regularly consult on Trust strategy and service planning.
Royal Brompton & Harefield NHS The council of governors, which academic partners and also the two Foundation Trust has been an comprises both elected and appointed London boroughs in which the Trust’s independent legal entity as a public governors, holds the non-executive hospitals are located. The council of benefit corporation since 1 June directors to account for the board’s governors appoints the Trust’s external 2009. The powers of the Trust are performance. The majority of the auditor; and a sub-committee of the set out in the National Health Service council are elected governors, who council, the nominations and Act 2006, and amended by the are drawn from the three remuneration committee, considers Health and Social Care Act 2012. The constituencies of the membership – the appointment of the chair and the Trust’s governance arrangements are patient, public and staff. Appointed other non-executive members of the laid out in the Trust’s constitution governors represent the Trust’s Trust’s board of directors. and standing orders, which include the membership, the council of governors and the Trust board of directors. There are four formal committees of the Trust board – the Quality Account Annual report and audit committee, the risk and safety accounts – Policy committee, the finance committee The Trust is required by law and performance and the nominations and to produce a Quality remuneration committee – which Account, which is an collectively provide the board with Visit our website to read assurance as to all aspects of the annual report to the public the Trust’s full annual report Trust’s performance. about the quality of and accounts for 2017/18 – services delivered. The www. rbht.nhs.uk/report- The Trust board plays a key role in Quality Account 2018/19 is shaping the strategy, vision and accounts – and for more purpose of the organisation. Board available on the Trust’s information about our members are responsible for assuring website at policy and performance – that risks to the patients and staff are www.rbht.nhs.uk/about- www.rbht.nhs.uk/ managed and mitigated effectively. us/our-performance/ performance The board is led by a chair, with a mix quality-accounts and on of both executive and non-executive members, and has collective the NHS Choices website. responsibility for the performance of the organisation.
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annual ReVIeW 2019 | Our board
Executive directors Non-executive directors Non-executive directors Full year / part year Full year Part year Robert J Bell Sally Morgan, Baroness Lesley-Anne Alexander CBE Chief executive Morgan of Huyton Chair Janet Hogben Dr Richard Grocott-Mason medical director/senior responsible Luc Bardin Professor Peter Hutton officer Mark Batten Dr Javed Khan Robert Craig Professor Kim Fox Kate Owen Chief operating officer (part year) Simon Friend Dr Andrew Vallance-Owen Jan McGuinness deputy chair Chief operating officer (part year) Richard Jones Nicholas Hunt director of commissioning and service development Richard Paterson associate chief executive Joy Godden director of nursing and clinical governance
Our council of governors
Public governors Patient and carer Staff governors Full year governors Full year George Doughty Full year Steve Caddick north West london Brenda Davies Elizabeth Henderson Bedfordshire and Hertfordshire Part year Professor Claire Hogg Caroline Karlsen Revd. Patrick Davies Carer Part year Rest of england and Wales Sean O’ Reilly Maxine Ovens Rt Hon Michael Mates Bedfordshire and Hertfordshire South of england Steve Palmer Dr Ejikeme Uzoalor Pravin Shah Anne McDermott elsewhere Bedfordshire and Hertfordshire Dr Laura Price Anthony Archer Part year Stuart Baldock north West london Helena Bridgman Jennifer Sano elsewhere Appointed governors Rest of england and Wales Lady Victoria Borwick Full year Robert Parker north West london Cllr John Hensley South of england Paul Murray london Borough of Hillingdon South of england Part year Jeremy Stern Professor Jadwiga Wedzicha north West london Imperial College london Edward Waite Tim Ahern South of england Royal Borough of Kensington and Chelsea
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| tRuSt aCCountS Royal Brompton & Harefield NHS Foundation Trust accounts for year ended 31 March 2019
Statement of comprehensive income Statement of financial position as at 31 March 2019 as at 31 March 2019
As at As at 2018/19 2018/19 31.03.19 31.03.18 £000 £000 £000 £000 Operating income from patient Non-current assets care activities 358,236 341,290 Intangible assets 12,209 13,623 Other operating income 38,181 78,653 Property, plant and equipment 189,967 194,704 Operating expenses (411,712) (398,498) Investment properties 93,653 101,210 Operating (deficit)/surplus Total non-current assets 295,829 309,537 from continuing operations (15,295) 21,445
Current assets Finance income 173 55 Inventories 10,182 10,290 Financial expenses (1,313) (1,348) Receivables 49,916 83,190 PDC dividends payable (7,663) (6,762) Cash and cash equivalents 20,818 20,847 Net finance costs (8,803) (8,055) Total current assets 80,916 114,327 Other (losses)/gains (7,609) 61,973 (Deficit)/surplus for the year (31,708) 75,363 Current liabilities Trade and other payables (47,318) (54,200) Borrowings (11,115) (18,665) Other comprehensive income Will not be reclassified to Provisions (3,270) (1,713) income and expenditure: Total current liabilities (61,703) (74,577) Revaluations 2,818 6,693 Total assets less current liabilities 315,042 349,287 Total comprehensive (expense)/ income for the period (28,890) 82,056 Non-current liabilities Borrowings (43,596) (49,192) Provisions (374) (597) Total non-current liabilities (43,971) (49,790) Total assets employed 271,072 299,497
Financed by Public dividend capital 109,069 108,604 Revaluation reserve 57,405 54,587 Income and expenditure reserve 104,599 136,307 Total taxpayers’ equity 271,072 299,497
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Royal Brompton Hospital Harefield Hospital Sydney Street Hill End Road London Harefield SW3 6NP UB9 6JH Tel: +44 (0)330 12 88121 Tel: +44 (0)330 12 88121
@RBandH www.rbht.nhs.uk