Annual Review 2018
Contents Contents
Introduction from the chair and chief executive 04
About us 05
Our vision and values 06
Performance and achievements 07
Health secretary visits Royal Brompton 08
New partnership to deliver world class care for heart and lung patients 09
The Darwin programme 10
Our specialist heart services in 2018 16
Our specialist lung services in 2018 22
A dedicated service for children and young people 28
A smooth transition: supporting young people moving from child to adult services 35
Record-breaking year for Harefield transplants 37
Harefield site transformed 40
Research highlights 42
Medical education 44
Listening to our patients 46
Emergency preparedness 48
Rehabilitation and therapies 50
Our charities 52
The healing arts 54
Our profile in the media 56
Governance 58
Trust accounts for year ended 31 March 2018 60
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Annual Review 2018 3 Introduction Introduction from the chair and chief executive
with a total artificial heart the challenge set by eliminating the need for any programme, and our Darwin to all teams has overnight stay at all. More cystic fibrosis experts are been embraced across than 90 per cent of patient pioneering opportunities the organisation. feedback has been positive. in remote digital care. You will read about both A key area of focus It is our focus on initiatives in this review, has been on reducing transforming and and many others. the length of stay after advancing treatment for procedures and getting patients with heart and In partnership with patients back to their lung disease that is the academic institutions, the homes and families sooner. inspiration behind our pharmaceutical industry planned collaboration with Baroness Sally Morgan - chair and device manufacturers, So at Harefield Hospital King’s Health Partners1 (page our teams work hard to cardiology patients can 9). Our clinical teams have harness new technology now have an invasive been working together and deliver the very highest procedure, recover in a over the past 12 months standards of patient care. comfortable chair and to design a new approach This year alone over 2,000 go home the same day, which we think can patients were recruited to thanks to an innovative revolutionise heart and lung 200 research programmes new ‘lounge’ developed care and research in the UK. that will contribute towards by our specialists. The We are working to redesign better patient care and cardiology lounge provides how we deliver services, outcomes, and our teams a quiet, comfortable research and education attracted more than space, where patients across the partnership and £7.9 million in external relax in lounge chairs as beyond – from services Bob Bell - chief executive grants for research. they recover from their in the community, to procedure in the cardiac specialist inpatient care, to The year has also seen catheter laboratories. laboratory-based research. It is with a great deal of significant advances personal pride that we in the way we deliver Patients have been This year will see a major present this annual review. care as a result of a enthusiastic about the new public consultation on our It reflects a year major transformational lounge, with 100 per cent of plans and we look forward that brought many programme Trust-wide. those surveyed after their to working with patients achievements and some The Darwin programme visit saying they were “very and staff on this bold notable improvements reviews how we provide satisfied” with the service. and exciting partnership in patient care. our specialist services and which has the potential through comprehensive And at Royal Brompton to benefit up to 15 million Few NHS organisations engagement with staff Hospital the Squire Centre children and adults in can celebrate being at and patients, ensures best offers patients the chance London and beyond. We the forefront of medical practice becomes standard to come in to hospital on look forward to updating innovation for over 175 practice, identifies and the day of a procedure you on our progress. years, but for our Trust, removes inefficiencies, (such as angioplasty) rather the responsibility to and in some cases than stay the night before. push boundaries and completely redesigns the break new ground in treatments we offer. The centre combines a Bob Bell treating heart and lung pre-assessment clinic with disease lies at our core. There have been some a day-case unit, and almost
impressive milestones two thirds of patients seen Today we are the only Baroness Sally Morgan in the programme’s first in the unit have been able NHS trust in the country year of operation and to go home the same day, 31 January 2019
1 King’s Health Partners comprises Guy’s and St Thomas’, King’s College Hospital, and South London and Maudsley NHS Foundation Trusts and King’s College London University
4 Royal Brompton & Harefield NHS Foundation Trust About us 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 the first coronary stent, founding By recruiting the best clinical and two hospitals – Royal Brompton the largest centre for cystic fibrosis non-clinical staff and investing in in Chelsea, West London, and in the UK, and pioneering intricate their development, we maintain our Harefield, near Uxbridge – which heart surgery for newborn infants. position as the leading UK provider of are each known throughout the respiratory care and a national leader world for their expertise, standard We carry out some of the most in the specialist areas of paediatric of care, and influential research. complex surgery, and offer some of cardiorespiratory care, congenital the most sophisticated treatment that heart disease and cystic fibrosis. As a specialist trust, we exclusively is available anywhere in the world. treat people with heart and lung We treat patients from all over the We work closely with academic disease – this means our doctors, UK and other countries, many of and industry partners to play a nurses and other healthcare staff are whom are unique in their medical leading role in pushing forward the experts in their chosen field, with needs, and demand for our services boundaries of medicine through many of them moving to us from continues to grow year-on-year. research, and by sharing what around the world so that they can we know through teaching, we develop their skills even further. Our fetal cardiologists can perform can help patients everywhere. scans at just 12 weeks, when a Over the years our experts have baby’s heart valve is just over a Our values (page 6) guide and been responsible for major medical millimetre in size, and our clinical support every decision we make breakthroughs including performing teams regularly treat patients to ensure our care is safe, of the the first successful heart/lung well into their 90s and help them highest quality and – crucially – transplant in Britain, implanting maintain a good quality of life. available to everyone who needs it.
Annual Review 2018 5 Our vision and values 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:
• improving patient safety and satisfaction
• providing world class specialist treatments that others cannot offer
• bringing innovation to clinical practice through our research partnerships
• attracting, developing and retaining world class clinical leaders
• 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 who enthusiastically encourage and challenge us to deliver our goals.
Our three core values are: And the following values support us in achieving them: Our values We care We believe in our staff At the heart of any We believe our patients deserve the organisation are its best possible specialist treatment for We believe our staff should feel valued values: belief systems their heart and lung condition in a and proud of their work and know that that are reflected in clean, safe place. we will attract and keep the best people thought and behaviour. When values are by understanding and supporting them. successfully integrated We respect throughout an We are responsible organisation, the result We believe that patients should be is a shared outlook and treated with respect, dignity and We believe in being open about where consequent strength, courtesy, and that they should be well our money goes, and in making our from performance informed and involved in decisions hospitals environmentally sustainable. through the style of about their care. We always have time communications to listen. We discover to the behaviour of employees. We are inclusive We believe it is our duty to find and develop new treatments for heart and lung disease, both Our values were We believe in making sure our for today’s patients and for future generations. developed by staff for specialist services can be used by staff. We have three everyone who needs them, and We share our knowledge core patient-facing we will act on any comments values and four others and suggestions which can help We believe in sharing what we know which support them. us improve the care we offer. through teaching, so that what we learn can help patients everywhere.
6 Royal Brompton & Harefield NHS Foundation Trust Performance and achievements Performance and achievements
During 2017/18 we:
Cared for more than Cared for nearly Attracted more than Carried out 99 transplant 200,000 patients in our 38,000 patients of all £7.9 million in external procedures: our highest outpatient clinics. ages on our wards. grants for research. annual total to date.
Helped 11,670 adults Received a 95% Extended the intensive Were in the top three who have breathing recommendation score care unit at Harefield most highly cited problems caused by in the annual Friends and Hospital so that an extra health research teams diseases such as COPD Family Test. 250 critically ill patients in England – with 862 and severe asthma. can be treated each year. papers published in scientific journals.
Recruited 2,284 Helped a patient spend Completed an £18 Improved our patients onto over 200 Christmas with her million improvement environmental research programmes family by implanting a programme at responsibility by reducing that will contribute total artificial heart Harefield Hospital, our carbon emissions towards better patient (page 38). transforming and future- by 13.76% and energy care and outcomes. proofing several areas of consumption by 7.95%. the hospital (page 40).
Launched a brand Invested in the Maintained one of Recorded a healthy new day case ward wellbeing of our the fastest arrival to £75 million financial for respiratory patients staff, appointing a treatment times for UK surplus at year end, including those with freedom to speak up heart attack patients – 23 including £38 million asthma, interstitial guardian and launching minutes compared with of bonus payments lung disease and cystic weekly wellbeing a national average of 56. from NHS England for fibrosis (page 15). and yoga classes. exceeding our annual financial targets.
Annual Review 2018 7 PerformanceHealth secretary and visits achievements
Health secretary visits Royal Brompton
Jeremy Hunt, former secretary of state for health and social care, praised the Trust’s commitment to transparency and ongoing improvement during a visit to Royal Brompton Hospital.
Rt Hon Jeremy Hunt gave a presentation He told the audience: “It is an exceptionally to staff about patient safety during one of good result that 90 per cent of your staff the Trust’s clinical governance days, which would recommend the care here. I was are regular days set aside for clinical staff to pleased to see in Richard’s presentation devote to study and knowledge sharing. – right at the top – was a point about getting the right safety culture.” He was introduced by medical director It is an Richard Grocott-Mason, who described Following the visit, Mr Hunt commented: exceptionally the Trust’s approach to patient safety, “Staff at Royal Brompton are able to provide good result that particularly human factors training, which some of the NHS’s best care to some of the 90 per cent of was delivered to 1,000 members of staff by country’s sickest patients because of their your staff would the end of 2018. open and determined approach to learning. recommend the care here. Jeremy Hunt, who was accompanied on the “I was delighted to join them and see visit by Dr Liam Brennan, president of the first-hand how they share learning Royal College of Anaesthetists, began his across their hospitals and use this presentation by telling the stories of public to champion patient safety, an campaigners who have lost loved ones in impressive approach which they’ve hospital to preventable causes. been pioneering for nearly a decade.”
8 Royal Brompton & Harefield NHS Foundation Trust King’s Health partnership
New partnership takes heart and lung care and research to a new level
In November 2017 it was announced near Westminster Bridge in London, that the Trust hopes to play a We will bring together which will bring together clinical, pivotal role in revolutionising world-leading specialist academic and industry expertise services for heart and lung patients, skills and expertise from in a unique, world-leading hub. By with the creation of a new global across healthcare, academia coming together we will not only centre of excellence for care and and industry to create a bring the best of each organisation research in partnership with globally-significant system – we will also create a unique model King’s Health Partners (KHP).1 of care that will deliver: that will help address the challenges faced by healthcare providers • Clinical services at the Encompassing children’s and adult across the country: fragmented care forefront of the 4th clinical services, academic education between organisations; challenges industrial revolution – and research, we have a united vision in recruiting and retaining key staff; leveraging the best of to create a global powerhouse for and insufficient scale to develop advances in technology, heart and lung medicine and research true expertise in sub-specialties. digital innovations and AI in London, providing the best We believe our partnership will to deliver truly integrated possible patient care and experience. be an exemplar for the way health patient pathways and The partnership presents a unique needs to be delivered in the future. preventative healthcare opportunity to build a world- leading clinical-academic system • World leading translational In April 2018 our boards of directors which will transform the lives of research that delivers approved a feasibility study which millions of patients on a regional, innovation from bench assessed the impact the collaboration national and international level. to bedside could have on treatment, research and education, and scoped out the cost Individually, our Trust, along with • World class training and and affordability. NHS England now Guy’s and St Thomas’ and King’s education – attracting the plans to run a public consultation on College London Foundation Trusts, best of global talent. our proposals in summer 2019. We have international reputations look forward to continuing our work for excellence in research and with patients and staff, our referrers, clinical delivery. Together, working of the largest cardiovascular and local communities and regulators, to alongside the academic expertise respiratory institutes in the world. develop our vision into a dynamic of King’s College London and other At the heart of our new system will be and inspirational new system for academic partners, we can build a collaboration of specialist services the delivery of exceptional care and on these strengths to form one around the St Thomas’ Hospital site research for generations to come.
1 KHP comprises Guy’s and St Thomas’ NHS FT (GSTT), King’s College Hospital (KCH), South London and Maudsley NHS FT (SLaM), and King’s College London (KCL) university.
Annual Review 2018 9 The Darwin programme
The Darwin programme
10 Royal Brompton & Harefield NHS Foundation Trust The Darwin programme
Future-proofing our specialist care During 2017/18 a Trust-wide transformation programme – the Darwin programme – was launched, with the single aim of protecting and future-proofing our world-leading services and research.
The Darwin programme is taking on secondment from around the the organisation as an opportunity a comprehensive look at how Trust, including areas such as to change for the better and a we provide care across the Trust, theatres, nursing and pharmacy. number of successful initiatives have with a view to identifying best started to have a positive impact on practice and making it standard The end vision is a trust that uses patients’ experiences of our care. practice, driving innovation, and the most modern, efficient and reducing any inefficiencies. effective approaches to patient A key area of focus has been on care and administration. reducing the length of stay The name ‘Darwin’ was chosen by after procedures and getting staff, and the programme is managed In its first year, the Darwin patients back to their homes by a project team comprising staff programme was embraced across and families sooner.
Annual Review 2018 11 The Darwin programme Harefield Heart Division: The cardiology lounge
Cardiology lounge patient Phillip Hamdorff discusses his aftercare with senior cardiac rehabilitation nurse Debbie Beach
Cardiology patients at Harefield day cases – with patients often there and then, and they did, so Hospital can now have an invasive arriving in the morning and going I’m pleased about that. And sitting procedure, recover in a comfortable home shortly after lunchtime. here is quite relaxing; I think you chair and go home the same day, Patients have been enthusiastic would feel more pressured in a thanks to an innovative new ‘lounge’ about the new lounge, with 100 ‘hospital’ arrangement, in a bed.” developed by our specialists. per cent of those surveyed after their visit saying they were “very Philip Hamdorff has experience of With limited beds available, satisfied” with the service. both approaches; he was admitted planned procedures would as an emergency in November sometimes be postponed to and cared for on a ward after he make room for emergencies 100 per cent of learned the ‘indigestion’ he had arriving at Harefield’s busy heart been suffering was in fact a heart attack centre – so the cardiology those surveyed attack. He returned for a follow team challenged themselves to after their visit said they were up procedure in December and find a more efficient way to treat “very satisfied”with the service. preferred the cardiology lounge. elective (non-urgent) patients. Joseph Goff spent a day in the He said: “This is the way to go. We’re The cardiology lounge provides cardiology lounge recovering ‘walking wounded’ and don’t need a quiet, comfortable space, from his angioplasty procedure to be sitting in bed, so the beds can where patients relax in lounge (where small tubes are guided go to those who don’t recover well chairs as they recover from into an artery near the heart to and need more intensive nursing. their procedure in the cardiac widen it and improve blood flow), catheter laboratories (cath labs). and was pleased at the prospect “I can’t fault the service I’ve had of going home the same day. here. We’re so lucky to have the This frees up beds for those NHS, and ideas like this that help who really need them, and He said: “I’m impressed. I came the service by saving money and allows specialists to carry out in for an investigation, but they freeing up beds are brilliant.” straightforward procedures as saw that they could do something >>
12 Royal Brompton & Harefield NHS Foundation Trust The Darwin programme
>> We have reduced our waiting times The concept builds on the ‘radial because this enables us to do more lounge’ model used in some elective procedures. The success hospitals to provide same-day of this project is thanks to our staff, recovery for simple coronary who have shown an unbelievable procedures performed through commitment and enthusiasm.” the radial artery, a blood vessel in the wrist. But Harefield gives While improving patient care is a much wider range of patients the top priority, the new lounge the opportunity to be treated is already delivering efficiency as a day case: from those who savings, according to cath labs have had a stent, to those having manager Sumesh Thiruthalil. pacemakers or intra-cardiac defibrillators (small devices that Dr Vasileios Panoulas regulate the heartbeat) fitted. He said: “The only expenditure The priority is keeping Dr Vasileios Panoulas, consultant was buying reclining chairs, and interventional cardiologist and patients safe while improving we’re looking at more than half a clinical lead for the project, explained their experience. million pounds of in-year savings. the benefits this brings to patients: They can now come in, have “The priority is keeping patients safe their procedure, recover “In the near future we want to while improving their experience. in a nice comfortable expand capacity and look at how environment and get home we can schedule our patients so we can do both morning and “They can now come in, have early in the evening. their procedure, recover in a nice afternoon procedures, enabling comfortable environment and us to treat more patients, in get home early in the evening. less time than ever before.”
Annual Review 2018 13 The Darwin programme
Royal Brompton heart division: Day case unit open for business
Healthcare assistant Anna Krawczyk and a patient in the Squire Centre waiting area
Invasive cardiology Suitable patients then gives us the option to Harefield Hospitals Charity, services are more efficient arrive at the unit on the treat suitable patients as including a significant and patient-friendly day of their procedure day cases, which is more donation from Geoff and than ever before, thanks before being taken to the convenient for them. Fiona Squire, after whom to an increase in the in-house cath lab, then the centre is named. number of patients being recover in a dedicated “It also brings a number treated as day cases. area with trolleys and of small but important Charity chief executive lounge chairs. changes to the experience Gill Raikes said: “One Royal Brompton’s Squire of coming to hospital – of the key reasons our Centre opened in March Almost two-thirds of from being able to keep donors support this 2018 and offers patients patients seen in the unit your own clothes on Trust is because of the the chance to come in to have been able to go home throughout your visit, to many innovative things hospital on the day of an the same day, eliminating being able to relax in the it is doing to improve invasive procedure (such the need for any overnight lounge and watch TV while patient care, and the as angioplasty) rather than stay at all. More than 90 per waiting for your lift home.” initiatives that make up stay the night before. cent of patient feedback the Darwin programme so far has been positive. The new centre comprises are fine examples of this. The centre combines a a reception and waiting pre-assessment clinic with Annette Sprules, cardiology area, clinic rooms, cath lab “We’re delighted to have a day case unit. Patients service improvement and MRI, large recovery been able to help the have their pre-assessment manager, explained area and patient lounge. Trust’s teams expand appointment with a nurse the benefits: “Patients their day case facilities at practitioner two weeks have lives, families and The refurbishment, which Royal Brompton, as this before their procedure, to jobs, and most prefer cost nearly half a million will help them see more see if they are suitable for not to have a prolonged pounds, was part-funded patients, and ultimately a same-day admission. hospital stay. This unit by the Royal Brompton & to save more lives.”
14 Royal Brompton & Harefield NHS Foundation Trust The Darwin programme New “one stop shop” is more convenient for patients with lung disease
Patient George Coldrake discusses his care plan with ILD clinical nurse specialist Charlotte Hogben
New interstitial lung disease (ILD) Dr George explained: “ILD patients golf, and looking after his patients at Royal Brompton can now are often breathless and may have grandchildren, was pleased that the get tested, diagnosed and given a limited mobility, so it is inconvenient visit was quicker than expected. comprehensive treatment plan – all in for them to make multiple trips to a single day. hospital. At the same time it is not He said: “Regular trips to Royal practical for us to use inpatient beds Brompton would have been a lot Previously, patients needed to attend for patients who are undergoing tests.” more inconvenient than just having multiple clinics or be admitted for a to come in for one day. three-night stay, to undergo the tests The clinics were redesigned needed for a clear diagnosis. around patients – the outpatient “It was very efficient. I got here at appointment starts in the morning 8.10am and I finished everything at But a wholesale clinic reorganisation, with tests including lung function, about 11.15am – so just about three led by consultants Dr Peter George bloods, CT scan and ECG (where it is hours. I’ve had a blood test, CT scan and Professor Athol Wells, means necessary to check a person’s heart and breathing test, and haven’t had to the team can now complete all rhythm). The results are reviewed by a wait much in between. It’s a lot better diagnostics in one day – improving consultant, who meets the patient to this way. the experience and eliminating discuss their diagnosis, and most are overnight stays for most patients. able to go home with a treatment plan “I knew everything in advance so I was in place by lunchtime. prepared, which was good. It’s been a lot quicker than I had thought and all Professor Wells said: “It’s a simple the people have been very pleasant. principle but it takes a great deal of I’ve been very impressed by it all.” work to ensure we have the personnel, the clinic space and admin, and the Currently, the one stop shop imaging and laboratory support, to approach is for new ILD patients, but create a seamless visit for patients. I the team is investigating how other would like to thank everyone involved clinics could be similarly streamlined. in this project for their role in making The new way of working will bring its this possible.” own financial benefits in reduced ILD admissions alone, with significant George Coldrake, 68, a retired savings expected when the method is brewer from Watford who likes rolled out to other conditions such as Dr Peter George to spend time travelling, playing asthma and allergies.
Annual Review 2018 15 Specialist heart services
Our specialist heart services in 2018
Clinical teams at Royal Brompton and Harefield hospitals are world leaders in the care of serious and complex heart conditions, including those present at birth, inherited or acquired.
16 Royal Brompton & Harefield NHS Foundation Trust Specialist heart services
Royal Brompton hailed as “stand-out area” of CHD research by European Society of Cardiology
Royal Brompton’s cardiac expertise was profiled in a leading European cardiology journal this year, and was described as a ‘centre of excellence’ with ‘stand-out’ research.
The September 2017 edition of the European Heart Journal, published by the European Society of Cardiology and one of the leading cardiology publications in the world, featured a profile of Royal Brompton’s unit.
The report describes the hospital as a centre that “prides itself on leading innovative research whilst providing first class care to patients.”
>>
Annual Review 2018 17 Specialist heart services
>> Highlighting that “research, Inaugural Arrhythmia innovation and education have been constant themes” at Royal Summit takes place Brompton since it was founded in 1841, the journal explained that the Trust produces more highly cited publications about respiratory and cardiovascular medicine than any other NHS trust in England.
Research highlighted in the article includes the CardioMems system, where a microchip is placed in the pulmonary artery for patients with heart failure to enable remote monitoring, and, in collaboration with respiratory specialists at the hospital, new ventilation and mask technologies for the treatment of Magda Greda, healthcare assistant and Shouvik Haldar, consultant cardiologist sleep apnoea and heart failure. A new annual scientific event While highlighting the launched by cardiology experts from There is a growing need hospital’s “world-class research the Trust took place in March, with facilities” and congenital heart more than 200 delegates attending. to provide high-quality disease as a “stand-out area of educational content research”, patient-centred care is The London Arrhythmia Summit here in the UK and this identified as the Trust’s focus. brought together experts from inaugural event sets the around the world to discuss the precedent for arrhythmia Consultant cardiologist Professor latest advances in electrophysiology education going forward. Kim Fox commented: “Everything and implantable cardiac devices, we do at Royal Brompton including important new studies and Harefield is based on our and changes to guidelines. Dr Shouvik Haldar, one of the patients. Our research is patient- consultants who directed the focused and we believe we The one-day summit on 16 event, said: “Our aim was to give can give the best care to our March 2018, was attended by electrophysiologists and arrhythmia patients by having a high-profile more than 200 delegates from specialists from the UK and beyond interaction between our clinical 10 countries, including the USA, a succinct review of all the important and research colleagues.” Canada, Iraq and South Korea. It developments and changes in featured in-depth presentations this arena over the past year. and thought-provoking debate involving eminent international, “There is a growing need to provide European and UK specialists. high-quality educational content here in the UK and this inaugural event The programme was dedicated to sets the precedent for arrhythmia highlighting guideline changes and education going forward. important developments that will impact daily practice, and considering “It is fantastic that the Trust is new developments on the horizon. taking the lead in this arena and we hope to develop this The summit, which was developed into an unmissable event in the by the heart rhythm team at the cardiology conference calendar.” Trust with the charity Arrhythmia Alliance providing logistical support, The second London is now set to be an annual event, Arrhythmia Summit will be providing an alternative forum for held on 15 March 2019. Professor Kim Fox arrhythmia education in the UK.
18 Royal Brompton & Harefield NHS Foundation Trust Specialist heart services Nurse wins national award for work with familial hypercholesterolaemia
Lorraine Priestley-Barnham and Heart UK Medical Director, Dr Alan Rees
A clinical nurse specialist at The award was launched in Harefield Hospital won an award memory of 11-year-old Rianna this year for her work in helping Wingett, who died suddenly in 2009 raise awareness and detection of following a cross country run at familial hypercholesterolaemia (FH). school, and was found to have been suffering from undiagnosed FH. Lorraine Priestley-Barnham won the Rianna Wingett Award, Simon Williams from Heart UK said which recognises healthcare that Lorraine was “a clear winner” of professionals who go beyond the the award. He said: “She has been call of duty to help treat FH. a great help to our charity, both personally and professionally. FH is an inherited condition which leads to exceptionally high “Her role in helping us to write cholesterol levels, double or even publications for children with FH, four times higher than average. Only giving us advice on the condition one in five people with FH know and helping us learn how to talk that they have the condition. to children with FH was incredibly valuable to our services. We now Nurses such as Lorraine are able have a children and young people’s to detect family cases of the programme, and three booklets full of condition based on data from information for them. She is always patients who receive treatment at there when we need a helping hand.” the Trust, helping to identify and treat more cases of the disease. Lorraine said: “I was both honoured and humbled to receive the award. Lorraine is a clinical nurse specialist in My focus is always passionately hypercholesterolaemia and cascade geared toward looking after the screening, and has worked at the Trust best interests of children. since 2014. She was presented with the award at an annual ceremony “By raising awareness to help hosted by Heart UK, a national charity increase early detection, it’s my that works to help prevent premature hope that children with FH will be deaths caused by high cholesterol appropriately managed and should and cardiovascular disease. not die from inheriting the FH gene.”
Annual Review 2018 19 Specialist heart services
New heart surgeon joins Trust
adult CHD programme with CHD are living longer and we are all extremely based at Central Manchester, than ever before and, as pleased that he chose and an honorary paediatric a result, demand for these to join us. We are cardiac surgeon at Alder services is increasing. committed to investing Hey Children’s Hospital. in, and protecting, “Royal Brompton is also our services for CHD He trained at Leiden recognised as the most patients – many of University Medical School influential research unit whom we treat from in The Netherlands. He in the world for adult birth to old age.” completed general and adult CHD, and I am absolutely cardiac surgical training delighted to be joining in London, Bristol and such an internationally- Manchester, and congenital respected team.” cardiac surgery fellowships Royal Brompton at Great Ormond Street Outside of his work in the is also recognised Hospital, Guy’s and St NHS, Mr Hoschtitzky is as the most Thomas’ Hospital, and Alder working to set up a new, influential Hey Children’s Hospital. self-sustainable congenital Mr Andreas Hoschtitzky research unit cardiac surgery service for Mr Hoschtitzky said: “Royal the north-east of Brazil, in the world for The Trust’s heart division Brompton’s congenital in conjunction with the adult CHD, and was strengthened this year heart disease (CHD) unit is International Children’s I am absolutely by the appointment of Mr one of the biggest and best Heart Foundation. delighted to be J. Andreas Hoschtitzky. in the UK: around 1,300 joining such an procedures are conducted Welcoming Mr Hoschtitzky internationally- Mr J Hoschtitzky was here each year and the unit to the Trust, Dr Richard respected team. previously lead surgeon for consistently has among the Grocott-Mason, medical the regional north west of best patient outcomes in director, said: “Andreas England and North Wales the country. People born brings a wealth of expertise
20 Royal Brompton & Harefield NHS Foundation Trust Specialist heart services Harefield Heart Live encourages teamwork in heart attack response
Harefield Heart Live 2017 attracted more than 200 staff, patients and members of the public in October.
The two-day event, which launched in 2007, involves sharing best practice in heart attack management with professionals, and gives patients and the public the chance to learn about CPR essentials.
Professionals, including doctors, nurses and paramedics, learned about the latest techniques and treatments in heart Wayne Hurst (matron in cardiothoracic surgery) and Sarah Chorbachi (practice facilitator in cardiology) showing Kajal, attack management, Melissa and Monty from Rickmansworth School some CPR essentials including a live simulation exercise, panel 70 students from 11 local and rehabilitation care, discussions and lectures. schools played the part of and most recently a giant focus group to give resuscitation in the Patients and public were feedback on the plans. general public. given the chance to learn The real ethos of how the Trust trains Consultant cardiologist “When most patients this event is around and develops its expert Dr Miles Dalby, who runs have a heart attack, their teamwork – how first contact is not with medical staff, and to learn Harefield Heart Live, said: those in the field, and practice the CPR “The real ethos of this one of our specialists or such as ambulance essentials that could one event is around teamwork even an ambulance crew, staff, work with the day help them save a life. – how those in the field, it is with a member of such as ambulance staff, their family or a stranger team in the heart The Trust team work with the team in in a public place. If that attack centre. demonstrated plans for a the heart attack centre. person can do some CPR ‘ready to resuscitate’ booth We’ve expanded it over the in those first moments, and app, which will teach years to include subjects the person’s chances of basic resuscitation, and such as post-heart attack survival are increased.”
Annual Review 2018 21 Specialist lung services
Our specialist lung services in 2018
Teams at Royal Brompton and Harefield hospitals are at the forefront of diagnosing and treating diseases of the lungs, ranging from genetic conditions such as cystic fibrosis, to those acquired through smoking or industrial exposure.
22 Royal Brompton & Harefield NHS Foundation Trust Specialist lung services
New procedure gives asthma sufferers hope
Asthma sufferers have been given hope for improved treatment with a new procedure at Royal Brompton Hospital. Professor Pallav Shah
The trailblazing therapy, targeted lung Professor Shah said: “We are aware the denervation (TLD), has shown excellent tiny branches of the vagus nerve – which results for the treatment of chronic stretches from the brain, down the windpipe obstructive pulmonary disease (COPD). and into the lungs and are wrapped Now, the RELIEF-1 trial is investigating around the outside of the lungs’ airways whether those with asthma can benefit too. – worsen the effects of the condition. In the worldwide Professor Pallav Shah, consultant respiratory “This is because the nerves cause the physician, said: “In the worldwide studies of muscles that line the airway to become studies of TLD TLD for COPD, about 70 per cent of patients overactive, rather than moving smoothly as for COPD, about who have undergone the procedure have they do in those without the disease. This, 70 per cent of seen an improvement in lung capacity, combined with the excessive production patients who breathlessness and quality of life. of mucus that coats the airways from have undergone the effects of chronic smoking, makes the procedure “We’re now looking at whether this them narrower and more irritated. have seen an treatment can also help those with severe improvement in asthma. Both these lung conditions “This constriction means the air cannot lung capacity, are triggered in the same way.” flow in and out so easily, so those breathlessness with COPD are left short of breath and quality of life. TLD works by using heat energy, in and often suffering from a persistent the form of radiofrequency waves, to cough, wheezing and a tight chest.” destroy branches of the vagus nerve that are no longer working properly. Professor Shah said the results with COPD This prevents the faulty nerve branches are very promising and the team at Royal from sending messages which cause Brompton hopes to see similar results muscles to tighten and produce mucus. when TLD is used with asthma patients.
Annual Review 2018 23 Specialist lung services Study highlights potential for life-changing lung procedure
benefits to patients with COPD, so it’s a real concern that people who may benefit from them are not being considered to see if they might be suitable for treatment.”
The study involved collecting the experiences of patients with emphysema (a type of COPD) who had a lung volume reduction procedure at Royal Brompton or Glenfield Hospital in Leicester.
Dr Hopkinson said: “We heard Research by Royal Brompton’s procedure can have a significant throughout this study that patients respiratory teams, published in the impact on length and quality of life. had to wait a long time before European Respiratory Journal Open The procedure involves removing eventually being referred to a Research, has found that patients damaged tissue, giving the healthy specialist. Health professionals may feel they are having to ‘fight’ to be parts of the lungs more room to not know about recent advances in referred for an important procedure, breathe. It sometimes involves an lung volume reduction treatments, despite it being recommended by operation, but can also be done they may not be sure how to refer the National Institute for Health using a fibre-optic camera. or they may think that procedures and Care Excellence (NICE). are riskier than they really are. Fewer than 100 patients undergo Lung volume reduction is suitable the procedure each year in the “Sadly, patients described to for some patients with COPD UK. Dr Nick Hopkinson, honorary us how they had to fight to be (chronic obstructive pulmonary consultant physician at Royal referred for these procedures, disease), a group of lung conditions Brompton Hospital, said: “These which could have a significant that cause breathing difficulties. The procedures can bring dramatic impact on their quality of life.”
“It’s completely changed my life. It feels like I can breathe again”
Penny Rickman, 62, had been told Penny’s lung condition deteriorated air in the lungs and means she can since childhood that her shortness to the point where she was dependent breathe more easily. of breath was a result of asthma. It on a portable oxygen concentrator. was only in 2002 – when Penny Penny said: “It’s completely changed was 48 – that she learned she had She was referred to Royal Brompton in my life. It feels like I can breathe emphysema, a form of COPD which 2014, where she was diagnosed with again, and I can do the things I love damages the air sacs in the lungs. alpha 1 antitrypsin deficiency: a rare, without using the oxygen at all. The inherited condition that can lead to procedure has been absolutely life- Penny said: “My symptoms would people developing COPD early in life changing for me.” suddenly worsen and it felt like there and may mean the disease progresses was an elephant sitting on my chest. more quickly than usual. Commenting on whether she I’d be really struggling to catch my should have been offered the breath at all. It was very frightening.” Doctors at Royal Brompton offered procedure earlier, Penny said: “I Penny the chance to take part in a didn’t know it was available. I just Despite regular visits to her GP clinical trial of a new technique for hope more people in my position over the next nine years whenever lung volume reduction. Three endo- ask their GP about whether they her condition deteriorated, Penny bronchial valves were implanted in might be suitable, and I hope wasn’t referred to a respiratory her left lung, which allow air to leave doctors realise what a difference it consultant for regular check-ups at damaged bronchi, but not to return. can make – I’m convinced it could her local hospital until 2011. This reduces the amount of trapped benefit a lot more people.”
24 Royal Brompton & Harefield NHS Foundation Trust Specialist lung services
Trust experts help shape the future of respiratory medicine Two experts at the Trust this year helped to shape the way respiratory conditions are diagnosed and treated, in the UK and further afield.
Professor Andrew Bush, easy to treat with the right Royal Brompton, has been consultant paediatric chest medication and the right appointed to the National physician, co-edited a advice. However, this has Institute for Health and special commission from bred complacency: anyone Care Excellence (NICE) The Lancet, which drew can diagnose asthma and panel that is reviewing the together research and anyone can treat it. But new national guidelines opinion from around the we should be thinking on chronic obstructive world to challenge doctors more about curing it.” pulmonary disease (COPD). to think differently about the way they diagnose Dr Nick Hopkinson, Dr Hopkinson, the Trust’s and treat asthma. reader in respiratory clinical lead for COPD, medicine and honorary will work with colleagues Professor Bush teamed up consultant physician at on the panel to ensure with colleague Professor that the latest national Ian Pavord from the guidelines on diagnosing Professor Andrew Bush University of Oxford and managing this group to create the Lancet of severe lung diseases are Asthma Commission, based on the right evidence. and says the aim of the There are 1.3 million publication from the outset people in the UK with Dr Hopkinson said: “There was to be provocative a diagnosis of COPD, are 1.3 million people in and challenging. so it’s important the UK with a diagnosis He explained: “It’s meant to make sure that of COPD, so it’s important to be a controversial the guidelines that to make sure that the document, meant to NICE produces guidelines that NICE shake people up. reflect the best produces reflect the available evidence. best available evidence. “We feel that asthma care This will help to ensure has stalled. There is no that our patients receive doubt that a lot of asthma is the best treatment.” Dr Nick Hopkinson
Annual Review 2018 25 Specialist lung services
Simon Harding-Rolls developed late- onset asthma in 2003 and was eager to find out if he was suitable for treatment with biologics.
He said: “I’ve been on daily steroids since 2005 and they have lots of side-effects: the most serious I’ve had was steroid-induced diabetes. I’m grateful for the treatment – without it I would probably be dead – but your quality of life is majorly affected by it.
“Asthma does make you old before your time. I used to go skiing and throw myself down every slope known to man, but now I can’t even get up a mountain. My 13-year-old son knows that when we go to the park ‘daddy doesn’t run’.
“I’d been aware of biologics for some time. I wanted to join the trials for them but couldn’t, which was quite a blow, but as soon as they became available I went for it – and it’s made a tremendous difference.”
New medicines help Simon is prescribed a biologic called Mepolizumab (Mepo), which is improve quality of life administered via injection during an outpatient appointment at Royal Brompton. A new group of medications biologics at the Trust. He said: As well as having improved overall lung has been enabling patients “For many years, high-dose function, Simon has not experienced with some of the most serious steroids were the only real option any acute periods of illness since being forms of asthma to enjoy for managing severe asthma on Mepo, which he says previously used a better quality of life. symptoms, so biologics have to happen two or three times a year. been a significant breakthrough. Biologics work by targeting He said: “I can do far more than I used and blocking specific parts of “Patients for whom this to be able to do. I can now jump off a the immune system that are medication is suitable train at Waterloo and walk into the city involved in allergic reactions have reported significant from there if I want to. In that sense, and asthma symptoms. improvements in their quality Mepo has been a game changer.” of life, and as this young family This year the respiratory team of medication develops further at Royal Brompton began using and new varieties become these medications to give patients available, we’re hopeful that an option that does not involve many more of our patients high-dose steroids – which can will be able to benefit.” have unpleasant side-effects.
While not suitable for all patients, those who have For many years, high- been able to move onto these dose steroids were drugs have reported reduced the only real option breathlessness and an ability for managing severe to be much more active. asthma symptoms, so Dr Andrew Menzies-Gow, biologics have been a consultant physician and significant breakthrough. respiratory division clinical Simon Harding-Rolls and Rachel Stead, director, led the introduction of clinical nurse specialist in asthma
26 Royal Brompton & Harefield NHS Foundation Trust Specialist lung services Research leadership success for cystic fibrosis expert
Consultant physician Dr Nick Simmonds received a national award on behalf of the cystic fibrosis team in recognition of its globally-significant research.
The Clinical Research Network Research shows benefits of Awards from the Royal College of Physicians (RCP) and National Tai Chi for patients with COPD Institute for Health Research recognise outstanding research Research by a Trust The study tracked to consider offering Tai leadership in the NHS. respiratory expert 120 patients with Chi as an alternative has shown that the COPD in rural China therapy that patients Dr Simmonds, who was also this ancient art of Tai Chi is a who had never used would then be able to year appointed to the position of lower-cost, more easily a bronchodilator (a continue unsupervised associate director of the cystic accessible alternative medication that makes in their own home. fibrosis department alongside to conventional breathing easier by colleague Dr Su Madge, was rehabilitation for chronic relaxing the muscles “The study has presented with the award at obstructive pulmonary in the lungs and implications for the UK the RCP’s Harveian Oration – a disease (COPD) patients. widening the airways). too. Provision of PR keynote lecture that has been can be patchy in some held annually for 500 years. Respiratory consultant After beginning daily parts of the country Professor Michael treatment with the and practising Tai Chi While Dr Simmonds was Polkey, alongside bronchodilator, subjects offers a more easily the named recipient, he is Chinese researchers were randomly assigned accessed alternative.” clear that the award was a from the State to groups receiving result of teamwork, saying: Key Laboratory of traditional PR or Tai Respiratory Disease in Chi. After 12 weeks, a “Research is something I feel very Guangzhou, carried clinically significant passionate about, so to receive this out a study of the difference in health recognition is extremely pleasing. impact of Tai Chi on status (as measured respiratory function. through a questionnaire) “The award is important because emerged favouring Tai it acknowledges research It showed that Tai Chi Chi. Similar trends were that takes place specifically is a viable alternative noted in performance of within the NHS – I believe that to pulmonary a six-minute walk test. ensuring research is embedded rehabilitation (PR), into our daily practice is a vital the usual form Professor Polkey way to deliver high quality of management said: “Physical activity patient care and outcomes. for improving is key to reducing respiratory function. symptoms in COPD. “We have a strong culture of We do recommend PR, Professor Michael Polkey research in this Trust, and Tai Chi, which but our study shows without the support of my originated in China, that Tai Chi is a viable The study was colleagues and the wider cystic involves stretching, alternative when there is published in the fibrosis research team this would breathing and no local PR service. We journal Chest. never have been possible.” coordinated movement. encourage PR providers
Annual Review 2018 27 Children and young people
A dedicated service for children and young people
28 Royal Brompton & Harefield NHS Foundation Trust Children and young people
Longer hospital stay improves outcomes for babies
A major transformation in how we The most widely-used and successful treat babies with a serious congenital treatment is a three-stage operation heart condition has raised the called the Norwood procedure, with survival rate to 100 per cent during one operation soon after birth, a It is normal once a child is a challenging period in their care. second a few months later, and stable for them to be discharged a final one at roughly four years until the second procedure, and Hypoplastic left heart syndrome (HLS) of age depending on the child. for 80% of them this is fine, but is a defect in which the left ventricle the complications that occur (lower pumping chamber of the heart) Data from all centres that perform the in 20% of cases are invariably is underdeveloped and much smaller Norwood procedure shows that 20 per than it should be, while the aorta cent of patients do not survive between fatal, because these are sudden (the main blood vessel that carries the first and second operations, events such as arrhythmia or blood from the heart to the rest of the so-called ‘interstage’ period. aspiration pneumonia that the body) is usually very narrow too. require quick intervention. The Trust’s hypoplast programme Even with medication, life expectancy was relaunched in 2015 by consultant is no more than four weeks. >>
Annual Review 2018 29 Children and young people
In reality, this means babies needing Mr Michielon says compares “very to stay in hospital for many months, favourably” with other centres. which is difficult for parents and resource-intensive for the Trust, so The children from the study are Mr Michielon launched a study to growing up fast, and he expects to examine whether this new approach perform the first stage three operation is worthwhile – and the evidence in the Trust’s new programme gathered is overwhelming. within the next few months.
He said: “Since May 2015 we Mr Michielon concludes: “Yes this have offered to keep all interstage is a use of resources beyond what children with HLS and its variants could be considered a normal level, in hospital, with daily and weekly but by doing this we are achieving investigations, so we could track a good quality of life for children survival across every stage. with a condition that is fatal – and Mr Guido Michielon that cannot be measured. What “Up to May 2018, we have had a total price can you put on a child’s life?” >> of 28 patients, of whom 26 survived paediatric heart surgeon Mr Guido the first operation. Of those, 24 Michielon, who introduced a new parents took up the offer to remain approach of keeping children in in hospital, and we have had no hospital until after they have recovered mortality during the interstage period. from their second operation. “What is very interesting is that 20 per cent of children did need escalation He explains: “It is normal once a child What is very interesting is is stable for them to be discharged of care, in line with what we would that 20 per cent of children until the second procedure, and for 80 expect, but they were taken back to did need escalation of per cent of them this is fine, but the theatre or moved to intensive care care, in line with what we complications that occur in 20 per cent and all survived. Had those events of cases are invariably fatal, because happened outside hospital, they would expect, but they these are sudden events such as would have invariably been fatal.” were taken back to theatre arrhythmia or aspiration pneumonia or moved to intensive that require quick intervention. Each operation in the process is care and all survived. major open-heart surgery and “We had the idea that being in carries a degree of risk, and two hospital during this time would patients in the study did not survive facilitate escalation of care – if the the second operation. However, child has any complications, they 24 patients out of 28 represents a are in exactly the right place.” survival rate of 90 per cent, which
The three stages of the Norwood procedure Patent Small (open) • Stage one stabilises the child and a vein is used to create a hypoplastic ductus and happens soon after birth. more permanent blood flow to aorta arteriosus atrial The surgeon enlarges the the lungs. tiny aorta, inserts a shunt to improve blood flow, and • Stage three is called the Fontan reconfigures the inside procedure and happens at a of the heart so that a mix later stage, usually around the of oxygenated and non- time the child starts school. This oxygenated blood is now procedure further reconfigures Atrial septal flowing around the body. the heart to create a more defect “normal” circulatory system – (opening between the • Stage two takes place around with oxygenated blood flowing atria) six months of age, when to the body, and non-oxygenated the shunt (which is made of blood going to the lungs. Small artificial material) is removed Hypoplastic left (hypoplastic heart syndrome left ventrical
30 Royal Brompton & Harefield NHS Foundation Trust Children and young people ‘Social Club’ makes time in hospital easier for babies and parents
It is normal for parents just went to the library but and carers of children it made a difference to his with complex conditions whole demeanour and his to remain in hospital with mum was very pleased. their children for long periods of time. This can “After that myself, play be challenging for their specialist Romilly Cuthbert own wellbeing, so the and family liaison Laura paediatrics team now runs Karlsen sat down to ‘Baby Social Club’ – enabling discuss how we could families to enjoy supported make life better for other quality time together patients here, especially outside the hospital walls. our hypoplast babies who are with us for at least six The inspiration for the months and miss out on club came from one very many normal experiences. committed mother, as paediatric intensive care “We knew from specialist unit (PICU) deputy sister neurological consultant, Rebecca McKeever explains: Naila Ishmailya, how important social experiences “Our longest ever stay in are for children’s PICU was a little boy, Zach development, and were Islam, who was here for supported by senior medical Social Club leads Laura Karlsen, Romilly Cuthbert and Rebecca McKeever (l-r), 21 months. His mum was and nursing staff including with Zach Islam and his mum Jushna very good at entertaining consultant intensivist Dr him and taking him out Margarita Burmester and and libraries, social coffee day in hospital can feel with his portable ventilator. PICU matron Claire Buckle.” shop outings, picnics, baby the same, and Social Club yoga, and visits to their gives them something to One day she was ill and Portable monitors supplied ‘secret garden’ (a walled look forward to – or in one couldn’t come in, and we by the Brompton Fountain garden within the hospital’s mum’s case something to noticed a real change in his charity enable the nurses grounds). In total around put her makeup on for! It’s behaviour, so we asked if to organise trips such as 150 children and their carers a really important project we could take him out. We story time at bookshops have joined the trips. for our team, and I think it makes a real difference to Zach Islam’s mum Jushna patients and their parents.” said she was delighted that her efforts to keep her son entertained during his stay on the ward had inspired a resource that is I can’t tell you how helping other parents. important it is when “It’s amazing,” she said. “I you and your child can’t tell you how important are stuck in hospital it is when you and your for a long time, to child are stuck in hospital have the opportunity for a long time, to have to do ‘normal’ things. the opportunity to do I feel really happy ‘normal’ things. I feel that this can benefit really happy that this can other people. benefit other people.”
Rebecca McKeever added: Social Club members enjoyed a trip to the local fire station to meet the firefighters “Parents tell us that every
Annual Review 2018 31 Children and young people
Festive trip for babies with congenital heart disease
during my pregnancy, but nothing prepares you for seeing your baby covered in tubes and not being able to hold him.
“The support I have had has been great though. I’ve even been able to start feeding Levi after two months, because of the breastfeeding support they give to the mums here.”
Zoya’s mum Agnieska Ikram, who had been by her daughter’s side in hospital for seven months, said: “It has taken her a while to recover and there have been problems but she has fought through everything, including Baby Zoya Ikram and mum Agnieska enjoyed an afternoon in Chelsea Garden Centre a cardiac arrest.
Two babies who had been in Royal for both babies, who immediately fell “All the doctors and nurses are really Brompton since birth with hypoplastic asleep after going outside. good, but it is still stressful because left heart syndrome, were able to take we are in hospital with our baby. a trip out to Chelsea Garden Centre to Levi’s mum Estera Enculescu said: There were moments when she was look at the Christmas trees. “It’s good to get outside. When we unwell and I couldn’t do anything. If I were upstairs in the hospital he was could give her my own heart, I would. Seven-month-old Zoya and two- crying, and as soon as we came out month-old Levi enjoyed looking at he fell asleep. “It’s lovely to come outside. To just go the brightly-coloured flowers and for a walk or go to the park, just you Christmas lights. Feeling the cool “It has been hard being in hospital for and your baby… for an hour it feels autumn air was a new experience all these weeks. They worked with me like normal life.”
Young patient raises money for babies in paediatric intensive care unit
to the generosity of patients, their Ramandeep, who raised the families and members of the public. money by selling cookies that she hand-decorated with One such supporter is thirteen-year- heart and lung motifs, said: “I old respiratory patient Ramandeep really wanted to do something Kaur, who raised money for the for the babies here.” charity while staying on the children’s ward for treatment after collapsing Dr Louise Fleming, consultant in the outpatients’ department. respiratory paediatrician, said: “Ramandeep is an absolute joy. Ramandeep had been attending She has such a positive outlook an appointment to manage an and is very determined. underlying condition, obliterative The portable monitors used by bronchiolitis, which causes the lungs “It was an incredible team effort to Baby Social Club were donated by to become scarred and lose function. resuscitate her. The outpatient staff, the Brompton Fountain, a charity The paediatric respiratory and intensive care unit and respiratory that focuses solely on supporting intensive care teams rushed to teams worked seamlessly. It is a our paediatric wards and – like outpatients to resuscitate her, before credit to them that Ramandeep all our charities (page 52) – is admitting her to PICU. She has has made such a good recovery.” able to make a difference thanks since made a good recovery.
32 Royal Brompton & Harefield NHS Foundation Trust Children and young people Man’s best friend brings fun to children’s ward
It was puppy love at first sight for young inpatients when therapy dogs came to visit the playroom.
The therapeutic benefits of spending time with pets are well-publicised, but it is not easy to bring animals into a hospital environment with vulnerable patients.
However, thanks to the hard work of paediatrics matron Claire Buckle and her team, children and their Care Quality Commission families can now regularly spend time with Finn the golden retriever places our children’s services and Brinkley the cockapoo. in top six nationwide Claire explained: “I sought expert advice on the best breeds of dogs for children – characteristics, Young patients and their care as 7/10 or higher – up character, how soft their fur is for carers have rated the Trust a from 88 per cent in the stroking – then we shortlisted and good place to be cared for in previous survey. Nearly half interviewed them in a local park.” the latest national Children rated their care at 10/10. and Young People’s Survey. Finn was the first dog to visit, with • A 50 per cent increase in his owner Helen Webb. During The survey covers both the number of parents who his inaugural visit to Rose ward, inpatients and day cases, and felt they were kept fully Finn met 10-month-old Reyan, asks 63 key questions about the informed about their child’s 18-month-old Freya, five-year-old experience of being in hospital. care – up to 96 per cent. Darcy and seven-year-old Isabella.
The Care Quality Commission The survey involved 132 acute Isabella’s mum Louise Eaton explained (CQC), which publishes the survey, and specialist NHS trusts across that Isabella has a number of health identified the Trust as one of only England. Key areas where our complications including being blind, five in England that performed scores were significantly higher so sensory input, such as the tactile “much better than expected” in than other trusts included: experience of petting a friendly the eight to 15 age category. dog, is very important for her. • how well staff kept The Trust’s results were also “better young people and their She added: “Isabella’s condition than expected” for children aged families informed and can be very isolating, so to have the up to seven years old. Combined, involved in their care opportunity to do this when she comes it means the Trust is one of into Royal Brompton is really special.” only six nationwide achieving • how available staff were when “much better than expected” a child needed attention, pain Pets as Therapy was founded in 1983. results for young patients. relief, or someone to play with Its volunteers take their own beloved pets to visit environments ranging • the level of dignity and There were also some significant from hospices and care homes, respect shown to young improvements in the Trust’s to schools and prisons, providing patients and their families score since the previous survey companionship and comfort to two years before, including: • the overall experience people who may not otherwise be able to spend time with animals. • 96 per cent of parents/ of receiving treatment carers rated their child’s in our hospitals.
Annual Review 2018 33 Children and young people Simulation doll provides vital lifesaving training left pumping chamber), However, Dr Naqvi invited and has the potential to him to visit the Trust and “learn” new conditions. see some of the congenital heart disease (CHD) team’s Dr Naqvi said: “The system outstanding work in has been created by storing research, education and images of numerous real patient care. Following babies with congenital this visit, he agreed to heart disease, and as such create a fully-produced it provides the opportunity model for the Trust – a for diagnostic training process that took several on an entirely new level. years and cost £26,000. It was funded with the help “Getting to scan the full of the Friends of Royal range of congenital heart Brompton charity (page 53). conditions in patients typically takes trainees Dr Naqvi added: “I years to accomplish, but cannot thank the charity this doll can provide enough for their help. realistic simulations We are thrilled to be of these conditions one of the first in the in just a few hours.” world to have this doll.” A bespoke simulation Leipzig, Germany, to ask doll that can ‘learn’ heart the inventor, Dr Michael The CHD team has already conditions has been Weidenbach, to make one used the doll to help produced to train doctors especially for the Trust. We are thrilled to be share knowledge outside to detect life-threatening one of the first in the the Trust. Forty doctors conditions in babies. The doll, named SOPHIA, world to have this doll. from around the world has been programmed visited Royal Brompton Paediatric cardiologist with information about for a specialist training Dr Nitha Naqvi came many serious congenital day, learning how to scan across the innovative heart problems, such The baby was Dr and identify different prototype on the internet, as hypoplastic left heart Weidenbach’s life work and paediatric heart conditions and was so inspired by its (a condition with an he was originally reluctant in one afternoon. potential that she flew to under-developed small to make any more.
Paediatric respiratory course success The Trust’s largest on workshops, clinical conditions, so it is Unlike invasive ventilation, ever course in and academic lectures, really important that which requires a paediatric non-invasive and a thought-provoking district general hospitals tracheostomy, NIV uses ventilation (NIV) has debate on whether children know how to look after expertly-fitted masks to trained 50 consultants, with severe cerebral palsy children who need NIV. deliver positive airway trainees and allied should be started on NIV. pressure via a ventilator health professionals so “We have been running to people who need they can confidently Course organiser Dr internal courses for some support with breathing. manage young patients Hui-Leng Tan, consultant time to train our own who need NIV to in paediatric respiratory staff, and we decided to It is commonly used support breathing. and sleep medicine, open one up to external in children with said: “The number of candidates. The day went neuromuscular disorders, The whole-day course, children requiring NIV has smoothly and I was really but can be used to help organised by Royal increased exponentially, as impressed by the feedback manage a wide range Brompton’s paediatric a result of better medical we received, especially of conditions including respiratory and sleep care and better survival considering it was the central hypoventilation and team, included hands- rates for a number of first course we had run.” obesity hypoventilation.
34 Royal Brompton & Harefield NHS Foundation Trust Transitioning patients
A smooth transition: supporting young people moving from child to adult services
Our paediatric teams provide specialist care from time for them and their families when it comes to before birth, through childhood and into teenage years, moving on from that familiar environment. for children with cardiac and respiratory conditions. Specialist transition nurses help plan, prepare Once patients reach around 16 years of age, they begin and move young people from children’s services their transition to adult services, and ensuring a smooth to adult healthcare. This is a gradual process of transition is vital for their health and wellbeing. change, giving young people and their families time to adjust and feel ready to make the move. Children with respiratory illness, congenital heart disease and acquired heart disease often need lifelong An important aspect of this programme is a range care. They have spent their young lives being cared of transition days that provide the opportunity for by children’s teams and it can be a worrying to meet key members of the adult teams.
GOSH patients meet the Harefield team
Many young transplant patients clinicians, who attend to offer support move from Great Ormond Street and formally hand over their care. Hospital for Children (GOSH) to have their adult care at Harefield. At this year’s event Olivia Cotter, 17, and Ella Armitage-Brown, 16, were The two hospitals work together to among the patients who attended. ensure young people are familiar with The girls have been friends since they their new services, and are ready to were in hospital together as toddlers. move on from GOSH. Olivia, who had a heart transplant Special events give the young patients when she was two years old, after the chance to become acquainted experiencing cardiomyopathy (a The picture of health: Ella Armitage-Brown and Olivia Cotter pose for a selfie with their new clinical care team and disease of the heart muscle) with have a tour of Harefield Hospital. secondary pulmonary hypertension (a to move on. Great Ormond Street type of high blood pressure that affects has been great, but it is a children’s They also give young people a the arteries in the lungs and right hospital and I’m no longer a child.” chance to say goodbye to their GOSH side of the heart), said: “I feel ready >>
Annual Review 2018 35 Transitioning patients
>> vital. Ben’s mum Kerry Adamson Ella, who also had a heart transplant said: “This day has been really because of cardiomyopathy, added: positive for us. The staff at Harefield “The staff have been very thorough. I’ve can begin to get to know Ben and found it helpful and so has my mum.” understand his specific needs.”
Ben Sporle, 18, also diagnosed Dr Helen Spencer, a respiratory with cardiomyopathy, had a heart physician from GOSH who specialises transplant in 2011. Ben has significant in cystic fibrosis, added: “This is an learning disabilities and needs extra emotional time. We have often looked support to understand his condition after these patients their whole lives. It and make decisions about his care, feels like family. Transition is a big deal Ben Sporle and mum Kerry Adamson so ensuring a smooth transition is – for all of us.”
Transition event inspires young heart patients with learning disabilities
An inspiring event for helped me when I was going young heart patients who through it all myself – it would have a learning disability have been great to have has helped them prepare to met other people like me.” move on to adult services. Clinical nurse specialist The event at Royal Brompton Virginia Meira said: introduced the adult congenital “Transitioning from paediatric heart disease (CHD) service to adult services can be and enabled the teenagers upsetting for patients – but to meet each other and it is made even harder to make new friends, as well as understand with the added giving them a chance to hear difficulty of a learning disability. from inspirational speakers We wanted to try and stop that whose learning disabilities potential upset by introducing have not stopped them from this event, and help them ease living remarkable lives. into adult services in a way that is more appropriate for them.” George Griffiths, who has Down’s syndrome, gave a Nana-Akua Mills attended moving speech, explaining with her son Jaden, who will that: “Before I was born, some soon be entering adult services. people told my parents that She said: “This is the very first it would be disappointing to chance we’ve had to go to an hold me and have to look after event like this since Jaden was me – but now I’m 19, and born. My husband and I found I’m proving them wrong. the two speakers really moving.
“I have not let learning difficulties, “What they showed was the or my heart condition, stop me other end of our son’s journey from doing what I want to do.” – overcoming that physical and mental adversity and Karl Butler, 37, who now works achieving so much. It was as a learning disabilities advisor really good for us to know that for NHS England, said: “Events he’s got a future out there.” like this would have really
36 Royal Brompton & Harefield NHS Foundation Trust A record year for transplants
Record-breaking year for Harefield transplants Harefield Hospital’s renowned transplant programme had its busiest year ever, giving 97 patients a new chance at life during 2017/18.
The record-breaking have been more than people having transplant calculate how many times 97 operations included 33 3,000 transplant operations, surgery here has increased it has had to beat in an heart transplants, 59 lung including the world’s significantly in the last 80-year-old. It cannot fail. transplants, and five heart first double heart and eight years. When I first and lung transplants – as lung transplant in 1983. came here they did seven “This means that there will well as the implantation heart transplants a year, clearly continue to be a need of five total artificial hearts Harefield has the best long- and now we are averaging for transplantation for the and 37 ventricular assist term survival rates in the UK almost three per month. foreseeable future, which is devices (a mechanical for patients who have had why we continue to invest in pump that supports a a heart or lung transplant. “Despite huge advances, developing our services, and weakened heart to pump engineering has not yet with our planned partnership blood around the body). Mr Andre Simon, director come up with a permanent with King’s Health Partners of heart and lung replacement for the human (page 9) I think we have very Since the first heart transplantation and heart. Let’s put it in context: good long-term options transplant was carried out ventricular assist devices, the human heart beats 70 for treating end stage at Harefield in 1980, there said: “The number of times per minute – now heart and lung failure.”
Perfusionists: a vital part of the transplant team
Clinical perfusion scientists Once the operation is over, Tim Pitt, head of perfusion, said: (perfusionists) are a key part of the perfusionists get the heart safely “When you see patients go onto transplant team – and the theatres restarted and withdraw patients the machines, and you have team overall. They are the experts who from machine support. the responsibility of being their ensure the heart-lung machines that heart and lungs, it grips you. take over a patient’s breathing and Most perfusionists are ITU nurses or blood circulation during surgery, work science graduates by background. “Our perfusionists go above and as they should. There are only 400 perfusionists in beyond what is expected at most the UK, of whom 20 work at the Trust. other hospitals, using the whole When patients have surgery, range of skills and techniques perfusionists are responsible for their The perfusionists at Harefield across theatres, transplant, cardiac output, blood gases and blood are the most experienced in intensive care and paediatrics.” pressure, while their heart and lungs the world at using the “heart are not working. in a box” system. (page 39)
Annual Review 2018 37 A record year for transplants Home for Christmas with a total artificial heart
When Selwa Hussain was urgently Selwa had her total artificial heart The artificial heart is powered by a referred to Harefield Hospital with implanted on 27 June 2017. Harefield portable driver that weighs seven end-stage heart failure in June 2017, is the only centre in the UK that kilograms and must be carried the only option to save her life was uses this device as a treatment with Selwa wherever she goes. to implant a total artificial heart. Only for patients with heart failure. six months later, Selwa was able to However, thanks to her personal temporarily leave the hospital and Selwa said: “All I remember from commitment to recovery and the spend Christmas with her family. before the operation was crying expertise of the Harefield team, to my sisters, and giving my final Selwa was able to be discharged Selwa is mother to two young wishes to my family. I remember home in time to spend Christmas children and was just 39 years when I woke up, being told my with her husband and children. old when she had her heart heart had been taken out, and I was removed from her body and so disorientated I thought ‘what She added: “Over Christmas I replaced with a machine. does this mean, have I died?’” could go shopping, visit my family and I cooked for the first time in She has familial dilated months. The device is an absolute cardiomyopathy, a genetic heart godsend. To spend time with my disease, but had no symptoms until I can’t thank the staff at family, to have some – even a little 2016. Her condition deteriorated Harefield enough, they are – normality back, is wonderful. quickly and in June 2017 she was all so positive for you, even urgently referred to Harefield when life felt very bleak. with end-stage heart failure. It is an incredible place.
Ms Diana Garcia Saez, specialty doctor in cardiothoracic transplantation at Harefield Hospital, Selwa spent the following month in said: “Despite us increasing her hospital learning how to walk, talk, medication, Selwa’s condition was eat and drink again, and building getting worse very, very quickly. up muscle strength through physiotherapy. She said: “I can’t “Often, a left ventricular assist device thank the staff at Harefield enough, can be used to maintain circulation they have been absolutely amazing;
in patients with failing hearts, but everyone, the doctors and the nurses, Selwa with her surgeon Ms Diana Garcia Saez this wasn’t an option because it the physiotherapists are such experts, would not have supported the failing and the caterers, the cleaners, the “Waking up at Christmas and seeing right-hand side of her heart. The healthcare assistants – they are all so the kids playing at the bottom of my only option to save her life was to positive for you, even when life felt bed was a tearful moment… it makes implant a total artificial heart.” very bleak. It is an incredible place.” you appreciate how precious life is.”
How do total artificial hearts work? A total artificial heart (TAH) is a major arteries. Once the TAH pump that is surgically implanted is connected, it duplicates the into the body. It replaces the heart action of a normal heart, enabling ventricles, which pump blood blood to flow through the body. out of the heart to the lungs and other parts of the body, if they are The TAH is controlled by a diseased or damaged. machine which is outside of the body. A portable device can be A TAH has four mechanical valves used outside of hospital – this that work like the heart’s own valves. fits into a backpack and weighs These valves connect the TAH to about seven kilograms. It can be the heart’s upper chambers and the recharged at home. Total artificial heart
©SynCardia Systems, Inc.
38 Royal Brompton & Harefield NHS Foundation Trust A record year for transplants
Harefield Hamsters Transplant Club
People who are waiting for an organ transplant, or who have had a transplant, often find it reassuring to speak to people who have been in the same situation.
The Harefield Hamsters Transplant Club supports people who have had or who are awaiting an organ transplant, and their families and carers. It provides support, information, and recreational and sporting activities to help with rehabilitation and overall health.
Founded in 1982 by a small group of heart transplant patients while at the fifth British Transplant Games in Cardiff, the club has grown considerably. In 1996 the ‘Heart in a box’ club gained charitable status.
Harefield was the first keeping the heart transplants using Throughout 2017/18, members of transplant centre in beating, just as it would OCS than any other the club have taken part in various the UK to adopt the inside the body, until transplant centre fundraising events, such as a ground-breaking Organ it can be transplanted in the world – 144 100km walk on the Isle of Wight Care System (OCS), also into a patient. since its adoption. and sky diving. Funds raised have known as ‘heart in a contributed to projects such as box’, as its method of Instead of needing to be Mr Andre Simon, a 3D printer for Royal Brompton storing and transporting used within three hours, director of Hospital that clinicians use to donor hearts for as is the case with ice transplantation, recreate their patients’ hearts to transplantation. preservation, a donated commented: “For us, help with diagnosis. organ can be kept viable the organ care system The service began for between eight and has become the gold Double lung transplant recipient using the technology 12 hours, enabling standard for organ Douglas Forbes, who is the club’s in 2013 because of patients at Harefield to retrieval – we use it deputy chair, said: “We aim to the number of donor receive organs from as for every single heart help improve quality of life by organs surgeons had to far away as Scotland. transplant patient. promoting rehabilitation and decline due to distance Firstly, it means we can providing a support network.” or unsuitability. Increasing the pool of treat more patients. potential organ donors Secondly, it means The system is a huge in this way means patients recover more leap forward from that there is more quickly, so spend less the conventional ice chance of a suitable time on intensive We aim to help improve preservation method new heart being care and in hospital quality of life by for organ storage and found for someone after their transplant. promoting rehabilitation transplantation. It on the waiting list. We have also reduced and providing a infuses a donor heart the incidence of support network. with warm, oxygen- Harefield’s theatres post-transplant rich blood – effectively have carried out more heart failure.”
Annual Review 2018 39 Harefield site transformed Harefield site transformed
An £18 million improvement more patients to receive world-class It combines a newly-built programme at Harefield was treatment in 21st century facilities. extension with refurbishment completed this year, transforming The projects have all kept the needs of the existing space. and future-proofing several areas of of staff, as well as patients, at the The team can now treat an the hospital. forefront, with larger staff rooms, better changing facilities, and more access extra 250 critically ill patients The works, which include a new to natural light and outside spaces. each year, including patients imaging centre and an expanded suspected of having tuberculosis intensive therapy unit, alongside a • Imaging or other serious infections, in new private outpatients department, two new isolation rooms. A new imaging centre has been have significantly improved developed, containing state-of- An innovative sun therapy terrace facilities and transformed patient allows staff to move patients’ and staff experience at the site. the-art MRI and CT scanners, and was opened in December 2017. beds outside to give them fresh air and sunlight, with medical The £18 million redevelopment, gases and power maintained £2.6 million of which was donated • Intensive therapy unit (ITU) through a convenient hatch. by Royal Brompton & Harefield Hospitals Charity, will increase The ITU has been expanded The refurbished ITU was capacity at Harefield and enable to provide six more beds opened in December 2017. and a modern scanner. >>
40 Royal Brompton & Harefield NHS Foundation Trust Harefield site transformed
>> • Acute cardiac care unit and a four-bed high-dependency unit. These works have freed up Investment in Harefield’s acute space on Maple ward, which is cardiac care unit has reinvigorated now being used for NHS ‘day of an area that was nearing the surgery’ admissions as part of the end of its working life. Darwin programme. (page 10) The existing building remains, but it has been refurbished with Director of planning and strategy new flooring, a new open- Piers McCleery, who led the re- plan nurses’ station, and subtle development programme, said: but helpful features such as recessed washbasins in the bays “Our staff displayed much patience to save space, and ‘sun pipes’ and willingness to adapt while these to filter additional natural light major works were carried out around and air through the ceiling. them. We are also grateful to the Royal Brompton & Harefield Hospitals • Private outpatients department Charity for vital donations of £1.5 million for the scanning centre and A new private outpatients and £1.1 million toward the expanded ITU. diagnostic facility has been built at the front of the hospital. This “These improvements will all includes three consulting rooms contribute to the gold standard of and a treatment/phlebotomy room. care our teams provide, and to giving The glass-walled extension patients the best possible experience.” is a striking addition to the front of the hospital.
• Private patients’ ward These improvements will all A new private patients’ ward has contribute to the gold standard also been built, replacing the of care our teams provide, hospital’s ground floor patient and to giving patients the area. It took 18 months to convert best possible experience. the second floor into a 20-bed ward, providing 16 en-suite rooms
Annual Review 2018 41 Research highlights
Research highlights
Research plays a crucial role in the Trust’s mission to provide world class specialist heart and lung care for patients.
Our research is fully integrated with biobanks including participation in the clinical activity, and the research strategy 100,000 Genomes Project for rare diseases. is continuously evolving in collaboration with clinical divisions. Each clinical care A total of £10 million of funding was group now has an appointed research leader awarded to Trust academics and their The third RAND whose role is to support activity in line with collaborators from a wide variety of funding analysis (2016), the Trust’s strategic research goals – to bodies including the National Institute which looks further enhance the organisation’s national for Health Research (NIHR), British Lung at influential and international research profile. Foundation, British Heart Foundation, biomedical and independent charities and the Health health research, The Trust continues to be a leading Foundation. Income from commercial highlighted centre for cardiovascular, critical care research contributed approximately £2.1 that the Trust and respiratory research. The third RAND million to research activity at the Trust. produces more analysis (2016), which looks at influential highly cited biomedical and health research, highlighted We continue to actively work with the publications that the Trust produces more highly cited Imperial College Academic Health Science publications about respiratory and critical Centre (AHSC) on collaborative research and about respiratory care medicine than any other hospital trust education activities that includes Imperial and critical in England – with researchers producing College, Imperial College Healthcare Trust care medicine 862 peer-reviewed publications in 2017/18. and the Royal Marsden Hospital. This than any other includes contributing to the National Health hospital trust Our global standing for research would Informatics Collaborative project by sharing in England. not be possible without our patients. In lung cancer data and participating fully total, more than 1,800 research volunteers in the re-launched research development were recruited to our research studies and programme across the AHSC.
42 Royal Brompton & Harefield NHS Foundation Trust Research highlights
Other research highlights over the year include:
• Two senior researchers individually • The Trust has been commended by received high value research grants. Mr NIHR for its high number of open 3 winners Eric Lim, consultant thoracic surgeon, commercial clinical trials (ranked second Royal in North West London) and recruitment was awarded £1.3 million from the NIHR College of for lung cancer research, while Stuart into clinical trials to time and target, Cook, professor of clinical and molecular with particular recognition for the cystic Physicians/ cardiology, was granted £2 million from fibrosis team, who recruited the first NIHR the British Heart Foundation for dilated global and first European patients into Awards cardiomyopathy research. multi-national studies.
• More than £800,000 of research funding • Promising outcomes for new cystic Commercial was awarded specifically to research fibrosis drugs following two phase III projects led by allied health professionals, trials led by researchers at the Trust were research nurses and healthcare scientists published in the New England Journal of contributed including physiotherapists, physiologists Medicine in November 2017. approx £2.1m and pharmacists. Our long-standing partnership with • Three out of 10 possible Royal College Liverpool Heart and Chest Hospital £1.3m of Physicians/NIHR Awards went to continues, working with them through awarded our researchers – Dr William Man, Dr the Institute of Cardiovascular Medicine Justin Garner and Dr Nick Simmonds and Science to run collaborative for lung – recognising their outstanding clinical trials and develop shared cancer contribution to research. education and clinical services. research
862 peer-reviewed publications in 2017/18
1,800 research volunteers were recruited
£10m funding was awarded to trust academics and their collaborators
To keep abreast of all the latest research news visit the dedicated research section of the Trust website, and sign up to the team’s newsletter www.rbht. nhs.uk/research
Annual Review 2018 43 Medical education
Medical education
Clinical skills simulation centre manager Andrew Sykes (right) demonstrates the features of the new simulation mannequin
We believe in sharing our knowledge Royal Brompton and Harefield to give better teamworking, to better equip through teaching, so that what we learn clinical staff access to the most up-to- them in their roles. Our training can help patients everywhere. date training and teaching. is internationally renowned, with teaching provided by experts in their Training is a crucial part of our work We train our teams in various complex fields, and it attracts attendees from and we have training facilities at both procedures, crisis management and around the world.
The power of simulation
State-of-the-art simulation centre. This year, the feature highly realistic such as a model arm to mannequins and highly education team acquired anatomy and skin texture, practise inserting cannulas immersive situations are two new state-of-the-art articulated limbs and or a torso for birthing. used to prepare our teams mannequins – one for joints. They can make for a range of different each hospital site – to add sounds, blink and breathe. Andrew Sykes, clinical scenarios, ranging from an extra layer of realism to skills and simulation centre a deteriorating patient in the simulation experience. The new mannequins are manager, said: “With paediatric intensive care, a far cry from the origins of part task training you are to a patient being flown The mannequins cost simulation, which began teaching a task. to Harefield’s heart attack £45,000 each and with ‘part task’ training tools >>
44 Royal Brompton & Harefield NHS Foundation Trust Medical education
The value of hands-on experience The mannequins cost £45,000 each and feature highly realistic anatomy and skin texture, articulated limbs and joints. They can make sounds, blink and breathe.
>> Modern simulation is an experience and enables us to practise for clinical events that most staff are unlikely to see particularly regularly.
“We have a particular focus on team training and encouraging multidisciplinary working. Historically, training has often been divided between doctors, nurses and allied health professionals, but in our Trust we recognise that when there is an incident, all these professions need to work together and human factors come into play, so that is what we are practising for when we run simulations.
A new training programme launched substitute for doing the real thing. this year gives junior doctors the “Now they each receive a day’s one- opportunity to learn how to carry out to-one training with a consultant, an advanced procedure on patients. during which they learn to insert central lines in patients.” Our highly-trained consultant cardiothoracic anaesthetists at Dr Mohamed Zuhair, one of the junior Harefield Hospital routinely insert doctors who has taken part in the ‘central lines’ into the larger veins programme, said: “It’s really valuable of patients about to go into surgery. because it equips you with advanced Once in surgery, the lines are used to skills to carry out the procedure on supply the patients with medication. patients who may urgently need to be treated in other medical situations Now members of the team are in future – without having to wait teaching junior doctors to carry for an anaesthetist to arrive.” Andrew Sykes prepares the mannequin for a training session out this advanced procedure in the same live environment. “In the 13 years I’ve been working in medical education, the Francesca Caliandro, consultant Now they each receive a advances in technology have cardiothoracic anaesthetist, who been minor compared with other led the initiative, explained: “Until day’s one-to-one training areas of medicine, but what really last year, junior doctors could with a consultant, during has evolved is our understanding only practise inserting central which they learn to insert of how we use simulation as a lines into a mannequin in one of central lines in patients. teaching tool and how to get the our laboratories. They acquired maximum value out of it.” the skills involved, but there’s no
Annual Review 2018 45 Listening to our patients Listening to our patients
One of the Trust’s core values is “We During 2017/18 we exceeded the targets Respect” – we believe that patients should set by NHS England for the number of be treated with respect, dignity and responses expected, and 95 per cent of How likely courtesy at all times and that they should those who responded said they would are you to be well informed about, and involved in recommend our care. recommend decisions about their care. We always our ward/clinic have time to listen to feedback, positive Actions taken as a result of the very small to friends/family if and negative. (two per cent of respondents) amount of they needed similar negative feedback received include: care or treatment? The Friends and Family test is a • Replacing toys in the children’s nationally-mandated feedback score, outpatients department which we were quick to adopt after its launch in 2012. It asks one simple • Establishing a pilot scheme to share 95% of those who responded question: “How likely are you to patients’ medications with their GP or said they would recommend our ward/clinic to local hospital electronically recommend our care friends/family if they needed similar • Trying out a system to offer electronic care or treatment?” appointment letters for outpatients.
View of our patients
Many patients who feel they have had a good experience are eager to praise the individuals responsible, and we consistently receive a wealth of good feedback via our comment forms, a selection of which is included below:
Royal Brompton improved my outlook caring and they spend time filled me with confidence Paul Wood ward and ability to do everyday explaining things. They and I felt fully involved. (cardiac care): activities without tiring. give the treatment you The staff who run the need as quickly as possible Royal Brompton The care you receive at sessions are tough but they and get you in asap. I York ward (cardiac care): Royal Brompton is first ensure I get the most out of rate this hospital 10/10. class – you don’t get the The team of doctors each session. They are very same care at any other and nurses were very friendly and the sessions Harefield hospital. We are all lucky kind, caring and full of are highly effective. Cherry Tree ward (day case): to be treated there. information and advice I arrived at hospital a little regarding my individual Royal Brompton nervous and apprehensive. queries. Fantastic hospital Harefield Lind ward (respiratory However… the staff were who have shown a Cardiac rehabilitation clinic: medium dependency unit): courteous and totally real duty of care, I The rehab sessions are run I can’t fault one thing professional in every way. would recommend this excellently – they have about this hospital, so The caring atmosphere hospital to everyone.
46 Royal Brompton & Harefield NHS Foundation Trust Listening to our patients
Harefield Harefield Some patients choose to Oak ward Acorn ward (acute cardiac care unit): (acute cardiac care unit): post their feedback online. This was an emergency Cannot speak highly situation for me. The rapid enough about the Care Opinion response when I arrived outstanding levels of website undoubtedly improved expertise and care. Even my prognosis for a full when it was busy, contact “The care my partner received recovery by minimising was personable, helpful. and support that I was given was quite honestly damage to my heart. I I was also able to have a outstanding. I am a registered nurse myself and was kept informed as joke and a smile which have therefore worked in a variety of hospitals. Royal things progressed and the helped to take away Brompton in both our opinions is faultless, and is a nurses in Oak ward were the anxiety of being in credit to the NHS.” wonderful. I have a lot of acute care and coming people to thank for saving to terms with a serious “My Harefield experience has been very positive and my life that night. condition. Real blessing I would recommend this hospital to anyone due to being sent to Harefield. the care, treatment and professional attitude of all doctors, nurses and other staff. Thank you so very Royal Brompton much for your dedication to your profession.” I can’t fault one Lind respiratory thing about this day case unit: “My husband spent five days [at Harefield] after a hospital, so caring Lung Wedge Resection. He is a cancer patient. and they spend time Everyone on Lind ward [is] very friendly and helpful. We’ve never experienced this level of excellent explaining things. The staff are always nursing and kindness in a hospital before. Since he’s busy but you never feel been home he has improved daily. Thank you so rushed. A credit to Royal much to the surgeon and nurses of Maple ward.” Royal Brompton Brompton and the NHS. Foulis ward (respiratory ward with special focus on Harefield NHS Choices cystic fibrosis): Cedar ward From the moment I (adult surgical ward): “I recently had surgery and the care exceeded my expectations. The staff were arrived I felt welcomed, I found the standard unpressured and cared exceptional and I felt in safe hands. The hospital is of professionalism and clean, the staff are friendly, dedicated and caring. I for. During my three-day care to be of the highest stay I greatly appreciated cannot express enough how grateful I am for all they order. You are not just have done for me.” not only the attentive classed as a patient but professionalism of all as an individual. In an the staff but also the “Staff on the Lind ward were fantastic. They were environment where caring, professional and helpful. They reassured me friendliness and calm they patients’ fears and showed towards me. when I was nervous about having a bronchoscopy. I anxieties need that little am really grateful for the care I received.” Harefield extra care, the staff were Cardiology lounge (page 12): superb in going that extra yard in reassuring their Everything was Others like to use social media charges. Well done to all explained to me and and keep up the fine work. the professionalism was Twitter appreciated. They all had Royal Brompton “@RBandH I can’t thank the PICU doctors and nurses the human touch. Your Sleep Centre: enough for looking after my 1 day old baby. He had an staff are a credit to the NHS. open-heart surgery at 6 days old. They are amazing As a first visit to the #longlivetheNHS” @saikareshi Royal Brompton sleep centre it was great. Rose ward (children’s ward): Excellent reception “Just got home after ICD replacement at @RBandH staff, very welcoming Fantastic care – talked (Harefield). Staff there humblingly professional and efficient, prompt through procedure so and dedicated to the nation’s health.” attentive service from all well with my daughter @almsforoblivion staff, approachable and and actually made it fun! knowledgeable clinicians. World class surgery and World class. To follow the Trust on Twitter, search @RBandH pioneering techniques.
Annual Review 2018 47 Emergency preparedness
Emergency planning and preparedness
The Trust has a statutory obligation to plan and prepare for the fullest possible range of major incidents and potential business disruptions, which could affect patient care.
These situations could range from extreme weather conditions to an outbreak of an infectious disease or a major transport accident, so we must be in a position to respond to such incidents while maintaining services to our patients.
We continuously assess for potential risks and undertake regular testing and exercises with different groups of staff, in order to update and improve our response plans.
48 Royal Brompton & Harefield NHS Foundation Trust Emergency preparedness
Special emergency drill: theft of a nuclear source
Part of our duty to our patients is and response manager, said: “While to anticipate and prepare for possible this was a very unusual exercise, it future risks, no matter how unlikely. is important that we plan for every While this was a very unusual possible scenario. I am pleased exercise, it is important that In summer 2017 a highly unique with how the team reacted and feel we plan for every possible exercise was held to see how teams confident that the Trust would be able scenario. I am pleased with at Harefield Hospital would respond to respond effectively to a real event.” how the team reacted and to the theft of a nuclear source. feel confident that the Trust Responding to the exercise, Harefield’s would be able to respond In the exercise – believed to be the first nuclear medicine team successfully effectively to a real event. of its kind in an NHS building – a fire notified the Environment Agency alarm was maliciously set off to create and police counter terrorism security a distraction to enable the theft from advisor. The area was cordoned off to the nuclear medicine department. preserve evidence and staff worked Similar exercises have since work with internal security and the taken place at Royal Brompton Catherine Philpott, the Trust’s police to gain quick access to CCTV Hospital and the private patients’ emergency preparedness, resilience with a view to identifying the offenders. facility in Wimpole Street.
Paediatric study day improves evacuation for babies equipment and are working with a product designer to create a version with a more rigid and stable base.
Paediatrics matron Claire Buckle said: “The safety of our patients is always our number one priority, and of course this extends to ensuring we have the optimum evacuation procedures for getting children out of harm’s way.
“It is only when you test equipment like this, that you can see any The paediatric intensive care (PICU) a mattress, and in the event of an potential issues with it, so this study team has designed two new pieces of emergency can used to evacuate bed- day has meant we could get to work equipment to help evacuate babies in bound patients by sliding the mattress on producing something much more the event of an emergency. out of the building. The new paediatric suitable for our patients and their ski sheets feature more straps for unique needs.” Staff devoted a full study day to added security, and the fixings have examining their evacuation procedures been updated to soft plastic which and discovered that standard is kinder to babies’ skin. These new Ski sheet evacuation equipment was not suitable sheets have been produced and are for PICU babies, who often need to now in use on the unit. Every single bed in the Trust be moved while still connected to has a ski sheet already situated ventilators and other equipment. Another piece of equipment that our underneath the mattress, so that experts felt could be improved is a in the event of an emergency, the After doing an evacuation exercise, the wearable cot that sits on the front of evacuation equipment does not team worked together to design a new an adult’s body and enables a single need to be fetched and patients ‘ski sheet’ for moving cot mattresses. member of staff to evacuate a baby. who cannot walk can be moved to A ski sheet is a piece of sheeting The team felt the standard model safety immediately. with straps attached which fits under was not sturdy enough to hold PICU
Annual Review 2018 49 Rehabilitation and therapies
Rehabilitation and therapies People with heart and lung conditions can find some daily activities a challenge. 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.
Developing our services
We continuously develop patients, previously only Long-term inpatients our rehabilitation and available for outpatients, have found ‘crafternoons’ therapies services to ensure have been opened up to and an activity trolley Preventing falls is they meet the needs of our inpatients waiting for a especially beneficial. essential to ensuring patients, many of whom heart transplant. The twice- have complex needs. weekly classes help those As part of the focus on patient safety. on the transplant waiting overall health and wellbeing, This year we rolled This year we launched an list maintain levels of fitness the Optimising Strength out a collection out-of-hours telephone in preparation for their and Resilience programme, of resources and service for people with life-changing operation. led by consultant clinical information across all supportive and palliative psychologist Dr Anne-Marie clinical areas, which care needs, giving them Holistic care has been a Doyle, continued this year. has resulted in a 24 instant access to one central focus this year, with This promotes an integrated per cent reduction of our clinical nurse psychological medicine approach to physical and in falls Trust-wide. specialists whenever they becoming an important psychological health, and need advice or support. part of critical care follow- includes workshops and Exercise classes for heart up clinics at both hospitals. staff training sessions.
50 Royal Brompton & Harefield NHS Foundation Trust Rehabilitation and therapies Whole-person services
Our rehabilitation and therapies service provides care for the whole patient, from exercise rehabilitation to psychological therapies and dietetics.
Our experts in recovery and therapy include physiotherapists, occupational therapists, dietitians, speech and language therapists, and clinical psychologists. We also provide specialist supportive and palliative care, chaplaincy, services for older people, safeguarding adults, complex discharge, and psychiatry.
Working collaboratively as multi-professional teams, our experts are able to consider all the needs of patients as they recover from treatment and tackle daily life, often with a complex or long-term condition.
Exercise programme supports people with lung diseases
People with lung problems can rowing machine and exercise find it difficult to move around bike. Educational sessions also run without getting breathless, which alongside the classes, covering can be frightening. This can topics such as airway clearance mean they reduce their activity techniques, advice on inhalers, and levels, which makes them stress management and relaxation. unfit and even more breathless. Pulmonary rehabilitation Anthony Page-Wood, 67, has can help break this cycle. been a patient at Royal Brompton for more than 30 years. He has Our respiratory physiotherapists alpha-1 antitrypsin deficiency, a run an eight-week, twice-weekly genetic lung disease and has had a Anthony Page-Wood exercise class programme which number of operations, including a helps people with lung problems recent lung reduction procedure. conditions and the programme to cope with their breathlessness He took part in the pulmonary is tailored to take into account and to feel stronger and fitter. rehabilitation exercise programme each person’s limitations. on the advice of his consultant. Patients who start the programme “Taking part in the programme has have their current exercise ability Mr Page-Wood explained that the stimulated me to do more exercise checked, to give a baseline programme helped him in a number and I can see small improvements to work from. Each one-hour of ways: “It was a good experience in my ability. It definitely also session involves a warm-up and for me and the benefits are definitely helped psychologically, and then a series of exercises using there. The people on the course the group really gelled as we all equipment such as a treadmill, have a range of lung and respiratory have something in common.”
Annual Review 2018 51 Our charities Our charities
Our hospitals are supported by a number of charities that raise money to support projects that lie outside NHS budgets, but are often vital to enhancing patients’ health and wellbeing.
Royal Brompton & Harefield Hospitals Charity
This charity supports initiatives across both hospital sites, raising money for innovative treatment, equipment and research.
Building for Brighter Futures MitraClip
A £1.1 million appeal to were added to the unit, things like a far superior Appeal help extend Harefield’s with a new MRI/CT waiting room for families Securing £175,000 intensive care unit (ICU) scanning room also being and better staff facilities from a generous funded as part of the are what make this project anonymous donor to Thanks to the second appeal, which will benefit so game-changing. I fund 15 life-saving largest appeal in the an extra 250 critically ill can’t put into words how ‘MitraClip’ procedures charity’s history, building patients each year. Sue thankful I am to everyone for patients too weak work on Harefield Mather, ICU matron/senior who donated.” for heart surgery Hospital’s new imaging nurse, said: “Not only will centre was completed in we be able to treat so many More can be read about Celia Coote, who 2017. Six new bedrooms more patients, but little this project on page 40. benefited from the procedure, said: “I was far too unwell to have more Heart of PICU Appeal surgery, yet my mitral valve was leaking. A clip Raising £65,000 to create more open and accessible manager, said: “I am so was the only chance I a better environment space for parents, and very delighted that we have had. My daughters and for parents of critically gives staff a much-needed achieved a space in which husband had prepared ill children on Royal private space to discuss people can feel confident themselves for the real Brompton’s paediatric delicate matters. A new the environment matches possibility that I might die. intensive care unit (PICU) medicine delivery system the expertise of the staff. helps staff deliver care It really achieves a large “As soon as the clip was Work began in March 2017 efficiently. amount of work in a small fitted, my heart started to renovate the nurses’ space; it’s beautiful and to recover. It saved my station and reception area. Lizzie Biggart, paediatric impressive and has been a life. I count my The new space provides a senior nurse and service great morale boost!” blessings every day.”
52 Royal Brompton & Harefield NHS Foundation Trust Our charities
Enhancing Critical Care
Raising £86,000 to support rooms, which were designed in Matron Jo Tillman said: the building of two specialist response to feedback from staff, “The new rooms are fantastic, as isolation rooms in Royal previous patients and their families. family can be present and not feel Brompton’s adult intensive care remotely like they are in the way. unit (AICU) to treat the hospital’s The spacious rooms feature most critically-ill patients floor-to-ceiling photography “Revamping the non-clinical and a comfortable furnished spaces will help make it more In January, staff welcomed their area for family members – a user-friendly and create a first patients into the fully upgraded UK first in intensive care. better working environment.”
The Brompton Fountain
The Brompton Fountain supports • worked with cardiac nurse families who have been children under the care of the Trust, specialists to provide home through similar experiences. by funding medical equipment blood testing machines for • funded various projects and and improvements to facilities, young patients. The machines purchased new items throughout focusing on boosting the overall help families to reduce their the hospital through events and experience for young patients and trips to hospital and makes sure appeals – including the portable their families. The charity works children avoid unnecessary monitors featured on page 31. closely with paediatric teams to time away from school. provide activities, services and specialist resources that are not • held support events and fun normally provided by the NHS. activities for families. Events such as an annual barbecue, Among other activities art workshops and pizza held during the 2017/18 evenings provide a fantastic financial year, the charity: opportunity to meet other
Friends of Friends of Royal Brompton Harefield Hospital
The Friends of Royal Brompton have Harefield has a sister charity, theFriends been supporting the hospital for 55 years of Harefield Hospital, that runs a popular and run two shops, operate a trolley refreshment pavilion onsite throughout the year. service for families on the wards, and host fundraising events throughout the year. During the 2017/18 financial year, the charity funded amenities within the hospital, such as During the 2017/18 financial year, the charity ward chairs, specialist mattresses and blood funded a variety of projects, including raising pressure monitors. £28,400 towards a one-of-a-kind simulation doll to help train doctors to detect life- They contributed to numerous charitable appeals, threatening heart conditions in babies, and including the ambitious renovation of the a donation of £9,240 towards production imaging centre, as well as donating a state of the of a post-operative bra to aid women’s art £45,000 mannequin for clinical simulation recovery after cardiothoracic surgery. training. (page 44)
Annual Review 2018 53 The healing arts The healing arts
rb&hArts brings the benefits of the arts to patients and staff, and the local communities surrounding our hospitals.
Delivered with funding from the Royal Brompton & Harefield Hospitals Charity, rb&hArts delivers a long-term creative programme to increase wellbeing, enhance patients’ experiences and improve the healthcare environment. In a typical year, rb&hArts runs 250 workshops in craft, music and visual arts, engaging 5,000 participants, and employing 30 artists.
Enhancing the patient experience
Music is particularly effective in healthcare settings, with evidence to support its efficacy in reducing pain and anxiety during the post-operative period1.
Live and participatory Crafternoons music making Crafternoons bring artists, volunteers The music sessions break Since January 2018, Adrian Garratt and patients together to learn the monotony of ward life. and Stac have played to inpatients at creative skills. Through creating (Patient feedback) both hospitals, taking requests and and making together, conversations providing moments of light relief for and relationships of trust emerge, patients, families, visitors and staff. reducing feelings of isolation Airborne and loneliness. Learning new Vocal Beats skills builds confidence and self- Verity Standen, an internationally esteem, and increases resilience. Vocal Beats is an innovative music renowned contemporary composer, project for hospitalised young people was invited to create a new vocal from infancy to 16 years. It offers composition to raise awareness of a range of personalised activities singing for lung health, which was Made the stay in hospital more including bedside singing and performed in and around the hospital enjoyable, less stressful and an vocal coaching, music tech, lyric over three days. More than 30 people opportunity to be creative. writing, recording and beatboxing. In took part, entertaining patients as (Patient feedback) 2017/18, we provided 48 beatboxing well as members of the public in workshops and 108 music-making/ local parks and transport hubs. singing workshops. Evaluation showed that the project increased “Lovely, uplifting and energising.” music-making levels of happiness, relaxation and singing workshops (Audience feedback) 108 confidence in young people.
54 Royal Brompton & Harefield NHS Foundation Trust Improving health outcomes Visual arts through active arts participation High-quality visual art Many people with long-term health conditions can develop and design is integral to mental health problems, particularly depression and anxiety2. positive, welcoming and Participation in the arts has shown to have a positive impact healing environments. on health outcomes, wellbeing and quality of life3. rb&hArts Evidence suggests its use offers participatory activities to patients to increase self- in healthcare settings can management, reduce isolation and improve wellbeing. alleviate anxiety, as well as making a more enjoyable Akademi and DanceWell environment for staff. DanceWell is a three-year Big Permanent collection Lottery funded project by Akademi The arts team manages a to improve levels of physical and collection of more than 1,000 mental health in older adults. In works of art across both hospitals, 2017/18, Akademi ran 12 workshops, comprising paintings, prints, teaching Kathak (a South Asian photography, drawings, textiles, dance style) which was then site specific commissions, performed to an audience of sculpture and new media work. family and friends. Of those that The collection will be audited attended, 65 per cent classified over the next three years to themselves as having a disability ensure all pieces are well cared or some limitation to their for and accessible, with a view to movement, and 95 per cent of finding new ways to use them to participants were aged 65 or over. engage with patients and staff.
Singing for Breathing Bespoke commissions Singing for Breathing is a weekly Professor Anita Simonds, vocal coaching and singing consultant in respiratory workshop programme to support and sleep medicine, invited older adults living with chronic artist Steven Appleby (who obstructive pulmonary disease decorated the sleep centre in (COPD). The workshops help 2016) to create a mural for a participants better manage their corridor in Royal Brompton’s symptoms, offering advice on breath respiratory wing. Appleby control and management. In 2017/18, created a colourful dreamscape the arts team ran 97 workshops. to welcome patients and new artworks for the bedrooms. workshops 97 run in 2017/18 Artist and cystic fibrosis patient Kate Hughes presented the body of work she created during a ‘virtual’ residency with the Trust My singing each week has – Message in a Bottle – which given me much confidence and included drawings, animations helped my breathing control. and an interactive installation in Royal Brompton’s Fulham Wing, (Singing for Breathing participant) which invited visitors to leave their own message in a bottle.
1 Hole, J et al. ‘Music as an aid for postoperative recovery in adults: a systematic review and meta-analysis’, The Lancet, 2015;386:1659–71. 2 ‘Creative arts as a public health resource: moving from practice-based research to evidence-based practice’ (Clift), Perspectives in Public Health, 2012;132:120–7. 3 Long-term conditions and mental health: The cost of co-morbidities, Kings Fund, 2012.
Annual Review 2018 55 Our profile in the media
Our profile in the media
The Trust’s communications team works closely with newspapers, television and radio broadcasters, digital and social media and other channels to share breakthroughs in treatment, innovations in research, and the experiences of patients cared for by our expert teams. Here are some highlights from 2017/18:
May 2017 to target the underlying September 2017 causes of the disease rather The Daily Mail highlighted than the symptoms. The Trust’s cardio-oncology the importance of clinic was featured on BBC professional advice for August 2017 Radio 4’s Inside Health those with suspected food and Today programmes. allergies. Consultant allergy Research led by consultant Consultant cardiologist Dr dietician Dr Isabel Skypala thoracic surgeon Mr Eric Alexander Lyon was joined explained why a referral Lim, which showed a rise by consultant oncologist Dr for proper testing is better in people who have never Susannah Stanway from the than simply cutting foods smoked undergoing lung Royal Marsden Hospital, to out: “Unless you’re good cancer surgery at the Trust, discuss the effects of cancer at replacing [the food you Dr Isabel Skypala featured in the national treatment on the heart. cut out] with things that media. Mr Lim explained contain similar nutrients, devastating lung disease that as lung cancer is harder October 2017 you could be doing more cystic fibrosis, trialled to diagnose without the “red harm than good.” internationally including at flag” of a cigarette habit, Pioneering lung volume Royal Brompton Hospital.” higher death rates could be reduction procedures, June 2017 A combination of two drugs expected. The story featured undertaken at Royal was found to improve in the The Times, Daily Brompton, featured on The Evening Standard lung function in children Express, The Independent BBC Radio 4’s Inside covered “a breakthrough in aged six to 11 within 15 and the Evening Standard. Health programme. treating children with the days and was the first >>
56 Royal Brompton & Harefield NHS Foundation Trust Our profile in the media
>> transplantation, Mr Andre Clinical trials of targeted Dr Nick Hopkinson, Simon, told presenter Dr lung denervation (TLD) – a honorary consultant chest Kevin Fong that mechanical procedure which destroys physician, explained devices are evolving all the parts of the vagus nerve to the programme’s time, but the challenges in the lungs and can help million listeners how the of reproducing the heart patients with COPD breathe procedures can benefit artificially were significant. more easily – featured in patients with chronic Mr Simon explained: “The the Daily Mail. Patient Kim obstructive pulmonary heart beats 70 times per Burgess, a former police disease (COPD). minute, so you can calculate officer, explained to the how many times in an Mail how taking part in the November 2017 80-year-old it has already TLD trial, led by consultant beaten. And it cannot fail… physician Professor Pallav NHS England’s decision to so you need a very, very Shah (page 23), resulted continue commissioning dependable device.” in an improvement in congenital heart disease lung function of 10 per services at Royal Brompton January 2018 cent: “massive for lungs Hospital was covered by as poor as mine.” the Evening Standard, Royal Brompton’s ECMO and ITV London TV news, (extra-corporeal membrane other regional and TV news oxygenation) service was programmes, and Health the headline item on Service Journal (HSJ). Channel 5 News, during an The Evening Standard item on flu, as they visited described the decision the hospital’s intensive as a “dramatic reprieve” care unit to look at how ‘a for Royal Brompton and specialist unit is treating described how, under the patients hardest hit by the Trust’s proposal, “a world winter flu outbreak.’ Health class heart and lung centre correspondent Catherine would be built beside St Jones reported, to a national Thomas’ campus.” (page 9) audience of around one Mr Toufan Bahrami million, that “when all else December 2017 fails, and flu is about to March 2018 claim someone’s life, ECMO The Mail on Sunday is the machine that can Harefield patient Mike featured patient Selwa save them – technology Adamson shared his Hussain – Harefield’s first so specialised that Royal experience of having a total artificial heart patient to Brompton is one of a new type of aortic valve be able to leave the confines network of just five hospitals replacement, performed by of the hospital for spells at where it’s available.” consultant cardiac surgeon home - Mrs Hussain told the Mr Toufan Bahrami, with Mail on Sunday: “Harefield February 2018 the Daily Mail. With the have been absolutely new procedure, patients magnificent. They came up ITV London visited Royal only need to spend 15 to with a solution that allowed Brompton’s paediatric 20 minutes on a heart- me to stay alive and to see cardiology clinic to catch lung machine and also New Year in with my family. up with 14-year-old patient recover from the operation For that I am eternally King Elyon Hutchinson, faster. Mr Adamson told grateful.” Further coverage who made news in 2003 the Mail: “I had the surgery included ITV London, Sky when he became the in December at Harefield… News, the Daily Express, youngest patient to have a I only needed to stay in The Sun and Metro. pacemaker fitted, at just two hospital for a week, with days old. Explaining how just some discomfort A BBC Radio 4 Inside Health King Elyon has had “seven on the first day. Three special, marking the 50th major operations” since weeks after the surgery I anniversary of the first heart then, ITV London reported could walk 15km and by transplant, covered possible that all his care has come four weeks I was able to future developments under the same paediatric go for my first gentle jog in the field. Director of consultant, Dr Jan Till. which was amazing.”
Annual Review 2018 57 Governance Governance
As a foundation trust, we are governed by an elected council of governors and independently regulated by NHS Improvement. We have around 11,000 members who we regularly consult on Trust strategy and service planning.
Royal Brompton & Harefield NHS and the appointed parties represent key Foundation Trust has been an independent stakeholders. Members are drawn from legal entity with a unique governance three constituencies: patient, public and structure since 1 June 2009. The powers staff. Independent regulation of the Trust of the Trust are set out in the National is undertaken by NHS Improvement. Health Service Act 2006, as amended by the Health and Social Care Act 2012. The Trust The council of governors appoints the governance arrangements are enshrined external auditor. A sub-committee, the Visit our website in the Royal Brompton & Harefield NHS nominations and remuneration committee, to read the Foundation Trust Constitution and include considers the appointment of the chair Trust’s full the Trust membership, the council of and the other non-executive members annual report governors and the board of directors. of the Trust’s board of directors. and accounts for 2017/18 – www. The Trust board plays a key role in Management of the foundation trust is rbht.nhs.uk/ shaping the strategy, vision and purpose delegated to the Trust’s board of directors. of the organisation. Board members There are three formal committees of report-accounts are responsible for assuring that risks to the Trust board: the audit committee, – and for more the Trust and the public are managed the risk and safety committee and the information and mitigated effectively. Led by an nominations and remuneration committee. about our policy independent chair, and composed of a and performance mixture of both executive and independent – www.rbht.nhs. Quality Account non-executive members, the board uk/performance has a collective responsibility for the performance of the organisation. The Trust is required by law to produce a Quality Account, which is an annual The council of governors, which report to the public about the quality of comprises both elected and appointed services delivered. The Quality Account parties, challenges the board and holds 2017/18 is available on the Trust’s the non-executive directors to account website at www.rbht.nhs.uk/qa and on for the board’s performance. The elected the NHS Choices website. parties are drawn from the membership
58 Royal Brompton & Harefield NHS Foundation Trust Governance
Our Board Executive directors Non-executive directors Non-executive directors – full year Sally Morgan, Baroness – part year Robert J Bell Morgan of Huyton Neil Lerner Chief executive Chair Deputy chair (to 31 May 2017) Dr Richard Grocott-Mason Lesley-Anne Alexander CBE Philip Dodd Medical Director/Senior Professor Kim Fox (to 26 July 2016) Responsible Officer Luc Bardin Simon Friend Robert Craig (from 1 August 2017) Chief operating officer (part year) Kate Owen Mark Batten Jan McGuinness Dr Andrew Vallance-Owen MBE (from 1 November 2017) Chief operating officer (part year) Richard Jones Richard Paterson Mr Philip Dodd Associate chief executive – finance Joy Godden Director of nursing and clinical governance Nicholas Hunt Director of service development
Our council of Governors
Public Governors Patient and Carer Staff Governors – full year Governors – part year Mr George Doughty – part year Dr Charlie Butcher NW London (appointed as lead Mrs Chhaya Rajpal Mr Steve Caddick governor February 2018) NW London Mr Anthony Archer Mr Tim Mack Appointed governors Bedfordshire and Hertfordshire NW London (served as lead – full year Mr Robert Parker governor to February 2018) South of England Mr Jeremy Stern Mrs Victoria Borwick London London Borough of Ms Jennifer Sano Kensington and Chelsea Rest of England and Wales Sean O’Reilly Bedfordshire and Hertfordshire Cllr John Hensley Royal Borough of Hillingdon Patient and Carer governors Staff Governors Professor Mary Morrell Imperial College London – full year – full year Dr Claire Hogg Mrs Brenda Davies Bedfordshire and Hertfordshire Mrs Elizabeth Henderson Dr Ejikeme Uzoalor Dr Laura Price Elsewhere Mrs Anne McDermott Ms Caroline Karlsen Representing patients and carers Mr Edward Waite South of England Mr Stuart Baldock Elsewhere
Annual Review 2018 59 Trust accounts Royal Brompton & Harefield NHS Foundation Trust accounts for year ended 31 March 2018
Statement of comprehensive income Statement of financial position
31 March 31 March 2017/18 2016/17 2018 2017 £000 £000 £000 £000
Operating income from Noncurrent assets 341,290 329,780 patient care activities Intangible assets 13,623 14,983
Property, plant and equipment 194,704 186,525 Other operating income 78,653 47,550 Investment property 101,210 37,294
Total non-current assets 309,537 238,802 Operating expenses (398,498) (386,151) Current assets
Inventories 10,290 9,957 Operating surplus/(deficit) 21,445 (8,821) from continuing operations Trade and other receivables 83,190 45,950 Cash and cash equivalents 20,847 32,668
Finance income 55 42 Total current assets 114,327 88,575
Current liabilities
Finance expenses (1,348) (1,038) Trade and other payables (54,200) (49,566)
Borrowings (18,665) (5,610)
PDC dividends payable (6,762) (6,063) Provisions (1,713) (2,011)
Total current liabilities (74,578) (57,187) Total assets less current Net finance costs (8,055) (7,059) 349,286 270,190 liabilities Non-current liabilities Other gains 61,973 27,147 Borrowings (49,192) (52,147)
Provisions (597) (638) Surplus for the year 75,363 11,267 Total non-current liabilities (49,789) (42,785)
Total assets employed 299,497 217,404 Other comprehensive income Will not be reclassified to income and expenditure: Financed by Public dividend capital 108,604 108,567 Revaluations of property, plant 6,693 (9,176) and equipment Revaluation reserve 54,587 47,894 Income and expenditure 136,306 60,943 Total comprehensive income reserve 82,056 2,091 for the period Total taxpayers’ equity 299,497 217,404
60 Royal Brompton & Harefield NHS Foundation Trust Annual Review 2018 61 Royal Brompton Hospital Harefield Hospital Sydney Street, London, SW3 6NP Hill End Road, Harefield, UB9 6JH
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@RBandH www.rbht.nhs.uk