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Royal Brompton & Harefield NHS Foundation Trust Annual Report

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Royal Brompton & Harefield NHS Foundation Trust Annual Report Royal Brompton & Harefield NHS Foundation Trust Annual Report and Accounts 2019/20 Royal Brompton & Harefield NHS Foundation Trust Annual Report and Accounts 2019/20 Presented to Parliament pursuant to Schedule 7, paragraph 25 (4) (a) of the National Health Service Act 2006 © 2020 Royal Brompton & Harefield NHS Foundation Trust Royal Brompton & Harefield NHS Foundation Trust Annual Report and Accounts 2019/20 CONTENTS Section Page 1. Performance Report 1.1 Overview of Performance 2 1.2 Performance Analysis 11 2. Accountability Report 2.1 Directors’ Report 21 2.2 Remuneration Report 54 2.3 Staff Report 67 2.4 Disclosures: NHS Foundation Trust Code of Governance 79 2.5 NHS Oversight Framework 83 2.6 Statement of Accounting Officer’s Responsibilities 84 2.7 Annual Governance Statement 86 Annex 1 Trust Financial Statements for the Year Ended 31 March 2020 Independent Auditor’s Report to the Council of Governors and Board of Directors on the Financial Statements Financial Statements 2019/20 1 1. Performance Report 1.1 Overview of Performance As a public benefit corporation, Royal Brompton & Harefield NHS Foundation Trust has been an independent legal entity since 1 June 2009. The powers of the Trust are set out in the National Health Service Act 2006, as amended by the Health and Social Care Act 2012. The Trust governance arrangements are set out in the Constitution of Royal Brompton & Harefield NHS Foundation Trust and include the Trust’s membership, the Council of Governors and the Board of Directors. Royal Brompton & Harefield NHS Foundation Trust is a partnership of two specialist heart and lung hospitals, Royal Brompton Hospital in Chelsea, London and Harefield Hospital near Uxbridge. We are a national centre, the largest specialist heart and lung centre in the country and among the largest in Europe, and as such our patients come from all over the UK (and beyond). The nature of the diseases and conditions we treat means many are with us for a lifetime of specialist care, and we are proud of the life-changing and life-saving treatments that our dedicated clinical teams provide. Our integrated approach to caring for patients, adults and children, has been replicated around the world and has gained the Trust an international reputation as a leader in heart and lung diagnosis, treatment and research. In common with other specialist trusts, we treat patients with rare and complex conditions and our clinical teams are skilled in the development and early adoption of new therapies and techniques. We are at the forefront of innovation in healthcare and are often responsible for breakthroughs in treatments, which are then adopted by the NHS and elsewhere. The following pages constitute the Annual Report of Royal Brompton & Harefield NHS Foundation Trust for the period 1 April 2019 to 31 March 2020, its tenth full year as a Foundation Trust. The information contained in this Report is presented and prepared in accordance with the requirements set out by NHS Improvement in the NHS Foundation Trust Annual Reporting Manual 2019/20. Summary of overall performance The Trust is committed to the provision of high-quality services for patients of all ages. During 2019/20 the Trust cared for more than 216,000 patients at our outpatient clinics and nearly 40,000 patients of all ages on our wards. NHS Improvement has continued to keep the Trust in Segment 2 under its NHS Oversight Framework. More information about performance against the NHS Oversight Framework indicators can be found in section 2.5 of this Annual Report. The financial outcome for the year was a deficit of £1.05m (after a revaluation gain of £1.1m, absorbing an annual leave pressure associated with Covid-19 of £1.0m, and combined Provider Sustainability Funding (PSF) & Financial Recovery Funding (FRF) of £29.8m). 2 Joint Statement from the Chair and Chief Executive The aim of our Trust has been to deliver the highest standards of care to patients with heart and lung diseases. We have always been proud of our work, in particular of the commitment and compassion of our staff; and we have not been complacent, continually seeking to improve the quality of our care by continuous improvement and innovation. The importance of this mission has arguably never been demonstrated so clearly as during the Covid-19 pandemic during the last quarter of 2019-20. As part of an exceptional London- wide and national response, both our hospitals nearly tripled their critical care capacity to accommodate just under 100 ventilated patients. As one of 5 adult ECMO centres in England, at one stage in mid-April Royal Brompton supported 26 Covid-19 patients on ECMO, with our Trust’s cumulative ECMO caseload being one of the highest in Europe. This required enormous flexibility and commitment on the part of all our teams, very many of whom took on new and challenging roles to enable us to meet the demand for expert critical care, re-skilling and re-familiarising themselves in a matter of days. For example, at the instruction of NHS England, we consolidated our specialist paediatric heart and lung patients at children’s hospitals elsewhere in London, and our paediatric intensive care teams immediately stepped in to support the care of a further 12 ventilated and ECMO-supported Covid-19 adult patients. The crisis also brought the best out of our clinical and supporting teams in terms of their ability to innovate: a system of webcams was implemented across all critical care areas within a week, with equipment crowdsourced via social media or through the Trust’s charity, which both enabled frontline staff to access virtual support from intensivist consultants at any time and also allowed patients in ICU to see and talk to family members who were unable to visit due to infection risks. In addition, ours was one of the most active in Covid-19 research units in the UK, taking the lead nationally in identifying the linkage between blood clotting and Covid-19 related lung failure. We have treated over 200 critically ill Covid-19 patients, the very great majority transferred in from intensive care units across London and Southern England, with more than two-thirds of these patients now discharged back home. In parallel to its efforts in caring for Covid-19 patients, Harefield was designated one of two centres in London to maintain an essential cardiac surgical and interventional caseload. Cardiac specialists from both our hospitals, and colleagues from GSTT (Guy’s and St Thomas’ NHS Foundation Trust) and ICHT (Imperial College Healthcare NHS Trust), have worked closely together with pooled waiting lists across all subspecialties. A daily cardiac clinical hub MDT has ensured not only that all patients have been appropriately triaged according to their clinical need but that our theatre, cath lab and recovery capacity has been utilised to a record high level of productivity. The fact that none of the c.150 (at the time of writing) surgical patients discharged home during the last 8 weeks were infected by the Covid-19 virus is testament to the rigorous planning and sheer hard work of all the clinical and supporting teams involved. Even with these demands on staff and capacity we still managed to carry out 21 cardiothoracic transplants during the first 5 months of 2020. With the acute phase of the pandemic now behind us, the Trust is both in readiness for any further phases of it, while also looking forward to deploying many of the new ways of working developed in response to Covid-19, as part of a transformation of our specialist model of care. Information technology is a big part of this – whether it be the use by all our doctors and specialist nurses of video-conferencing for follow-up outpatient appointments, which increased significantly and successfully during the Covid-19 pandemic; or the launching of apps through which patients on cardiac surgical waiting lists and with long-term chronic diseases such as asthma and pulmonary hypertension can record and report symptoms, enabling better prioritisation of treatment according to clinical need; or the greater degree of self-management by cystic fibrosis patients of their own condition through an app linked to devices (e.g. pulse oximeter, blood pressure cuff, weighing scales) that they use at home. In addition, our clinical service leads across the Trust are also starting to define more clearly how they can deliver existing and emerging sub-specialty services (e.g. in the treatment of cardiogenic shock and 3 complex aorto-vascular conditions) more effectively across a wider geography in partnership with colleagues from GSTT (Guy’s and St Thomas’ NHS Foundation Trust) and KCH (King’s College Hospital NHS Foundation Trust). In March 2020 our Board resolved with the GSTT Board to pursue a merger of our two organisations through a joint letter of intent to create a new, expanded academic healthcare system. We believe that this goal is best pursued through a merger, since it will provide clearer governance and a simpler means of pooling resources and driving efficiencies across our combined, integrated services. We believe too that it is the most effective way to secure the longer-term future of our Trust’s world-renowned services for the benefit of patients across the UK and beyond. Importantly, our proposed merger was endorsed by the Boards of NHS England and NHS Improvement (NHSE/I) in January 2020. Work is ongoing to prepare a business case for the merger. Forging a new academic healthcare system presents exciting opportunities for better coordination of care; for developing new treatments; and for building new partnerships in research and multi-professional education.
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