Annual Report and Accounts 2019/20 Royal Free London NHS Foundation Trust includes: the Royal Free Hospital, Barnet Hospital and Chase Farm Hospital. 2 Royal Free London 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. 3 © 2020 Royal Free London NHS Foundation Trust 4 Table of contents 1 Performance report…………………………………………………………………...6 1.1 Overview……………………………………………………………………………...6 Our objectives………………………………………………………………………..10 Our highlights………………………………………………………………………...13 1.2 Performance analysis………………………………………………………………………19 Financial review……………………………………………………………………...23 2 Accountability report………………………………………………………………………..30 2.1 Directors’ report……………………………………………………………………………30 2.2 Disclosures as set out in the NHS foundation trust code of governance……………33 2.3 Remuneration report………………………………………………………………………87 2.4 Staff report………………………………………………………………………………..100 2.5 Single oversight framework……………………………………………………………..117 Statement of chief executive’s responsibilities as accounting officer……………...118 2.6 Annual governance statement………………………………………………………….120 3 Annual accounts…………………………………………………………………………...130 4 Auditor’s report……………………………………………………………………………..188 Please note: Due to COVID-19, the Quality Report will be produced and published under a separate cover later in 2020. 5 Performance report 1.1 Overview This section is a summary of the Royal Free London NHS Foundation Trust (RFL) – our purpose, our objectives, details about any key risks to the achievement of those objectives, and information about how we performed during 2019/20. 1.1.1 About the Royal Free London • 1828 – The Royal Free Hospital was founded 190 years ago to provide free healthcare to those who could not afford medical treatment. • 1837 - The title ‘Royal’ was granted by Queen Victoria in recognition of the hospital’s work with cholera patients. • 1887 - The Royal Free Hospital was the first hospital in London to accept women medical students. • 1991 - In April 1991, the Royal Free became one of the first NHS trusts. • 2012 - The hospital was authorised as a foundation trust under the name the Royal Free London NHS Foundation Trust. • 2014 - In July 2014 Barnet and Chase Farm Hospitals NHS Trust became part of the Royal Free London. • 2016 – The trust receives a ‘good’ rating from the Care Quality Commission. • 2017 – The Royal Free London group is established, and North Middlesex University Hospital NHS Trust joins us as our first clinical partner. • 2018 – The new Chase Farm Hospital opens on time and on budget; West Hertfordshire Hospitals NHS Trust joins the group as our second clinical partner. • 2019 – Chase Farm Hospital is awarded HIMMS level 6, making it one of the most digitally advanced hospitals in the country. 1.1.2 Our work and activities The Royal Free London is one of the largest hospital trusts in the country, employing more than 10,000 staff and serving a population of over 1.6 million people across 20 sites in north London and Hertfordshire. We attract patients from across the country and beyond to our specialist services in liver, kidney transplantation, haemophilia, renal, HIV, infectious diseases, plastic surgery, immunology, vascular surgery, cardiology, amyloidosis and scleroderma. The Royal Free Hospital provides the only high-level isolation unit of its kind for the care of patients with the Ebola virus and similar infectious diseases. The trust is a member of the academic health science partnership, UCL Partners. The Royal Free London group Our ambition is to become the leading healthcare group in Europe – bringing the best of the NHS to every patient no matter which of our hospitals they are treated in. 6 The Royal Free London is one of four NHS trusts which have the permission to develop and lead a group of NHS providers who will share services and resources in order to improve the quality and experience of patients. By working as a group, we can bring together larger numbers of clinicians to share their knowledge about the very best ways to treat patients in line with very best care available across the globe. We continue to work closely with West Herts Hospitals NHS Trust and North Middlesex University Hospital NHS Trust in clinical partnerships to share best practice and improve efficiency. Over time we believe this collaboration with other organisations will continue to develop, either through growth in the RFL group or via our work as part of the NHS focus on integrated care systems. Our focus will take us outside of our hospital walls, expanding our horizons to the health of the population we serve. This will mean working more closely with our non-hospital partners in the NHS and in social care to help people to live longer in good health, rather than just treating people when they are sick. Our group will help us deliver this aspiration. 1.1.3 Key issues and risks The board assurance framework identifies the biggest risks to delivering our group goals aligned to the committees responsible for managing those risks. The framework describes each risk and provides details of the mitigations in place, sources of board assurance and further actions required. See page 120. 1.1.4 World class care values All of our staff are expected to treat our patients, visitors and each other in line with our world class care values which expect us to be: • positively welcoming • actively respectful • clearly communicating • visibly reassuring 1.1.5 A word from our chairman and chief executive It is impossible to be prouder of our staff for their monumental efforts and achievements in what will go down as the year the NHS faced the single largest challenge in its history. 2019/20 began with a clear focus on consolidation – getting ourselves back on track in key areas where our performance was not where it should be. This meant trying to live within our means financially, but most importantly ensuring that our patients were receiving the highest standard of care, and that meant improving the time it took for them to be treated whether they attended A&E or were waiting for cancer treatment. In addition to this keen focus on getting the basics right, there were some significant achievements. 7 We celebrated our 2,000th liver transplant with a wonderful event at the Emirates Stadium, attended by many of the patients whose lives had been transformed by the world-leading service since it was established in 1988. We opened the UK’s largest and most advanced decontamination unit in Enfield which will clean approximately four million instruments every year – with the capacity to do five times more. Our Streams app, developed in partnership with Google Health and which is improving outcomes for patients with acute kidney injury, was rolled out to clinicians at Barnet Hospital. And in March, we were delighted to announce the appointment of our brilliant Royal Free London group chief nurse Deborah Sanders as the new chief executive of Barnet Hospital. Chase Farm Hospital, which celebrated the first anniversary of its £200 million rebuild, was recognised as one the UK’s most digitally advanced hospitals. And, of course, we are now looking forward to the opening of the Pears Building, the new home to UCL’s Institute of Immunity and Transplantation whose research will take our understanding of conditions like cancer and diabetes to a new level. But it was with their response to the COVID-19 pandemic that our staff really shone – inspiring us and leaving us in awe. They showed leadership, commitment, skill, expertise, sacrifice and devotion to our patients in the most testing circumstances. The patients our colleagues have cared for - many of whose lives they have saved - have rightly hailed them as heroes and communities have applauded them every week from their doorsteps. In February, as one of four specialist centres for infectious disease in the UK, the Royal Free Hospital admitted some of the first patients with the virus at a time when the aim was to contain the spread. As the scale of the crisis became clear, the NHS went into overdrive. Within the space of a few days, our whole trust had re-organised itself as we began to admit increasing numbers of COVID-19 patients and our clinical teams adopted new models of care at an unimaginable pace. At the time of writing, we have treated more than 1,400 COVID-19 patients, provided 350,000 free meals to our staff and received 251,000 donations of essential items from our amazing communities. Support services including porters, domestics, catering teams and admin and clerical staff stepped up to the plate – many of them taking on new and unfamiliar roles. These were people who, like most of us, had mums, dads, sons, daughters and grandparents to worry about as they joined other key workers on their daily commute every morning. We owe them a huge debt. It was crucial that we supported our staff in every way possible and for that we’re grateful to The Royal Free Charity for managing the incredibly generous donations of food and essential items from our local communities, as well as for setting up an emergency fund. 8 This enabled us to provide free meals for staff during their shifts; set up a free supermarket at the Royal Free Hospital so they could get the supplies they needed after a long day at work; and deliver much-needed items to staff rooms and kitchens across Barnet Hospital. Recognising the impact on our colleagues’ wellbeing and mental health has also been hugely important. We introduced more services and avenues to help our staff take care of themselves, including guidance on our intranet, access to wellbeing apps, our mental health first-aiders and a seven-day helpline. At the time of writing we are working closely with clinical leaders, thinking about when we are going to restart services, and how we do that.