Royal Free London NHS Foundation Trust Annual Report and Accounts 2017/18 Royal Free London NHS Foundation Trust ANNUAL REPORT AND ACCOUNTS 2017/18 Presented to Parliament pursuant to Schedule 7, paragraph 25 (4) (a) of the National Health Service Act 2006 ©2018 Royal Free London NHS Foundation Trust Contents Performance report 05 06 Overview 26 Performance analysis About The Royal Free London NHS Foundation Trust Key performance measures and meeting standards The Royal Free London group Financial review A word from our chairman and chief executive Improving our environment Our objectives Our 2017/18 highlights Accountability report 39 40 Directors’ report 98 Staff report 43 Disclosures as set out in the NHS foundation Workforce overview trust code of governance Staff survey The role of the trust board Equality, diversity and human rights The Royal Free London group and its committee structures 111 Single oversight framework Audit committee annual report 2017/18 114 Annual governance statement Council of governors Patient care 90 Remuneration report 123 Annual accounts 173 Quality report 174 Part one: embedding quality 269 Annexes Statement on quality from the chief executive Annex 1: statements from commissioners, Our trust: Implementing a group model to deliver world local Healthwatch organisations and overview class expertise with local care for a larger population and scrutiny committee Annex 2: statement of directors’ responsibilities i 186 Part two: priorities for improvement and n respect of the quality report statement of assurance from the board Annex 3: limited assurance statement from Priorities for improvement external auditors Statements of assurance from the board 280 Appendices Reporting against core indicators Appendix a: changes made to the quality report 239 Part three: review of quality performance Appendix b: glossary of definitions and terms Overview of the quality of care in 2017/18 used in the report Performance against key national indicators Our plans 4 Annual Report and Accounts 2017/18 Performance report 06 Overview 06 About the Royal Free London NHS Foundation Trust 08 Welcome to the Royal Free London group 14 A word from our chairman and chief executive 17 Our objectives 20 Our 2017/18 highlights 26 Performance analysis 26 Key performance measures and meeting standards 30 Financial review 34 Improving our environment Annual Report and Accounts 2017/18 5 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 2017/18. About the Royal Free London 1828 The Royal Free Hospital was founded 189 years ago in 1828 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 1887 patients. 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. 6 Annual Report and Accounts 2017/18 / Performance report 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 1.6 million patients across 20 sites in north London and Hertfordshire. We attract patients from across the country and beyond to our specialist services in liver and kidney transplantation, haemophilia, HIV, infectious diseases, plastic surgery, immunology, neurology, Parkinson’s disease, vascular surgery, cardiology, amyloidosis and scleroderma. We are a member of the academic health science partnership UCL Partners, which brings people and organisations together to transform the health and wellbeing of the population. The Royal Free Hospital provides the only high-level isolation unit of its kind for the care of patients with the Ebola virus and other infectious diseases. The trust is a member of the academic health science partnership, UCL Partners. Key issues and risks The board assurance framework has been re-organised to align the risks with the Royal Free London group goals and the committees responsible for managing those risks. The framework describes the risks and mitigations in place, sources of board assurance and actions required for each risk. See page 59. 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 Annual Report and Accounts 2017/18 / Performance report 7 Welcome to the Royal Free London group Our staff are doing a fantastic job under growing pressure - treating more people than ever before. To manage this increasing demand we need to think differently about the way we deliver our services. For far too long, hospitals and other healthcare services have worked independently - collaboration and partnership working has to be the way forward. We have the opportunity of a generation… We have been given the opportunity of a generation to improve the care we deliver to our patients through the NHS vanguard programme. We have been chosen to set up and lead a group of NHS providers who will share services and resources in order to improve the experience of our staff and patients. To deliver on this opportunity, the Royal Free London group was established in July 2017. by doing things differently… We will have a new operational structure with: • local hospital management teams in place at our three main hospitals: Barnet Hospital, Chase Farm Hospital and the Royal Free Hospital • new divisional structures • a group board and group executive team which sets the strategy for the group. and collaborating with our partners… Working side-by-side with other healthcare experts we can share ways of working which we know deliver the best outcomes. By working collectively we can reduce variations in patient care and the cost of treatment that we see across the group, increasing our purchasing power. We will also be able to share services which are essential to the day-to- day running of a hospital. By working at a larger scale, teams such as HR and finance can support a group of hospitals, rather than just one. This means we can improve efficiency and have more money to invest in patient care. 8 Annual Report and Accounts 2017/18 / Performance report we will lead a group of NHS providers… Our plan proposes to bring together a range of acute providers to create a ‘group’ of hospitals, connected by a single group centre – similar to models seen internationally, such as Intermountain Healthcare in Utah, USA. Individual trusts will be able to join the group under a range of membership options, from full membership to arrangements such as buddying. to transform the experience of our staff and our 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 the very best care available across the globe. At the heart of this approach are clinical practice groups, or CPGs. CPGs are clinically led ways of working across several hospital sites aimed at reducing variation and ensuring all patients receive the best standard of care, wherever they are treated. Hospital teams come together to design pathways – that is the way a patient is treated in hospital for a particular health issue. They work to ensure diagnostic and treatment decisions are consistent and based on the latest evidence to deliver the best possible outcome for patients. CPGs also ensure that staff are working at the top of their capability. A consultant will not always be the most appropriate medic for a patient to see. Nurses and therapists are being empowered to see more patients and make clinical decisions, freeing up consultants to see the cases where a specialist opinion is required. This improves the time in which a patient is seen and overall patient satisfaction and outcomes. The Royal Free London has four CPGs: • Women’s and children’s • Medical and urgent care • Transplant and specialist services • Surgery and associated services These four areas were chosen by the RFL group executive team, division leads and clinicians as they met certain criteria. They are: priority areas for the group; high cost; high volume; and areas with widespread, unwarranted variation. Unwarranted variation refers to differences in the way a patient is treated - both within the individual hospitals and between the sites - without there being any improvement on the outcome. This can result in inefficiencies and variations in outcomes for patients. Within each CPG there are between five to nine different pathways, for different areas of care, where we are working to smooth out variation by using the latest evidence to improve care for patients. How we are working with North Middlesex University Hospital NHS Trust North Middlesex University Hospital NHS Trust (NMUH) joined Royal Free London group in September 2017 as our first clinical partner. As a clinical partner, NMUH will work alongside the RFL to ensure there are consistent approaches to designing and delivering care, based on evidence and best practice – nationally and internationally. The partnership is the culmination of more than two years of close working between the Royal Free London and NMUH.