Agenda item

The Chairman invited to the table:

·         Dr. Steve Shaw, Chief Executive of Barnet Hospital. 

Royal Free Group Model:

At the invitation of the Chairman, Dr. Shaw provided the Committee with a presentation about the Royal Free London Group.  The Committee noted the presentation, which included the following points:

·         In 2009 the Royal Free had one of the smallest local hospital services portfolios amongst the 23 London acutes, with a small paediatric service, an equal second smallest A&E and maternity service and below average volumes in general medicine and general surgery.  The hospital had major overlaps with UCLH on specialist services.

·         In 2012 the Hospital was authorised as a Foundation Trust.

·         In 2014 the Trust acquired Barnet Hospital and Chase Farm Hospital

·         In 2016 the Trust received accreditation as a Group.

·         Within the context of its position within London, the Royal Free currently provides good services at a below-average cost.  However, the Trust’s aspiration is to provide outstanding services at a below-average cost. 

·         The Group would aim to transition from a standalone hospital model to working with others in a total system provider model

·         The Group CEO is Sir David Sloman.

Dr. Shaw informed the Committee that North Middlesex University Hospital NHS Trust had joined as a clinical partner of the Royal Free London Group two weeks ago.  Whilst they were not yet full members of the Group, they would take part fully in the clinical practice group whilst retaining their own Board. 

Dr. Shaw informed the Committee that the Group would be undertaking work to understand what brought a patient to hospital and how they could be supported to leave hospital safely and promptly.  Dr. Shaw expressed the need to involve colleagues in primary care and social care as part of a whole patient pathway. 

Responding to a question from a Member, Dr. Shaw informed the Committee of the need to provide assurance to regulators that there is a plan for the Royal Free, Barnet and Chase Farm Hospitals to deliver financial improvements.  The Committee noted that the Royal Free undertakes very complex specialist procedures which require high cost drugs. 

A Member questioned how streamlining would fit into the group model. Dr. Shaw informed the Committee that streamlining would be an essential part of the group process because of its impact on the patient experience. 

A Member noted the relationship between cost and quality of care and questioned to what extent the Trust could achieve its aspirations independently of how other hospital Trusts are achieving theirs.  Dr. Shaw informed the Committee that it would benefit everyone if costs come down so that more money could be reinvested into the NHS.  

A Member noted that it seemed sensible to standardise procedures and pool expertise.  The Member questioned the extent of variation existing between the same hospitals within a Trust.  Dr. Shaw informed the Committee that there was a surprising amount of variation within the NHS, as indicated by the fact that there were 150 different types of prosthetic hips available.  Dr. Shaw explained that work looking at the treatment of Pneumonia with antibiotics had shown a variation between hospitals in their amounts, types and costs.  Dr. Shaw advised that the Trust had a duty to provide the best care at the lowest cost. 

Streams Technology:

The Chairman invited the following to join Dr. Shaw at the table:

·         Dr. Chris Laing, Consultant Nephrologist

·         Tosh Mondal, IT Director at the Royal Free London NHS Foundation Trust

·         Councillor Gabriel Rozenberg.

The Chairman introduced the report and the Committee noted that, in November 2016, the Royal Free London had entered into a five-year partnership with the British technology company, DeepMind, in order to transform care through the use of a mobile application called Streams.

Dr. Laing informed the Committee that the clinical software app was being used to support patients with acute kidney injury (AKI) by getting the right data to the right clinician at the right time.  The Committee noted that AKI was responsible for up to 20% of A&E admissions.

The Committee noted that a change in a patient’s kidney function can be picked up by a blood test.  The Committee noted that the Royal Free London had felt that there was an opportunity to receive real time notifications for blood tests on a mobile platform. 

The Royal Free London explained that it would have approximately 2000 blood tests going through the system per day and that the vast majority of these blood samples would be tested for kidney function.  The Committee noted that Streams uses a range of patient data to determine whether a patient is at risk of developing AKI and sends an instant alert to clinicians who are able to take appropriate action promptly.  Because patient information is contained in one place, on a mobile application, it reduces the administrative burden on staff and means they can dedicate more time to delivering direct patient care.  The Committee noted that within less than a second, relevant information can be notified and actioned. 

Tosh informed the Committee that the platform had been safely deployed with consultants at the Royal Free and that access to the data was extremely secure. 

A Member questioned if it was possible at this stage to quantify improved outcomes for patients as a result of this app.  Dr. Laing informed the Committee that rigorous evaluation of the project would be undertaken and that the app’s impact on survival rates would be going through academic service evaluation.  He stressed the importance of being cautious about claiming hard clinical benefits before formal evaluation but noted that the early signs were encouraging.  He noted that there was huge potential in the long term for leveraging clinical progress.

Responding to a question from a Member, Dr. Laing informed the Committee that Streams technology is really surveillance through more rigorous analysis. 

Councillor Rozenberg questioned why the Royal Free London had decided to work with a company that uses independent data tools.  Dr. Laing informed the Committee that DeepMind have a number of other skills including security infrastructure and clinical design. 

The Chairman questioned if the Streams Technology was currently just operating out of the Royal Free Hospital site.  Dr. Laing advised the Committee that the implementation was single site, but it could be activated from the Barnet site.  The Committee noted the long term aspiration to standardise this method of working.

A Member questioned how much progress had been made to resolve the concerns raised by the Information Commissioner’s Office with respect to the Royal Free acting as a data controller.   Dr. Laing informed the Committee that the Trust had certainly learned from the problem and had agreed to carry out the five undertakings that the ICO had requested.

RESOLVED that the Committee noted the report.