Decision details

The Chairman invited the following to the table:

Dr Steve Shaw – Chief Executive Officer of Barnet Hospital, Royal Free London NHS Foundation Trust

Ms Kay Matthews - Director of Commissioning, Barnet CCG

Dr Debbie Frost - Chairman, Barnet CCG

Ms Sarah de Souza - Director of Commissioning, Barnet CCG

Ms Lisa Robbins – Manager, Healthwatch Barnet

Dr Shaw explained that further to the Royal Free Hospital (RFH) achieving Foundation Trust status in 2012 and acquiring BH in 2014, in 2017 the Royal Free Group (RFG) had been set up as part of the NHS Vanguard Programme. This model involved groups of providers sharing services in order to reduce unwarranted variation in patient care and to increase efficiency.

Dr Shaw noted that Mr Dominic Dodds is Chairman of the RFG and Sir David Slomon is CEO. Ms Kate Slemeck had been appointed Chief Executive of the Royal Free Hospital (RFH) in January 2018 and Ms Natalie Forrest is Programme Director for the redevelopment of Chase Farm Hospital.

Dr Shaw reported that the past winter at the RFH and BH had been challenging, but an improvement on the previous year, despite severe weather. The national target currently requires that 90% of patients who attend A&E are seen within four hours and then either admitted or discharged. This target will increase to 95% in 2019.

Dr Shaw explained that there were increasing pressures on both A&E and Ambulance Trusts but targets were being met at BH and the RFH was close to meeting them (87% of patients seen within 4 hours in 2017/18). Ambulance handovers were an important aspect of the target and huge improvements had also been made, whereas in some parts of the country ambulances queued for several hours to get patients through the Front Door.  BH was in the top five Trusts in London for ambulance handovers.

The RFH had a new A&E which was at least five times the size of its former one.

Both hospitals had seen increased A&E attendance. The average was 340 patients a day at BH and 320 at the RFH. This was a national problem and the solution was complex and needed to include GPs and Adult Social Care.  However, new mechanisms had been put in place within the hospital to encourage staff to be more alert to slow ‘processing’ regarding patient care. BH was also undergoing a major digital programme to incorporate paperless records.

National Emergency Care teams had been set up to help share best practice around the country and help to release beds earlier in the day to help with the typical surges into A&E in the evening. One tool was the ‘Red2Green’ campaign introduced by NHS England – a visual management system which reduced wasted time in a patient’s journey through the hospital. Culture change across the entire hospital was also needed to achieve A&E targets by helping the flow in and out of the hospital.

Ms Matthews added that a pilot scheme had been carried out at the Front Door of Barnet Hospital (BH) which involved redirecting patients to GPs where appropriate. Appointments were offered directly into nine GP Hubs and this had proved successful. This was due to become ‘business as usual’ at BH. The same pilot scheme had recently been set up at the Royal Free Hospital (RFH).

An additional 38,000 Primary Care appointments had been introduced at the Hubs and the GPs had access to full patient records. Ms Matthews would forward a map of the Hubs to the Committee after the meeting. The sites had extended hours, with two of them open from 8am-10pm. Received by Governance Officer

Ms Matthews noted that patients from areas outside the Borough were also using Barnet’s A&E and Walk-In Centres and the CCG was liaising about finance with colleagues particularly in Herts Valleys CCG and Camden CCG.

The Care Closer to Home Integrated Networks (CHINs) had been the driving force behind the Hubs, but detailed data on the reasons for people attending them for Primary Care Services as opposed to elsewhere were not currently collated. However it had been found that there was variation in how patients from certain GP practices were accessing services and this was important for GPs to understand e.g. it could be related to telephone accessibility, or GP opening times, as well as demographics.

The CCG was also working closely with Local Authority colleagues to ensure that patients had the support they needed to enable them to leave hospital. Dr Shaw expressed thanks to the CCG and Barnet Adult Social Care colleagues as they had been important in helping BH and RFH achieve their objectives. Regular dialogue with Herts Valleys CCG had also been instrumental in improving transfer of care.

Ms Matthews noted that the RFH had been ranked 8 out of 18 in London for Winter performance in 2017/18.

Barnet Hospital Parking Update

Dr Shaw reported that a development master plan had been presented to the Barnet Planning Team as a Pre-Planning Application, which included a 1300-space multi-storey car park at BH. This had been well received and the Trust had procured a professional team to work up a formal masterplan to take forward a Planning Application for the entire Barnet site. This was likely to be submitted in Spring 2019.

Dr Shaw added that the car park was likely to take around three years to complete once the Planning Application had been approved. The Chairman noted that there were already problems accessing the hospital due to lack of parking spaces and that the problem would be exacerbated when further roads around the hospital went into the CPZ in September 2018. A Member stated that the RFH was much better served by public transport. She suggested approaching TfL to discuss possible improved bus routes to BH. Dr Shaw would feed this back. Action: Dr Shaw

Dr Shaw would keep the Committee updated on progress including the final number of car parking spaces agreed. He would also try to ascertain what would happen to the wasteland behind the 200 spaces at the current Barnet site. The Chairman would also ask Barnet’s Planning Officers to keep the Committee informed.  Action: Dr Shaw, Chairman

RESOLVED that the Committee noted the verbal report on the Front Door at Barnet Hospital and the Royal Free Hospital.