Agenda item

·       Group Chief Executive’s Vision for Royal Free London NHS Foundation Trust

·       Wuhan Novel Coronavirus

·       Barnet Hospital Planning Application

 

Caroline Clarke, Group Chief Executive, Royal Free London NHS Foundation Trust

The Chairman invited to the table for the following five updates:

·       Caroline Clarke, Group Chief Executive, Royal Free London (RFL) NHS Foundation Trust

 

Group Chief Executive’s Vision for the Royal Free London (RFL) NHS Foundation Trust

 

Ms Clarke provided an overview of the RFL Vision for the next few years which included:

 

Working in clinical partnerships with other Trusts and local GPs to achieve:

• Excellent health outcomes for residents
• Positive experiences for staff and patients
• A sustainable health system with reduced carbon and waste

 

She continued that the key of RFL’s Clinical Strategy included:

 

• Development of cardiovascular and cancer services
• Focus on services for women and children
• The completion of the Institute for Infection and Immunity at the Royal Free Hospital (RFH) site
• Increasing the integration of services with Primary and Community care
• Increasing capacity for regenerative medicine and organ transplantation as well as gene therapy and manufacture of cells

 

Ms Clarke noted that Barnet Hospital (BH) was very busy and there was too much variation in patients’ care. RFL would work together with partners across health and social care, including Barnet Council, to provide a better standard of service.  Building relationships was an important factor as well as engaging more effectively with local communities.

 

A Member asked about the resource implications of the vision. Ms Clarke responded that the Royal Free Hospital (RFH) has a fantastic charity and a fundraising campaign would be launched until 2028. The Trust would also continue to try to reduce costs by reducing variation of care and by reducing indirect costs through further consolidation of support services across North London.

 

 

A Member asked about the implications of Brexit for recruitment. Ms Clarke noted that the RFH has 10,000 staff and 1,000 volunteers but it was likely that there would be difficulties in recruitment due to new government policies. One way of managing this is the use of technology and digital care. NHS policy is moving towards self-care and preventative care. In the shorter term, the Trust would work across the Sustainability and Transformation Partnership (STP) and with local government and would continue to try make working in north London a positive experience for staff.

 

Ms Clarke reported that 12% of the Trust’s staff were from the EU and there had been a big reduction in applications for posts since Brexit. Recent recruitment drives in other parts of the world, such as India and the Philippines, had been positive.

 

A Member asked about the use of agency staff. Ms Clarke responded that the Trust was trying hard to reduce this as it was expensive and had an impact on team stability. Nationally there is an initiative to train nurses via apprenticeships rather than higher education. The Trust is working with the Executive Director of Adults and Communities at Barnet Council and her team around supporting Nursing Homes and working together to encourage recruitment in Barnet. The NHS People Plan is emerging nationally and should help with this.

 

A Member asked how much the clinical strategy included the use of options to save Consultant time, such as tele-dermatology. Ms Clarke responded that this was a good model to help reduce face-to-face appointments and enabled Consultants to spend more time teaching, doing research and working in the community.

 

A Member asked how much work had been undertaken to help to train people locally as she thought that a few local Colleges and Universities held medicine-related courses. Ms Clarke stated that most of the local staff had joined RFL via University College London (UCL) but she agreed that RFL could engage more with other Colleges and Universities. She added that nursing open days which had been run at BH had been very successful.

 

Wuhan Novel Coronavirus (COVID 19)

 

The Chairman invited to join the table:

 

• Dr Janet Djomba, Public Health Consultant, Barnet Council

 

Dr Djomba noted that a briefing on COVID 19 had been sent separately to all Members prior to the meeting.

 

Ms Clarke reported that a High Consequence Infectious Disease Unit had been set up at the RFH for several years so they had the infrastructure and staff capability to deal with a range of diseases. Five sites across England had these units and during the containment phase of the virus the RFH could be called upon by national teams to receive patients who had tested positive. So far, three patients had been cared for with Coronavirus and all had recovered and been discharged.

 

In addition, all A&E Departments were expected to have ‘Pods’ for suspected Coronavirus patients. Chase Farm had set theirs up and BH would open theirs in the next few days.

 

Dr Djomba reported that there was no COVID 19 epidemic so far in the UK and globally this was not yet a pandemic. The World Health Organisation (WHO) had announced that preparations should be in place for a pandemic as this was likely. The peak levels seem to have been reached in China and the situation there was stable. There were no new cases and numbers infected were slowly decreasing. Recent developments in South Korea and Italy meant that preparation was vital for a potential pandemic. Preparations were similar to that for pandemic flu and Barnet had a plan. There was no vaccine against COVID 19 so far and this was unlikely to be developed soon.

 

Dr Djomba reported that a preparation exercise with Barnet residents would be carried out on 11 March, to check that plans were sufficient. The Government and Public Health England (PHE) were working hard to keep the virus contained though contact tracing was not part of the standard pandemic flu plan. PHE was working on prevention and urging people to wash their hands thoroughly and disinfect them as well as to reduce contact with unwell people. There was no evidence that face masks were effective outside of clinical settings.

 

A Member enquired about methods of testing for the virus. Dr Djomba stated that the first symptoms were a cough, high fever and difficulty breathing. A swab from the throat is used for diagnosis. The advice to the public is to dial 111 if they have these symptoms.

 

A Member asked whether individuals would remain contagious after recovery. Dr Djomba stated that the evidence was inconsistent but usually coughing and sneezing indicated a virus still being infectious.

 

A Member asked what preventative measures were being taken in the UK. Dr Djomba responded that patients arriving at Heathrow Airport were being screened and a hotel had been provided there for quarantine. 

 

A Member asked whether research had been carried out on why children were less affected. Dr Djomba stated that PHE was working on this but it may be due to their general health status. Some may be infected but do not show any symptoms.

 

 

Barnet Hospital Planning Application

 

The Chairman reported that the Planning Application for a master plan and a multi-storey car park at BH had not been submitted. Instead, an application had been submitted for the demolition of one of its buildings to create 70 parking spaces. Ms Clarke reported that BH’s Decontamination Unit had been moved to a new combined unit on the North Circular Road. BH had applied to demolish the small building which was its former Decontamination Unit with a view to providing additional parking. The application would be heard by the Planning Committee the following week. 

 

 

Update on investment in A&E ahead of winter

 

Ms Clarke reported that three initiatives had been set up to increase capacity at the Front Door at BH:

 

·       An Urgent Treatment Centre (UTC) had been set up as well as adjustments to make the reception area less crowded

·       An increase in the number of ‘short stay’ beds which offer ambulatory care (same day urgent care)

·       Discussions were ongoing about where to place an additional ward and how to fund this, given the growing population

 

 

Article in The Guardian, 19 February 2020

 

The Chairman invited to join the table:

 

• Sarah D’Souza, Director of Commissioning, Barnet CCG

 

The Chairman introduced an item on an article published in The Guardian about RFH patient letters that did not get sent to GPs due to an IT error. The article had been published with the agenda as a late supplement.

 

Ms Clarke reported that this had been caused by a coding error. The RFH has been using a well-known provider, Cerner, since 2007 for this service, but takes responsibility for the error and is taking the matter very seriously. A ‘serious incident’ protocol has been put in place. So far there is no evidence of harm to any patient following this incident but doctors are still checking records to ensure that this is the case. Conversations had taken place with Cerner and there is no concern that this would happen again. Following the Harm Review a more formal investigation would take place.

 

Ms Clarke reported that she had had conversations with GPs and derived some assurance from this. However, GPs had fed back that the RFH’s follow-up process is not as effective as they would like. Ms Clarke noted that if any Members are aware of issues that she would be keen to hear from them so that she could try to understand the problem.

 

The Chairman asked why the problem had taken six months to be detected. Ms Clarke stated that this remained unclear but as most of the patients had regular follow ups none of them had raised concerns.

 

A Member noted that she had been notified in the past of patients not being referred for further care when they should have been. She hoped to be reassured that this was not a common occurrence. Some conditions such as cancer could be time critical. Ms Clarke noted that cancer patients were recorded on a separate system with different pathways.

 

The Chairman asked for an update to be brought to the next HOSC by Dr Chris Streather on 11May. Ms Clarke would inform Dr Streather.

Action: Ms Clarke and Governance Officer

 

A Member asked whether the information should be available to GPs on their own IT systems. Ms Clarke responded that this would be available but not all GP Practices are on the system. Patients would usually be told to see their GP for follow-up appointments, so the letters were an additional measure. In around two years’ time, the same system should be accessible to all GP Practices.

 

A Member asked whether an assessment had been made of Cerner’s competency to continue as the provider. Ms Clarke responded that Cerner was well respected and used worldwide. They had had the contract with the RFH since 2007, and appropriate commercial conversations would be held with Cerner but she did not wish to speculate at present on what had caused the problem.

 

 

Ms D’Souza reported that the CCG would follow up on the Clinical Harm Review through its Quality Review Group to ensure that the Review was carried out appropriately. A Member noted that the article in the Guardian suggested that an independent review would have been better. Ms D’Souza reported that the CCG had considered this but was concerned that an independent review could lead to additional delay. The hospital could carry out the Review immediately and the Consultants carrying out the Review had not been involved in the errors, which were technical errors. The CCG had been assured that the process was thorough but they would continue to ask questions and would have an opportunity to quality assure the Review and Action Plan. She noted that the HOSC could request to see the Action Plan from the RFH following the Review.

 

The Chairman agreed that the HOSC would ask to see the Action Plan. The Governance Officer would ask Dr Streather to present it at the HOSC meeting on 11May.

Action: Governance Officer

 

The Committee RESOLVED to note the updates.