Morning everybody.
Hi there, my name’s David Sloman and I’m the Chief Executive of the Royal Free London
NHS Foundation Trust and I’m joined by my colleagues, Dr Robin Woolfson, Associate Medical
Director, Caroline Clarke, my Deputy and our Chief Finance Officer, and James Manford,
our Director of Quality.
James is new to the school so hasn’t got the right uniform yet but he will be catching
up.
In summary, our Vanguard Bid proposes the establishment of the Royal Free London as
a credentialised hospital group that others, that is open for others to join.
I won’t tell you much about the Royal Free but I will mention one or two things about
the work that we’ve done recently in the space of Acute Care Collaboration.
Firstly, we are one of the founding members of UCLP Academic Health Sciences Centre and
Network and its predecessor, Organisational Work Around Clinical Networks.
Is there anybody here from UCLP?
Give us a wave, give us a wave.
Secondly, we were in the first wave of buddying, when we buddied with our colleagues in Basildon
and Thurrock, is there anybody here from Basildon and Thurrock?
Hello Claire.
And thirdly, just over 12 months ago we made the acquisition of Barnet and Chase Farm Hospitals
to in essence immediately become a nascent chain or group.
What my colleagues are now going to share with you is some of the progress we’ve made
over the course of those years in standardising clinical care, standardising financial variation
and adding real value to patients.
We’re going to start in the space that matters most which is of course clinical services
and I’m going to ask Dr Woolfson to talk a little bit about what we’ve done.
Thanks David very much indeed.
I’m going to talk to you about two areas of specialised medicine and one area of general
medicine where we’ve made great progress over the last 12 months particularly.
First of all I’m going to talk about urology.
So, at the Royal Free we implemented a new care model for our urology patients to reduce
waiting times for new patients, and to increase discharge follow-up.
Following the acquisition of Barnet and Chase, we’ve rolled out that model to Barnet and
Chase and we’ve also centralised in-patient activity and complex urology surgery at the
Royal Free site.
And we’ve most importantly developed sub-specialty interest for all the consultants in our patch.
Renal cancer is a service that under the egis of London Cancer we now deliver at the Royal
Free Hospital for North Central and North East London.
Through intensive work with clinical stakeholders all over the sector, we have developed fantastic
pathways that are now resulting in exemplary surgical outcomes and our FFT score of 98%
recommendation which is just great for our patients and our service.
Over the last 10 years we’ve developed a clinical network for nephrology patients.
This network spans five NHS Trusts in North London and three additional sites in order
to optimise the delivery of patients to their treatment…
delivery of treatment for our patients.
And we now offer, well we now have achieved and deliver top decile performance in dialysis,
in vascular access and in transplantation.
Finally, with the acquisition of Barnet and Chase Farm Hospitals, we took on another emergency
site and we’ve been working really hard to standardise performance across A&Es on
both sites.
We’ve managed to lift our performance in the, for our target from 90% to 95% in the
face of a 13% increase in attendees.
Consistent with this, our FFT recommendation has risen from 80% to 86% across the patch
for which we and myself are really, really proud.
I’m going to pass you over to Caroline, who’s going to talk to you about clinical
and non-clinical support services.
Thank you.
So I’d like to describe some of the progress we’ve made to date in what you might call
the middle office, so that’s clinical support services and the back office, which is corporate
support services.
I’ve got three examples.
First of all, I’d like to tell you about pathology services.
Last April we set up a joint venture with a commercial supplier and another NHS organisation
to supply pathology services to all our organisations.
We’ve already got our first customer.
Our transformation plans indicate that we’ll take costs down by about 15% in the first
18 months and still give great performance to our front office, if you like, clinicians,
so we’re very proud of that and think it will be a great offer for anyone who joins
the Royal Free Group.
Secondly, I’d like to tell you about the work we’ve done on integrating our pharmacy
services.
We’ve been standardising prescribing practice across the new organisation since last year,
and I can give you an example, for example where we’ve changed a single dose banding
for Infliximab and we’ve saved over £1 million in the last year.
So again something for us around standardising both clinical and operational management protocols
and processes.
Finally, I’d just like to talk about the corporate services, or back office as Simon
Stevens calls it.
I’m a Back Office Director, I’m not quite sure I approve of that title.
We’ve centralised our core corporate functions, so that’s Finance, IT, HR, the administrative
transactional functions and we’ve reduced our head count over the last year by about
25%.
We think that we can do more, again as Northumbria said, putting that money back into frontline
clinical services for patients and we think again that would be a great thing we can bring
to bear with our group model.
Now how are we going to do that and make it sustainable and roll it out across members
of the Royal Free Group, James, our Director of Quality is going to talk about that.
Thanks Caroline.
So, as we’ve been hearing this morning several times, to get the greatest benefits from a
group, you’ve really got to get into the heart of how care is designed and delivered
and we’re putting in place, what we call the Royal Free Way, of putting continuous
improvement into that routine delivery.
Now I’ll give you one example, many of you will be working on Sepsis and the Sepsis Six.
Across the Royal Free, there’ve been step changes in outcomes.
That’s what it’s about but the really important thing for here is how that’s been
done.
So it’s been done by supporting staff to learn from each other, to discover how, in
their context, they can reliably do the steps that are needed for patients to get best outcomes.
And this has been a crucial part actually of building one Trust across the Royal Free
and indeed our buddying work with Basildon, where clinicians from the Royal Free were
based at Basildon, and a very rich two-way learning dialogue and indeed wider partnership
work across UCLP.
So at the heart of the Royal Free Way is this skills and attitudes and belief of frontline
staff.
You know frankly what does being a good professional look like?
What do I come to work to do?
And our staff are now going through a programme, again initially from Basildon, on specifying
the ways that they should go about designing and delivering care.
So it’s about better value, reducing waste, consequences of that range from re-work and
inefficiencies to harm to patients, that’s what the best systems do and that’s what
we’re about.
Thank you.
Questions from [unclear 00:07:35].
Question over there.
Hello.
I’m [unclear 00:07:41], clinician.
Both your presentation and the previous presentation did sound amazing in terms of what you’re
already achieving.
And I just wondered what would happen if you didn’t get the Vanguard Bid?
Would all the work carry on as you’re already doing?
So what we’re aiming to do with the group model is actually to develop three broad offerings.
So, at one end of the range, you have the full ownership offering which is currently
what we call today an acquisition.
Right at the other end is buddying and there’s the sort of buddying that we’ve done with
Claire and colleagues in Basildon and Thurrock, which was frankly light touch.
I thought the hospital was in very, very, very good shape and we learnt a lot from Basildon.
And then in the middle, what we want to do is have an offering where people can join
if they want to.
So they could avail themselves as the pathology organisation, they could avail themselves
as some of the service improvement models.
So, we think we will do it anyway.
But what we think being part of the Vanguard process gives us, is firstly an opportunity
to learn with others and we’ve heard from both Salford and Northumberland about how
we can really operate I think at pace if you learn with others.
And secondly there are some issues that we’re grappling with which we think are difficult.
So one example I’d use, that we would like some help and support around is, to ensure
if you are running multiple sites, that you have a regulatory system which is proportionate
and actually really does add value to the patient rather than a blanket approach across
a group.
So for us there are real benefits of being part of the Vanguard process.
Question over there.
Good morning, my name’s Trevor Clower, I’m a non-paid carer and I’m a Patient Representative
for NHS England from Nottingham.
What is not clear is the carer involvement and what lengths you go to it.
I’ve been hearing, I’ve been listening to all the presentations up to now and I’m
listening for words, for systems that are in place, where you can get the patient’s
carer involved, like the Triangle of Trust, sorry Triangle of Care.
Most Trusts have signed up to the Triangle of Care and it’s in place and it’s been
there for two and a half, nearly three years now, and it’s all about valuing the carer
and seeing the carer as a resource.
That’s not been obvious on any of the presentations as I can see at the moment, and it’s that
important, you know, it’s that important workforce that’s actually out there, the
unpaid carer, is an actual resource, not somebody that wants passing onto another you know care
organisation or something like that.
They actively need to be recognised as such as in the Triangle of Care.
Okay, thank you very much.
I’ll pass over to Dr Woolfson actually.
Thanks very much for that, it’s just a great question.
Thank you very much indeed for asking it.
On the one hand we’ve got the FFT results which of course we respond and review our
services, but within the services that we’ve been involved in the transformation of, particularly
for example the renal network, the dialysis and the transplantation support, we have a
fantastically active Kidney Patient Association, both a local one and a national one with whom
we’ve worked really closely over the years in order to develop services.
Within our London Cancer bid for renal cancer services, London Cancer is very focused as
an organisation and having patient involvement, we had a lot of patient involvement in our,
and continue to do so, in our service development.
We couldn’t be doing it without them, there’s just no question of it.
Another question from the lady here.
Yes thank you.
representing the Royal College of Physicians and one of the medical societies.
I was interested in your work on Infliximab so I just wanted to probe a little bit more
on that in terms of international best practice with regards to medicines management in Infliximab.
So I’d be very interested in how you’d use that to inform your work?
I’m really hoping that somebody on this Panel can go into the detail of answering
that question but I’ve just got this sneaking suspicion that might be one that’s best
taken outside of the room.
That’s a team.
We have time for one more question.
Lady at the front.
Hi, I’m Helen Crump from the Nuffield Trust.
I was interested in what you were describing around your like very high-performing process
you have in place already.
And I wondered what your thinking was around how you might continue to kind of bring out
innovation from your staff across the multi sites if you were operating a more standardised
approach?
What’s your [unclear 00:12:28] on that James?
So, in the clinical arena and outside the clinical arena, we believe it’s the people
who are doing the job that understand what the job involves that are closest to the patient
or customer and they have the ideas and the task of people who are more remote is to find
ways of bringing them together and giving them systems in which that can be done reliably.
So, we are forever bringing people into the same room, creating dialogues, trying to do
that through all sorts of innovative ways, but they have the answers and our job is simply
to unleash and unlock that within a framework.
Thank you very much, we’ll leave it there.
Many thanks to the Royal Free.