This world renowned heart and lung hospital is a few minutes drive from Ruislip. Its reputation for clinical excellence is second to none, despite its old buildings.
There are plans to rebuild the hospital on its present site, but that lies a long way ahead. It is part of the Royal Brompton and Harefield NHS Foundation Trust and we obtain regular reports on that Trust’s Board Meetings held in public
At the March 2015 meeting of the community Voice, of which we are a member, the guest speaker was Dr Richard Grocott-Mason, Consultant Cardiologist and Divisional Director, Heart Division Harefield Hospital, speaking about 'Heart Disease, Prevention and Treatment'
a) Dr Grocott-Mason described the heart and explained that we each have 60,000 miles of blood vessels. It takes approximately 20 seconds for blood to circulate around the entire vascular system; the heart beats about 100,000 times each day and pumps about 2,000 gallons of blood per day. Mortality rates from heart disease have reduced over the years and life expectancy has increased.
b) Common types of heart disease (HD) include blocked blood supply, leading to angina and possibly heart attack; weakened pumping of the heart muscle, causing heart failure; abnormal rhythm (atrial fibrillation) and problems of the aortic and mitral valves. Angina is caused by narrowing of an artery when blood flow at rest is satisfactory, but limited on exercise, causing chest pain and breathlessness. In a heart attack, heart tissue can die due to a blocked coronary artery. In a cardiac arrest, the heart cannot pump and so the electrical signal becomes chaotic.
c) The risk of HD can be reduced with timely intervention. At risk of HD are those with a family history of the condition, smokers, diabetics, the overweight, people with increased waist measurement, with high blood pressure or high cholesterol, certain ethnic groups and the socially deprived.
d) Dr Grocott-Mason described procedures for dealing with various forms of HD, including primary angioplasty, coronary artery bypass, aortic stenosis and he listed advances made in recent years.
e) In answer to a question, he explained that prevention and treatment of a stroke (blockage of a blood vessel to the brain) and of a heart attack (blockage of a blood vessel to the heart) are similar.
f) The British Heart Foundation (www.bhf.org) recommends 150 minutes of exercise per week. However, whilst it is important to exercise, age is a risk factor.
g) Large waist measurement is the best indicator of risk of stroke or heart attack, being more reliable than body mass index or height, but as some patients could have a large waist but not be overweight, there are no hard and fast rules.
h) Recovery after the insertion of an arterial stent can be rapid if the artery is unblocked quickly. However, after 3-4 hours there is irreversible damage to the heart muscle. If someone has a stroke or a heart attack it is important to call an ambulance at once. It is a good idea to take an aspirin as it will thin the blood and might clear the artery blockage.
i) Can a heart attack be confused with indigestion? Signs of a heart attack are: central chest pain radiating to the jaw and (usually) the left arm, sweating, feeling faint. There might be no pain, just a feeling of being unwell. Such signs should not be ignored.
j) Stents last longer than they used to, and nowadays one stent can be inserted inside another.
The speaker was thanked by David Potter on behalf of the audience and he was applauded very warmly as he left the hall.
This will bring more critical care and in-patient beds, better diagnostic imaging and scanning capability, a new theatre and endoscopy suite. Services at the hospital will be able to grow, including treatments for asthma, emphysema and allergies.
NB: This is not a summary of the papers, but notes items of interest
Finance: At the end of Month 11 the Trust had a surplus of £2.9m, which was £1.4m above budget. The planned surplus for the year is £2.3m. During the period October- December the Trust was awarded 8 new research awards totalling over £1.6m income
Planning problems for Royal Brompton: In order to fund its plans to consolidate services in one part of its site the Trust needs to sell land with planning permission for development for residential use. The Royal Marsden Hospital, its neighbour, is objecting to this change of use and has offered to buy the relevant land - but at a fraction of the value it would have with planning permission for residential development, which is unacceptable to the Brompton Trust. That trust has tried offering space to the Marsden within its own development plans, which has not been accepted. Deadlock ensues and much hangs on the outcome.
Infections: With zero tolerance for cases of MRSA, the Trust has failed its whole year MRSA target, having recorded two cases earlier in the year.
The trust hoped to meet its target for clostridium difficile, a maximum of 12 cases in year, but it has now exceed that target by one case and it awaits the end of year uncertain what financial penalty will be demanded – a fine in the order of around £200k is to be expected.
For 2014-15 the Department have notified the Trust of a target of maximum 9 cases of clostridium difficile, which is very challenging.
Staff Survey 2013: The Trust’s response rate was 38%, slightly lower than last year, which was disappointing. However, the results have been very encouraging. In particular, the Trust has the top score nationally for all Acute and Acute Specialist Trusts in “Staff recommendation of the Trust as a place to work or receive treatment”
Care Quality Commission (CQC) unannounced inspection of Harefield Hospital: This took place on 3rd February. The report published on 4th March shows full compliance with all the standards inspected and contains many examples of positive patient feedback.
The inspectors visited several areas, speaking to staff and patients in each of them. All parts visited were clean and staff were observed complying with good practice for the prevention and control of infection. Staffing met the needs of patients. Staff considered that they had good quality training and felt confident in their roles and tasks.
Subsequently the Trust was moved from Risk Band 3 to Band 5, a major improvement, taking the Trust close to the lowest risk category, Band 6.
Cancellation of operations at Harefield Hospital: During Quarter 4 there was a marked increase in cancelled admissions and cancelled operations. The number has been growing since October 2013 and in February 2014 it reached 65 cancellations. However, there have been errors in the criteria used for reporting cancellations, leading in the past to understating of numbers. Also, in February there was also exceptionally high bed-occupancy in level -1 wards and very high bed-occupancy in critical and high dependency care (level 3 and 2).
Level -1 wards at Harefield in February 20114 had an occupancy of 124% (I,e, all beds full and very high patient turnover 7 days/week).
Bed occupancy has also been very high in critical care and high dependency wards during recent months, reflecting the high level of activity in the transplant and mechanical assist device programmes, continued demand for cardiac surgery and critical admissions.Operations cancelled twice / cancelled and not then performed within 28 days: In the year to date the Trust has reported four urgent operations cancelled for a second time and seven last minute cancellations of operations for non-clinical reasons where the operation was not then carried out within 28 days. Action plans are in place to prevent similar problems in future
The temporary chairman went through the agenda fairly rapidly, saying he assumed that people had read most of the papers prior to the meeting, and he would take that as read.
He wanted to give the Chief Executive (CE) enough time to explain what has been happening with the regard to the pre-planning application and the issues that had started to arise due to objections from the Royal Marsden and Imperial College. They are objecting strongly to the proposed plans to sell off parts of the estate and have those assets rezoned as residential so as to realise capital to allow other areas to be redeveloped. They want it maintained and used for their purposes.
Mr Bell (CE) sounded quite annoyed that the Marsden had adopted this tone and he felt that much of it was due to a continuing historic hostility to any plans proposed by the Brompton to move forward and provide patients with a better environment, an assumption that Marsden’s needs are more important that anyone elses, and a basic unwillingness by some people to accept that things change, not always necessarily in their favour.
He went to say there was “not a pleasant meeting” recently under the auspices of Kensington and Chelsea Council (K & C) involving planning officers, board members from the Brompton and others from the Marsden and there was not a meeting of minds. Mr Bell commented that they were in for a long and uncomfortable fight to get the plans through despite the hospital taking the best possible advice and K & C’s willingness to engage in the pre-planning process. Watch this space!
There was a slide presentation outlining the changes to information and technology services that will occur over the next five years. The current situation was a complete mish-mash that needed to be cleared away and a new streamlined environment created. There were so many legacy systems in use, so much data to be cleaned and stored and new equipment coming in all the time that strong action was needed to get something like 2,400 PCs updated over the next months.
Some changes had been forced on them by issues such as support being stopped (Windows XP, for example) but they had decided the way to proceed was not to create yet another unique system but buy off the shelf software where possible and adapt.
Much training would be involved but this was a task that had to be undertaken and they had already started in some areas. Any supplier not up to scratch would be dumped and a close eye would be kept on costs and keeping to proposed rollout dates.
There was one “Never” incident at Harefield Hospital in December when a patient died after receiving an air bubble when an arterial airline was flushed. Two other incidents were reported, both referring to pressure sores. There were also two radiation incidents detailed.
The issue of cancelled operations at Harefield was raised. The number increased at year end and explanations offered. The yearly total were down from 270 to 192 but action was needed to prevent such cancellations occurring, mainly caused by lack of a space and emergencies.
There was the usual quarterly financial report. This was a bad quarter, with losses mounting due to the failure of NHS England and CCG to pay monies owed despite being repeatedly pressed. However, there was a payment from Project Diamond. Ironically, the finance director said during a later presentation that NHS England were going to challenge the hospital with regard to their charges under this scheme. In Any Other Business, I commented that this could only happen in the Kafkaesque world of NHS finance. I suggested than NHS England approach a payday loan company to pay their debts before complaining about others! Despite all the above, the hospital had submitted is usual rating to Monitor regarding its solvency.
The Finance Director also demonstrated the new Service Line Reporting methodology, implemented Q2, 2012/13. This breaks down costs into cost centres and allows forensic examination of many areas. He claimed that the data is now 90% accurate. However, when some consultants were confronted with their cost breakdowns, they were less keen to admit how much things cost and some still turned their face against such analysis.
The usual items were presented and accepted and when the chairman asked for questions from the public I raised the issue of parking at Harefield for those who were regular patients or those visiting on a daily basis as requested by Joan. She has now received their formal answer separately.
Then came the most contentious moment of the whole afternoon. A gentleman, claiming to represent 32 local groups and churches, made a statement prior to asking a few questions. He stated that the local residents were extremely opposed to the hospital’s development plans, especially the selling off of D1 classified land (hospital use). He said developers would 'snap it up, build ultra-luxury properties and sell them to foreigners as bolt holes as had happened already.' Locals would be frozen out and they would also lose their local market.
The public consultation was a sham: the last one had just nine people attending. He asked how much money had been spent so far on experts, plans, consultants and PR (currently £8 million over three years projected), this was yet another futile exercise by the hospital (and he listed St Mary’s, White City, mergers here and there) and announced that the whole scheme was already coming off the rails due to opposition from the Marsden and elsewhere. Questions would be asked of the Council and in the House of Commons about this terrible scheme.
Both the chairman and CE were not taken aback by this tirade and insisted they could only discuss issues relating to the running of the hospital at the meeting. Mr Bell disputed much of what the man had said but acknowledged that the hospital was between a rock and hard place: they wanted to develop a 21st century facility and offer patients better and more comfortable care and selling off some assets was the only way the funds could be raised. The property concerned was not Marsden: it was Bromptons, and with the help of the council they would do what they felt was best for everyone, not just the few.
It can be said that it was a rancorous end to the meeting.
11 October 2013
Royal Brompton Hospital has met eight essential quality standards following an unannounced inspection by the Care Quality Commission (CQC) on 13 August. The CQC report also highlights, the excellent feedback provided by staff and patients.
Inspectors, including an expert-by-experience, visited 11 wards and departments at Royal Brompton over two days. They spoke to patients, families or carers and a number of staff, including the chief executive and three non-executive directors of the trust board.
The following standards were checked in all areas visited, which included paediatric and adult outpatients departments:
- Respecting and involving people who use services
- Care and welfare of service users
- Meeting nutritional needs
- Cleanliness and infection control
- Supporting workers
- Assessing and monitoring the quality of service
All of the standards were met.
Comments from patients about their care particularly impressed the CQC inspectors: “’I have been coming to this hospital for 15 years, and I have been to other hospitals in the country, my opinion is this is the best hospital in England’. This patient also said ‘the staff are very knowledgeable about the care I receive, my treatment plan is reviewed daily by the doctors and nurses. I feel very safe in their care’.”
The report states: “Patients we spoke with had had a positive experience of care and treatment at the hospital. They were treated with dignity and respect and were complimentary about staff.”
Positive comments from patients and the inspectors themselves were noted in relation to food, hygiene, privacy, being involved in decision making and having treatments explained.
On the paediatric ward, parents were very satisfied with the way their children were looked after at Royal Brompton: “care and treatment was planned, developed and delivered with their involvement throughout the process. One person said ‘I am involved totally with the treatment my child is receiving’ and another said ‘I am confident that any changes to my child’s treatment are discussed with me. Staff are excellent at communicating information’.”
Essential standards relating to staffing and supporting workers also gained praise in the CQC report: “We found all grades of staff open and friendly and there was strong leadership provided in the wards and departments visited. Staff told us that the management teams were supportive and provided ongoing training.”
Staff interviewed said: “I am proud to work here, I work with a fantastic team", "I love working here, it's hard work but very rewarding" and "I get great support from team colleagues".
Caroline Shuldham, Director of Nursing and Clinical Governance at Royal Brompton & Harefield NHS Foundation Trust, said: “We are very proud of the feedback and comments in this CQC inspection report. We continuously monitor all aspects of care and take action to improve whenever needed. Staff work hard to ensure standards are met at all times so that patients continue to experience the highest quality care. A report such as this is a pleasing reward for our ongoing commitment to excellence.”
Read the full report on the CQC website.
1. Safe and Sustainable Review: This has now been overtaken by a new review. In 12 months time NHS England will have a new reconfiguration scheme on congenital heart disease services for both adults and children - not just for paediatric cardiac surgery, which was the only issue in the Safe and Sustainable Review. This is a long term issue.
2. Chelsea and Westminster / Royal Brompton co-operation proposals: Discussions are being undertaken. Answers are wanted by year-end. There are planning issues regarding re-use of existing C & W buildings. Another meeting is planned in August. Hopes for a successful outcome are not high.
3. Sales of existing property at Royal Brompton to release funding: Two meetings have been held with the local Council. The Borough planners are constructive and have given useful advice. Eventually a minimum of six planning applications will be submitted, at a cost of £200k, to allow the Council to respond to the applications in 2014. Any proceeds from land sales will be ploughed back into Royal Brompton and Harefield Trust.
4. Infections: Two cases of clostridium difficile have been reported in the Trust this year and one case of MRSA bacteraemia. Hillingdon accepted one breach of c.diff as its responsibility. Modern matrons are monitoring actions to prevent infections, including use of new wipes to combat infection. Estates and cleaners are working to improve the cleanliness in the old buildings.
5. Finance: Doing rather better than plan.
6. Harefield Mansion: £500k taken from penalty provision and allocated to repair of the Harefield Mansion. It is a Grade II listed building. Hillingdon Council is involved in discussions with National Trust and English Heritage as a further £250k is needed immediately to preserve and protect the building. A preservation expert is to be called in, but the building needs 2-3 years to dry out. There is a risk of a Council fine if nothing is done.
7: New appointments: The Trust expects to welcome a new IT Director in October. A new consultant has been appointed at Harefield Hospital.