This item is to discuss a proposed joint bid for Royal Brompton Hospital by Imperial College Healthcare NHS Trust, and, Chelsea and Westminster Hospital NHS Foundation Trust.
Professor Tim Orchard briefly explained the background to the report, which had considered options at a meeting in September. Proposals had been submitted by Kings Health partners, which proposed to move most of the services from the Royal Brompton Trust (RBH) to a site on the St Thomas hospital campus (part of Guys and St Thomas NHS Foundation Trust). This would be an expensive proposal, involving the transfer of congenital paediatric heart surgery services. Professor Orchard explained that the proposed joint bid (Imperial College Healthcare NHS Trust; and Chelsea and Westminster Hospital NHS Foundation Trust) would provide similar services, without moving them out of the NW London area, building on existing networks, utilising local expertise in both Imperial, and Chelsea and Westminster. High level documents had been produced which set out how these services could be provided more efficiently. The proposal had been submitted to NHS England, which would be meeting next week to discuss the joint bid. Professor Orchard indicated that when they had first approached NHS England, their preferred option had been for services not to be removed from RBH, however, they would aim to work as a collective of providers, to ensure that services remained local. Professor Orchard made the following points:
· An adult cardio-respiratory unit on the Du Cane Road site would be established. There was currently an empty block, available and this had been submitted as part of the proposal to NHS England. An in-patient care facility would also have to be built;
· New cardio service on Chelsea site;
· National heart and lung service would become part of the Hammersmith hospital; and
· Combined paediatric services, to maintain a unified approach.
Professor Orchard considered that this was the beginning of the process and further consideration as to how this would fit in with the options for public consultation, was required. He was hopeful that the first response from NHS England would indicate what proposals could be consulted upon. This would also offer an opportunity to further discuss with other providers.
Councillor Kwon asked if there was capacity at St Thomas’s to accommodate services moving from RBH and the possible impact on their reputation. Professor Orchard explained that there would be a new build and confirmed that there would be capacity at St Thomas’s. He speculated that there would be some reputational impact on RBH services moving to another NHS trust.
Councillor Caleb-Landy asked about the possible timeline for the transfer of services and what the plans were for consulting Hammersmith & Fulham residents about the changes. Professor Orchard confirmed that this was a significant decision and that there would be a special remit for consultation, which was complex. As most of work at RBH was commissioned by NHS England, there needed to be a mechanism for the whole the service to be consulted on. It was critical to get the right input.
In a response to a question from a member of the public, Professor Orchard confirmed that co-operation between Imperial, Chelsea and Westminster and St Thomas’s was good. He clarified that this was not a “takeover bid” and did not think it would impact on the relationship. The link between the trusts was positive and extended to sharing expertise and collaborative work, for example, patient record sharing. Professor Orchard concurred that residents in Kensington and Chelsea were well served by RBH, as a specialist hospital.
A representative from Save Our Hospitals sought further information and clarity about the planned consultation and was concerned that no information had been provided about the new bid by RBH. Professor Orchard said that in terms of the consultation proposals, it was not a simple matter of residents engaging with the consultation process. The responsibility of developing consultation rested with statutory organisations, and not RBH. It was important to consider the breadth of the consultation, so that all views could be collected, and for this to be shared with NHS England and the CCGs.
Councillor Robert Freeman, Chair, Health and Adult Social Care Overview and Scrutiny Committee, from the Royal Borough of Kensington and Chelsea explained that the Committee was the designated scrutiny lead with a statutory remit to report to the Secretary of State as to whether any proposal for variations in services was in the best interests of residents. If RBH services moved to the South Bank, Councillor Freeman was of the view of the that this would mark the eventual end of RBH. It was difficult to see how two trusts could be based on one site. Equally, it was likely that RBH would not survive the transfer of services to Imperial, and Chelsea and Westminster. RBH had strong links with Chelsea and Westminster and worked closely with the Royal Marsden. Many residents and stakeholders had worked hard to support RBH and its closure would be a great blow.
George Doughty, Lead Governor, Council of Governors, RBH, gave an assurance that neither governors or staff had anticipated being in this position. RBH was unique in providing treatment that spanned an individual’s lifetime. In his view, NHS England had tried to undermine RBH for many years and had unfortunately wanted to impose regulations for the operation of neonatal clinical units, which RBH was unable to comply with. Mr Doughty explained that NHS England had determined that the distance between the Chelsea and Westminster site and RBH was too far (although to date, Mr Doughty reported that he was not aware of a single fatality). Pericardial and paediatric respiratory services were delivered well, together but RBH had been forced in November to close the paediatric service.
Mr Doughty was of the view that this was very much an issue of colocation and hoped for a solution. RBH was a centre of excellence that dealt with patients from all over the UK and whose services warranted protection. It was confirmed that the all cardio-respiratory patients would have to be moved from the RBH site by April 2022. It was feasible that the Westminster site might still be under construction and that was unrealistic. Mr Doughty was adamant that the trusts would not merge. The financial drive will be heavily dependent on how RBH was able to fund raise.
Professor Orchard clarified that the Imperial, and Chelsea and Westminster joint bid was a reaction to a proposal which would see services moving out of the locality and stated that he would welcome the opportunity to form a working group to consider other proposals.
Councillor Coleman asked Mr Doughty if he felt fettered by NHS England. Mr Doughty explained that RBH as a site had been in place for 110 years and some buildings were not fit for purpose. He welcomed the possibility of the Trust remaining on the site as RBH was equipped with phenomenal equipment, but the physical structure was inadequate. The conundrum was how to support patients during a refurbishment, while ensuring that they continued to receive the best possible care.
Professor Orchard said he was familiar with the issue and commented that Imperial had considerable experience of providing services out of poor-quality buildings. He explained that he had not had the opportunity to discuss proposals with providers but that this would be helpful. Councillor Coleman suggested that if this was the case, then NHS England should be invited to attend a meeting of either the scrutiny committees or the health and wellbeing boards.
Dr Richard Grocott-Mason, Medical Director, RBH, reported that there had been many conversations with Imperial; and Chelsea and Westminster, in addition to discussions with NHS England, without consensus. He reported that the Imperial / Chelsea and Westminster proposal had not been discussed with RBH, before making it public. Dr Grocott-Mason stated that he would have welcomed the opportunity to attend the Committee’s meeting and present his views on behalf of the Trust. He maintained that inaction was not an option, given the condition of the buildings and existing staff structures. Current services would be even less sustainable, if children’s services were to be removed and suggestions as to how the current impasse could be addressed were welcomed. It was reiterated that the fragmentation of RBH services was unacceptable.
Professor Orchard replied that the proposal from Kings Health had not been made public. He explained that interaction with RBH, had not led him to believe that there was any appetite to discuss the proposals. He did not have a suggestion, but that there was potential to discuss relationships within the sector. Professor Orchard confirmed that he would be happy to meet and undertake discussions as a working group, with the aim of keeping services within the North-West London area. There had never been any intention for the joint proposal to be regarded as a hostile takeover bid.
Councillor Richardson commended providers for managing to retain the facility, which was clearly an indication that providers were keen to put patients first.
ACTION: Imperial and Chelsea and Westminster to provide and update of the progress of the joint bid for RBH services
That the report be noted.