It is with mixed emotions that we present this annual review of 2015-16.
It has certainly been a year that has provided cause to celebrate the great achievements of our staff. This year our teams have cared for nearly 200,000 patients in our outpatient clinics and 40,000 on our wards. They have recruited an impressive 4,400 people into ground- breaking research studies and introduced a number of new treatments for diseases such as chronic bronchitis, heart failure and congenital heart disease.
Our research teams have published extensively: discovering a genetic cause for a heart condition that develops during pregnancy; pioneering a blood test to detect cancer; undertaking innovative gene therapy to replace the faulty gene responsible for cystic fibrosis (CF); using airway valves to treat people with chronic obstructive pulmonary disease (COPD); and leading research on a new comprehensive genetic test to diagnose the most prevalent inherited cardiac conditions (ICCs).
In February, the third international analysis of influential biomedical and health research confirmed the leading role played by our researchers on the global medical research stage. The report showed that experts at the Trust produced more highly cited publications (HCPs) about respiratory and critical care medicine than any other NHS trust in England. In cardiovascular medicine, the proportion of Trust research papers quoted in subsequent studies was joint highest.
The report highlighted our close partnership with Imperial College London, with our two organisations having the most co-authored HCPs compared with all other healthcare and academic partners in England. In July, we were delighted to formally join the Imperial College Academic Health Science Centre – a move that offers significant opportunities to drive innovation and improvements in patient care.
Sir Robert Finch
The past year also brought with it a blow that knocked many of us sideways. The untimely death of our chairman, Sir Robert Finch, over the Easter holiday, was a great shock to everyone at the Trust.
Sir Robert was a great colleague, supporter and friend. His support on a number of demanding issues enabled the Trust’s executives to adopt bold and sometimes controversial strategies. Most noteworthy of these was the action taken to protect our children’s heart services in 2011-2013. Throughout a lengthy and challenging campaign, Sir Robert steadfastly stood by the decision to do everything in our power to ensure that our youngest patients did not have their services decimated. When the Secretary of State for Health announced in June 2013 that the Safe and Sustainable review of children’s heart services was to be withdrawn, it was the end of a distressing two years that had seen patients exposed to a completely unacceptable level of uncertainty about their future care.
It is with a sense of disbelief that we find ourselves in a similar position today.
Congenital heart disease service review
The joint review of adult and children’s congenital heart services that followed the demise of Safe and Sustainable appeared to be taking a more intelligent approach. When the standards were endorsed by the NHS England Board on 23 July 2015, it was on the basis that “major reconfiguration of specialist services, with associated risk and upheaval, can probably be avoided”.
Experts at the Trust produced more highly cited publications about respiratory and critical care medicine than any other NHS trust in England.
But in July this year we learned that, on the basis of not meeting a standard on co-location of children’s facilities, a clinical service caring for 12,500 patients was at risk of being dismantled.
Royal Brompton is the largest UK centre for congenital heart services. As a specialist heart and lung centre, our teams work closely with colleagues at neighbouring Chelsea and Westminster Hospital for consultant opinion on a number of supporting clinical disciplines. Several medical consultant appointments are operated jointly, so that expertise can be readily shared across the two hospitals.
Particularly close links exist across paediatric care. A formal contract (service level agreement) with Chelsea and Westminster has been in place for several years so that expert opinion can be gained across a number of clinical speciality areas, including paediatric general surgery and paediatric gastroenterology, both during and outside normal working hours. The partnership works well and regular audits ensure that the necessary medical opinion is achieved within the agreed timeframes. Our clinicians are confident that our close working partnership with Chelsea and Westminster meets national standards. They would not accept any arrangement that provided anything less than the best possible specialist care for their patients.
As this review goes to press, we have been informed that because the Chelsea and Westminster clinicians are not based within our buildings but have their main base a few minutes away, because their names are not on an office door in Royal Brompton, then the care they give is somehow substandard. There is no evidence for this position; commissioners and regulators acknowledge that there are no concerns about the quality of the Trust’s congenital heart disease services, which remain among the best performing in the country.
No account has been taken of the serious knock-on effects this would have on other world leading specialist services at the hospital, including paediatric intensive care and paediatric respiratory care.
Our patients are our priority, and if this plan was the best option for them, we would not hesitate to support it. Instead, we see no benefit to patients and fear that the proposal will only lead to a worse service and the break-up of internationally renowned care and research teams.
We will fight these irrational proposals as we fought their previous incarnation. It is a source of deep regret that we are forced to take this position, but the 12,500 congenital heart disease patients in our care deserve nothing less. We look forward to securing a successful outcome for them, and for future generations.
Acting chairman Neil Lerner (left) and chief executive Bob Bell