Agenda item

To receive a verbal update on the Royal Free and North Middlesex Hospitals partnership.

Caroline Clark, Group Chief Executive of the Royal Free, and Dr Nnenna Osuji, Chief Executive of the North Middlesex Hospital, reported on the strategic partnership arrangement that had been developed between the two NHS trusts. 

Ms Clark stated that it was important that all providers in north London worked together.  In particular, there needed to be equity between services in the north and south of the area covered by north central London.  The aim of the partnership was to strengthen services and improve access.  In addition, it would allow further consolidation of more specialised services.  Chase Farm hospital had been rebuilt and was now a great facility for all in north central London.  There were also plans expand provision on the site further. 

She reported that it had been found that there were variations in community services in the area and the need to invest in them was greatest in the area around the North Middlesex hospital.  Such investment was likely to assist with the performance of the hospital.   The partnership arrangement could also help staff to work across the health system and area as well as bringing in more resources.

Dr Osuji stated that the two trusts had been working in partnership since 2017.  The relationship had now been formalised though and this has made it easier to respond quickly to challenges.   There was now a Partnership Board and a Memorandum of Understanding.  The North Middlesex hospital served the vast majority of the population of Enfield and Haringey.  There was a need to ensure that there was equity and parity in service provision and the closer arrangements would enable further consideration of inequality, including scrutiny of relevant data.  Consideration was being given to bringing the population health committees from each trust together. 

It was intended that the closer arrangements would increase the sum of the individual efforts of each NHS trust.  It would also provide specific opportunities for development.  The North Middlesex Hospital was a local hospital for local people and would always provide a range of core services, such as ITU, emergency care and maternity services.  There were some more specialised services that the trust was less able to provide and the new arrangements would assist in making them more accessible. 

She reported that during the Omicron upsurge in Covid cases, additional beds had been put in place quickly on the Chase Farm site and Cape Town ward had been established. The new arrangements had enabled this to be undertaken quickly.  There was a need to level up services in Enfield and Haringey and additional funds had been acquired to expand the community mentoring scheme.   The Emergency Department at the North Middlesex dealt with challenging numbers of presentations but less than 10% of those attending needed to be admitted and most could be dealt with better in other settings. Work had taken place with primary care to provide access at the hospital and different models were currently being looked at for longer term provision.

In answer to a question on risks, Dr Osuji stated that it was essential that there was honesty and explicitness regarding challenges.  It was not the first time that there had been a partnership with the Royal Free and it was important that there was clear messaging regarding its benefits.  It was a partnership of equals with each partner contributing.   Ms Clark stated that they wanted to be open and transparent.  The objective was to ensure that there was a better offer for all patients.  

In answer to another question, Dr Osuji stated that the new arrangements provided the opportunity to create different job opportunities, including progression, diversification and new posts.  Both trusts were currently holding vacancies.  There was a particular need for investment in community services. 

Sarah Mansuralli, Executive Director for Strategic Commissioning at NCL Partners, reported that there had been a review of community services and this had revealed a large amount of inequity and this manifested itself in hospital performance.  NCL Partners were looking to invest, particularly in the area around the North Middlesex Hospital, which was where there were the most significant gaps.  This would be resourced by growth funding, delivering care in different ways and productivity gains. 

In answer to a question, Ms Clarke stated that Chase Farm was being developed as the elective orthopaedic centre for the area, with the intention of it providing more low complex procedures.  The increased levels of activity would improve quality and provide economies of scale.  There were now 120,000 people awaiting treatment and there was a clear need for additional capacity to address it.  In addition, there also needed to be the staffing resources required to reduce it. 

Dr Osuji stated that transport was an important issue for the North Middlesex hospital and discussions were planned with Transport for London.   In addition to making it easier to travel between sites, this could also help to address the green agenda.  She would be happy to come back to the JHOSC to report further on this. 

In answer to a question, Ms Clarke stated that the development of Chase Farm had been designed with the recognition that it may have to be expanded further in due course.  It would therefore be relatively easy to develop further the existing buildings on the site.

RESOLVED:

1.    The trust report further to a future meeting of the JHOSC on the action that they were taking to address staff recruitment and retention and mitigate any areas of shortage; and

2.    That health scrutiny overview and scrutiny committees in each borough be recommended to consider the role of their borough in the development of community services in their area.