To receive a verbal update on the North Middlesex University Hospital NHS Trust Merger into Royal Free London Group.
Minutes:
· Dr Nnenna Osuji provided the committee with an update on the progress of a potential merger with the Royal Free London, this currently held a planned date of the 1st January 2025. Officers had been working in close partnership with the Royal Free London and had since created an infrastructure which included having a chairman who was the chair of both the Royal Free London and North Middlesex University Hospital, there would also be an accountable officer. There was a full business case for the proposed merger submitted to each board in July. They were approved by both boards and had since been formally submitted to NHS England, this would then go on to the Secretary of State.
· One of the reasons for the merger would be to make improvements for patients. Another reason for this merger would be to have access to greater infrastructure and the ability to widen the hospital’s portfolio. From a Royal Free perspective, this would also allow access to a broader population. There would be an opportunity for staff to move more easily between organisations and that would allow for further career opportunities and fluidity.
· A question raised was whether this merger would help deal with North Middlesex urgent and emergency care demand. Officers explained that not in and of itself, however the work done around this would continue. One of the commitments officers made was that local services would always be provided to local people; this change would never deplete the local provision of care, it would hopefully increase speed of access to specialist care.
Questions :
· North Middlesex research populations did not reflect the demography of the patients served, people who came from black and minority ethnic backgrounds were underrepresented in research trials. By bringing together the infrastructure that the Royal Free offered and the population North Middlesex served, there was hope to try and balance some of the recruitment into trials. Often when people discuss research and development, they refer to therapeutic trials, but there were other types of trials around social research and health behaviors that could also be looked at.
· It was critical to ensure that there would be an equity if a population had differential needs and differential levels of disadvantage. One of the committees brought together before any formal merger had been a Population Health committee between the two organisations. This meant that officers would always maintain a look to understand if they were maintaining equity in terms of access. Whilst a lot of work had been done around staff voice, there was more which needed to be done around patient voice.
· In terms of making sure the hospital had the right staff and did not lose talent, there had been a pattern where people who trained at North Middlesex often remained working in the hospital. There was a clear opportunity for people to look at stretching their careers and this would therefore potentially attract greater talent.
· One of the elements around travel was that officers were not changing the configuration of services as such that patients would need to travel for local services. There was a commitment taken back to the programme board to look at how this could be better communicated. There was not an expectation for staff or patients to necessarily have to travel between sites other than what they would already do to access specialist care. However, this was going to be looked at further to see what additional enabling transport would make this a more positive experience.
· The hospital would not be reconfiguring services en masse, so there would not be a new requirement for most patients to travel. More work needed to be done to understand where transport needed to be strengthened for specific elements. In general, there was not an expectation for there to be a mass movement of people across sites. Officers would reinforce the existing routes of transport to those sites. One of the pieces of feedback regarded the Hampstead site, for example, there was a different element around parking. There was work which needed to be done to look at what the implications would be in select areas.
· As part of the business case, North Middlesex were being held to account on which benefits had been demonstrated to patients. A discussion was had around the creation of a patient lens to hold the hospital to account, this would be an action taken forward.
· Officers acknowledged that patients did not know enough about how best to access transport services or how to check what they might be entitled to. This would be taken forward as a joint action between the committee and the trust.
· Capital was now looked at as a system, the challenge around this was not necessarily about the merger. Each organisation had managed its own capital budget and had its own list of critical infrastructure that needed capital. With the merger, that prioritisation would be looked at as a collective. Things that were statutory from a health and safety point of view would always be at the top of the list. Within the context of a wider system, allocation of capital was one of the areas as part of the merger flagged as needing more attention and could pose as a potential risk and issue.
· Currently, North Middlesex were looking at the year balance deviation and doing some recovery action towards that. The trust was committed to a balanced position and a small surplus as opposed to the position of Royal Free which was a commitment to a deficit position.
· Finance was not the reason for this merger and would not be the basis on which the merger would be managed. The total system finance position would not change as both groups were contributing to it; the combination of contributions will be seen as one.
An action was taken to meet as a subgroup to further discuss details of this merger and to bring the voice of the patient more strongly into the evaluation of success.