Annual Review 2020-21 - A lifetime of specialist care - Royal Brompton Hospital
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RBH annual review 2021-FINAL.qxp_Layout 1 06/08/2021 12:57 Page 1
A lifetime of specialist care
Annual Review
2020-21
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Contents
Introduction from the chair and chief executive 4
About us 6
Our vision and values 7
Bob Bell retires after 16 years leading the Trust 8
Rising to the challenge of COVID-19: the first wave 10
The continuing challenge of COVID-19: the second wave 24
Our profile in the media 36
New imaging centre progresses well 38
Research highlights 40
Pulmonary rehabilitation team celebrates national first 42
Royal Brompton Hospital ranked in world’s top 10 hospitals 43
Listening to our patients 44
The healing arts 46
Our charities 48
Governance 50
Royal Brompton & Harefield NHS Foundation Trust accounts 52
This review covers the period 1 April 2020 to 1 February 2021, at which point Royal Brompton and Harefield hospitals
became part of Guy’s and St Thomas’ NHS Foundation Trust.
Other formats
If you would like a copy of this report in another format, please contact the communications team at
editorial@rbht.nhs.uk or on 0330 12 88671.
editorial@rbht.nhs.uk, 0330 12 88671
Bu raporun Turkçe kopyası için lutfen komunikasyon bölumundeki communications team ’la görusun.
editorial@rbht.nhs.uk, 0330 12 88671.
If you would like a copy of this report in large print, please contact the
communications team at editorial@rbht.nhs.uk or on 0330 12 88671.
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Introduction from the
chair and chief executive
It is hard to find the right words to The first phase of the pandemic saw immediately stepped in to support the
chronicle the extraordinary our organisation cope with care of COVID-19 adult patients in our
circumstances that emerged in the unprecedented levels of activity, in intensive care units.
period covered by this report. extremely challenging circumstances.
The response from our staff to these
At the start of 2020, nobody predicted As part of a London-wide and national unprecedented circumstances was
the chain of events that was about to response, both our hospitals nearly exceptional. We remain deeply proud
unfold across the globe. On tripled their critical care capacity to of the way our teams responded to
5 January, the World Health accommodate just under 100 such an immensely difficult situation,
Organization (WHO) announced that ventilated patients. This required putting patients before themselves,
44 patients with ‘pneumonia of enormous flexibility and commitment working long hours in unfamiliar
unknown etiology’ had been reported on the part of all our teams, many of environments, and supporting each
by the national authorities in China. It whom took on new and challenging other in ways that had never been
is fascinating to reflect on those early roles to enable us to meet the demand seen, or needed, before. They
days. To quote from the WHO news for expert critical care, re-skilling in a achieved things that were truly
release: “Based on the preliminary matter of days. As one of only five remarkable, while at the same time
information from the Chinese adult centres for ECMO (an advanced furthering knowledge about, and
investigation team, no evidence of form of life support) in England, at one understanding of, COVID-19, on a
significant human-to-human stage in mid-April Royal Brompton national and international stage.
transmission and no healthcare supported 26 COVID-19 patients, with
worker infections have been our Trust’s cumulative ECMO caseload In addition to its role treating
reported.” being one of the highest in Europe. COVID-19 patients, Harefield was
designated one of two centres in
Of course, we now know just how At the request of NHS England, we London to maintain essential cardiac
destructive this new virus would be, consolidated our specialist paediatric surgery. Cardiac specialists from both
devastating whole countries and heart and lung patients at children’s our hospitals, and colleagues from
taking the lives of over two million hospitals elsewhere in London, and Guy’s and St Thomas’ NHS Foundation
people by the end of January 2021. our paediatric intensive care teams Trust and Imperial College Healthcare
our adult eCmo teams saw unprecedented numbers of patients
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NHS Trust, worked closely together to be included in many messages of of a larger Trust and its associated
with pooled waiting lists. A daily gratitude and thanks. By Christmas security, while also retaining the
cardiac clinical hub meeting ensured 2020 there were 100 families whose identity of our two famous hospitals.
all patients were appropriately triaged loved ones have been returned to Being part of an integrated hospital
according to their clinical need. them thanks to the skill and dedication system will provide immense benefits;
of our expert teams. One hundred together we will be stronger.
At Royal Brompton, clinical teams lives saved, and husbands, wives,
continued to care for heart and lung daughters, sons, grandparents and Healthcare will undergo radical
patients who needed emergency grandchildren given back a future transformation over the next 10 years
treatment throughout the pandemic, that they feared had been taken and as healthcare providers we need
but the higher number of COVID-19 away forever. to respond. From our earliest
patients being cared for meant that discussions with Guy’s and St Thomas’
most cardiac activity was diverted to Merging with Guy’s and St Thomas’ we realised we had the chance to
Harefield. Our cancer programme was create something new and dynamic
delivered by the west London Cancer Colleagues at Guy’s and St Thomas’ with colleagues who shared our values
Alliance, hosted by Royal Marsden. were a source of support on many and our appetite for innovation and
Harefield’s transplant programme levels during the first phase of the transformation, which is vital if we are
continued throughout. pandemic, as we were for them. Many to break new ground in heart and lung
relationships were strengthened and disease treatment and research and
Saying thank you to our dedicated as we assessed new and better ways in turn, transform patient care.
teams for their hard work, of delivering our services, it became
commitment and flexibility during clearer than ever that the collaboration This is a genuine milestone for the
such a challenging time has felt between our two trusts would provide NHS. Our merged organisation will put
completely inadequate. When we significant opportunities to excel in the UK’s heart and lung care and
reflect on what our Trust patient care. research at the forefront of global
accomplished, each and every person efforts to combat these two debilitating
that contributed should be We were delighted when both the diseases, which still account for many
tremendously proud. Their Board and Council of Governors had millions of deaths each year.
determination to provide the very best the foresight and ambition to approve
patient care, whatever the our application to merge with Guy’s Patients will now be part of a dynamic
circumstances, has been inspirational and St Thomas’ Foundation Trust in and innovative network giving direct
and their resilience in the face of some late 2020. access to a wide range of medical
very real challenges, extraordinary. expertise, from primary care right
When we began our discussions with through to specialist care for rare
The real thanks, of course, comes Guy’s and St Thomas’ in 2016, we conditions. We will continue to work
from our patients and their families, recognised that there was a real closely with them as we take forward
and we have been fortunate enough opportunity to benefit from the scale our plans.
Sally morgan Bob Bell
Baroness morgan of Huyton Chief executive
Chair
31 January 2021 31 January 2021
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About us
Royal Brompton & Harefield NHS Foundation Trust is
the largest specialist heart and lung centre in the UK
and one of the largest in Europe.
The Trust is a partnership of two are unique in their medical needs, and
hospitals – Royal Brompton in demand for our services continues to
Chelsea, West London, and Harefield, grow year-on-year.
near Uxbridge – which are each
known throughout the world for their Our fetal cardiologists can perform
expertise, standard of care, and scans at just 12 weeks, when a baby’s
influential research. heart valve is just over a millimetre in
”
size, and our clinical teams regularly By recruiting the best
As a specialist trust, we only provide treat patients well into their 90s and
clinical and
treatment for people with heart and help them maintain a good quality
lung conditions. This means our of life. non-clinical staff
doctors, nurses and other healthcare and investing in their
staff are experts in their chosen field, By recruiting the best clinical and development, we
with many of them moving to us from non-clinical staff and investing in their
around the globe so that they can development, we maintain our maintain our position
develop their skills even further. position as the leading UK provider of as the leading uK
respiratory care and a national leader provider of respiratory
We carry out some of the most in the specialist areas of paediatric
complex surgery and offer some of cardiorespiratory care, congenital care and a national
the most sophisticated treatment that heart disease and cystic fibrosis. leader in the specialist
is available anywhere in the world. areas of paediatric
We work closely with academic and
Over the years our experts have been industry partners to play a leading role
cardiorespiratory care,
responsible for major medical in pushing forward the boundaries of congenital heart
breakthroughs including performing medicine through research, and by disease and cystic
the first successful heart/lung sharing what we know through
fibrosis.
transplant in Britain, implanting the first teaching, we can help patients
coronary stent, founding the largest everywhere.
centre for cystic fibrosis in the UK, and
pioneering intricate heart surgery for Our values (page 7) guide and support
newborn infants. every decision we make to ensure our
care is safe, of the highest quality and
We treat patients from all over the UK – crucially – available to everyone who
and other countries, many of whom needs it.
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Our vision and values
Our vision is to be the UK’s leading specialist centre for heart and lung disease,
developing services through research and clinical practice to improve the health
of people across the world.
The Trust will achieve this vision by:
improving patient safety and satisfaction
providing world class specialist treatments that others
cannot offer
bringing innovation to clinical practice through our
research partnerships
attracting, developing and retaining world class clinical
leaders
investing in services, technologies and facilities to
support new service models at both sites.
We are supported in this by active patient and community
groups that enthusiastically encourage and challenge us
to deliver our goals.
Our values
At the heart of any organisation are its values: belief
systems that are reflected in thought and behaviour.
When values are successfully integrated throughout an
organisation, the result is a shared outlook and
consequent strength, from performance through the
style of communications to the behaviour of employees.
Our values were developed by staff for staff. We have
three core patient-facing values and four others
which support them.
And the following values support us in
achieving them:
Our three core values are:
We believe in our staff
We care We believe our staff should feel valued and proud of their
We believe our patients deserve the best possible work and know that we will attract and keep the best people
specialist treatment for their heart and lung condition in a by understanding and supporting them.
clean, safe place.
We are responsible
We respect We believe in being open about where our money goes,
We believe that patients should be treated with respect, and in making our hospitals environmentally sustainable.
dignity and courtesy, and that they should be well
informed and involved in decisions about their care. We We discover
always have time to listen. We believe it is our duty to find and develop new
treatments for heart and lung disease, both for today’s
We are inclusive patients and for future generations.
We believe in making sure our specialist services can be
used by everyone who needs them, and we will act on We share our knowledge
any comments and suggestions which can help us We believe in sharing what we know through teaching, so
improve the care we offer. that what we learn can help patients everywhere.
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Bob Bell retires after
16 years leading the Trust
In early 2021, after 16 years as chief executive, Bob Bell announced his
retirement.
Responding to the announcement, unnecessary bureaucracy and red tape
Trust chair, Baroness Morgan of are well known, yet he resolutely
Huyton (Sally Morgan), described follows due process and procedure
the contribution Bob made during when appropriate.
his tenure:
“His unswerving loyalty to staff and to
“It is no mean feat trying to the patients under our care has a place
encapsulate Bob’s significant in NHS folklore. In 2011 he went to the
achievements but I do not want to let High Court to protect the Trust, when
this opportunity pass without putting others would have taken a much less
on the record my immense debt of controversial and easier option. In
gratitude to him for his leadership 2017 he marched alongside many of
during my own tenure. us through the streets of Chelsea
when further threats were on the
“To be an effective chief executive horizon. But his resolve to protect the
there are a number of qualities that are Trust at all costs began years before Chief executive Bob Bell
essential, some that are desirable and this. In 2005, soon after he arrived and
others that take a candidate from following the cancellation of the
good to exceptional. To have a chief Paddington Health Campus project,
executive who demonstrates all these Bob ensured a plan by the Strategic combine the specialist
qualities is rare indeed – yet that is Health Authority to close Harefield cardio-respiratory expertise of two
what I found when I joined the Trust Hospital never saw the light of day. of the country’s most respected and
in 2017. successful Trusts, in a partnership that
“It is fitting that as Bob begins the final will create unrivalled opportunities to
“Bob is resilient, committed, driven, chapter of his leadership, he has improve patient care, enhance
strong, determined, astute and ensured that an exciting and secure research and innovation programmes
visionary. But he is also kind and future awaits all of us as we plan to and develop outstanding training and
compassionate; unable to tolerate join Guy’s and St Thomas’ NHS career possibilities, will in many ways
inequality or unfairness. His views on Foundation Trust. Our vision to be his legacy.”
Bob meets members of the trust's physiotherapy team Bob presents the annual staff
champion awards
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Bob, second from left, greets HRH prince Charles when he visited the trust
In his farewell letter to staff, and time again, words seem “The advantages of moving forward
Bob said: inadequate. Courage, commitment, with a partner of choice, with shared
compassion, resilience, determination values and vision, are immense.
“My 16 years leading the Trust have and strength, are as close as I can get. Creating a new academic model by
been fascinating, infuriating, building on our strong relationship
enjoyable, challenging and without “One of our greatest strengths has with Imperial College, developing new
doubt, the most rewarding of my always been our ability to provide a collaborations with King’s College,
49-year career. I am deeply proud of very personal approach to care. and investigating other strategic
all the things we have achieved Patients often comment on the alliances, will support our mission to
together at Royal Brompton, Harefield ‘family’ feel of our hospitals and thank deliver cutting-edge, specialist
and Wimpole Street. us for treating them as individuals. services to patients now and in
I like to think that we adopt the same the future.
“When planning my retirement, I could approach with each other, and the
never have predicted that it would support I have received over the years “The foundation trust may disappear
take place in the midst of a global is testament to this. on 1 February, but I leave Royal
pandemic. And while my respect and Brompton and Harefield hospitals,
admiration for you, our talented “It was never going to be easy to step each with a reputation that spans the
workforce, was always high, the way back from my role; I am one of those globe, stronger and more sustainable
you have responded to a series of fortunate people who genuinely loves than when I arrived in 2004. The
immensely challenging situations over his job. But to be moving on at a time expertise and knowledge that sits
the past year has been exceptional. I when the Trust is moving up, makes it within our organisation is unique, our
am not a person who normally easier to relinquish my responsibilities. combined skills are a force to be
struggles for words, but when reckoned with.
considering the immense obstacles “Our merger with Guy’s and St
you have overcome, the focus with Thomas’ creates an unparalleled “Thank you for giving me 16 of the
which you have put patients first, time opportunity on the NHS landscape. most memorable years of my life.”
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Rising to the challenge
of COVID-19
The first wave
As specialist heart and lung centre, teams at the Trust were at the forefront of the
national response to COVID-19. During the course of the pandemic, we treated and
saved the lives of hundreds of critically ill patients – with most of them transferred to
us from intensive care units across London and Southern England.
When the pandemic began, we were many of our staff took on new and our dedicated staff were overwhelmed
called upon to triple our critical care challenging roles, and our teams used by the support they received from our
capacity to accommodate just under their exceptional abilities to introduce charities, external organisations,
100 ventilated patients in a matter of new innovations and ways of volunteers, celebrities and even royalty.
days. As one of only five adult working to help us meet the demand their acts of kindness helped us get
extracorporeal membrane for services. through the pandemic.
oxygenation (ECMO) centres in
England, we supported up to 28 teams at Harefield also played a major the insights from our research projects
patients on ECMO (a form of life role in maintaining essential cardiac (see page 41), the swift introduction of
support) at any one time, making our services in london, as one of only two CoVId-19 testing and, more recently,
Trust’s caseload among the highest designated emergency cardiac surgical the vaccination programme, give us
in Europe. centres in the capital. hope for the future.
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Coronavirus
I always describe the situation in the first wave as being like the
beginning of a disaster movie when the principal actor is
timeline
wandering around knowing that something bad is happening 2020
while everyone else around them is just carrying on as usual.
After a new coronavirus emerged in
We were planning for the pandemic in February 2020, but I Wuhan, China, the UK detected its
remember walking in the King’s Road near the Royal Brompton first cases in late January. As the
virus spread internationally, Italy
just thinking everyone is just carrying on as normal, experienced the first European
no-one knows what’s coming.” surge in February.
MARCH 2020
Lorraine Campbell
Lead nurse and associate hospital director 4 March
Cases of COVID-19 increase in the
UK, with officials announcing the
biggest one-day increase so far of
34 cases bringing the total to 87.
Taking on new 12 March
Staff are asked to test technology
which will enable them to work
responsibilities to fight from home if needed.
13 March
COVID-19 Visiting is limited to one essential
visitor per patient following
guidance from NHS England to help
prevent the spread of the virus. Our
Caring for patients with COVID-19 was a challenge unlike any restaurants, coffee shops, retail
other of recent times. To look after more critically ill patients, our shops and other facilities are
“temporarily closed” to members of
hospitals were reconfigured in a matter of weeks and staff asked the public.
to embrace new ways of working.
Many patients who are due to visit
our hospitals for outpatient
Stepping up to care for needed, but the team took learning appointments are offered telephone
COVID-19 patients new skills in their stride. Everyone consultations instead.
stepped up and moved seamlessly to
Transformative and innovative change provide this new level of critical care. I Staff are asked not to travel
internationally and almost all
was acutely evident on Elizabeth ward am in awe of all of them, and very
recruitment to clinical research
at Royal Brompton where nurses proud to be part of this team.” studies at both sites is postponed –
learned vital new skills so they could with just a few exemptions.
look after patients with COVID-19 who Moving from caring for child to
needed advanced intensive care. adult patients 16 March
Prime Minister Boris Johnson delivers
Previously a high dependency unit Royal Brompton’s paediatric intensive the first of many daily news
conferences urging everybody in the
providing specialist care for adults with care unit (PICU) transitioned from a
UK to work from home and avoid
different medical and surgical paediatric to an adult intensive care pubs and restaurants to help prevent
conditions, the ward became an unit (AICU), with most child patients the spread of COVID-19, to give the
intensive care unit looking after 26 transferred to other hospitals. NHS time to cope with the pandemic.
COVID-19 ventilated patients.
To prepare for the transition, PICU 17 March
The nursing team, led by senior sister became an “education machine” says The first patient with COVID-19 is
admitted to Royal Brompton
Denise Breen, ensured the right senior nurse and service manager in Hospital.
equipment was in place and paediatrics, Lizzie Biggart, with the
undertook intense training sessions to entire team quickly learning many new
ensure everyone had the necessary skills, including how to operate
skills and knowledge to look after equipment and administer medication
patients requiring such complex care. to adult patients in a completely
Continued
Denise said: “It was a huge challenge different environment.
overleaf
to ensure that patients on ventilators
had the advanced level of care they Continued overleaf 4
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Taking on new responsibilities to fight
COVID-19 (continued)
Lizzie said: “Everything was different Transforming Harefield’s cardiac the IT team implemented new
for our PICU team. Few of the care unit systems for the clinical teams
paediatric nurses had ever looked after and many other staff across the
adults and they had to contend with The Adult Cardiac Care Unit (ACCU) at hospital stepped up to deliver what
entirely new parameters of care – Harefield Hospital, which includes two was needed.”
which they did absolutely brilliantly. wards and is normally home to
patients with heart failure or those Matron Mandy Brown, who leads the
“Our nurses are proud they are PICU recovering from heart procedures, nursing team on ACCU, added: “Our
nurses. They are taught to question, was transformed into a facility to care nurses had to learn lots of new skills,
enquire and learn in order to provide for patients with COVID-19. use different systems and work with
excellent, exquisite care for patients different clinicians. Each and every
who sometimes weigh less than one Peter Doyle, divisional lead nurse and one of them went far above and
kilo. To be asked to look after very sick associate general manager at beyond their usual roles and we are
adult COVID-19 patients in a completely Harefield, said: “To turn this around in immensely proud of them.”
different environment was a massive just a few weeks was phenomenal.
ask, but one which they accepted with Everyone came together so well – the Healthcare assistants
their usual professionalism, courage estates team built new partitions and
and commitment.” installed sinks to keep the areas safe, Healthcare assistants (HCAs) across
the Trust upskilled to help colleagues
put on and take off personal
protective equipment (PPE) – so-
called donning and doffing.
Putting on and taking off PPE
correctly is a critical process that
requires training and involves
significant care. Properly fitted PPE
protects staff from catching
COVID-19. Careful removal and
disposal of PPE that has been exposed
to COVID-19 is particularly important
to prevent transmission of the disease.
In areas where the highest level of
PPE was required, hundreds of staff
had to don and doff gowns, masks,
gloves and face shields every day –
sometimes more than once.
The HCAs worked long hours to make
sure that colleagues would always
have someone available to help them
get carefully in and out of their PPE.
Aude Taittinger, practice educator for
HCAs, said: “The HCAs worked
tirelessly on the donning and doffing
stations, playing a crucial role in the
COVID-19 operation at the Trust. They
all exhibited such fantastic team spirit
and kept smiling all the way through.
Their positivity, resilience and
adaptability has been a real asset for
us in these challenging times and
we are all so proud to be supported
by them.”
putting on and taking off ppe correctly is a critical process that requires training
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FROM THE FRONTLINE
19 March
Access to hospital sites is limited.
Laura Davis, clinical nurse specialist, redeployed This is monitored carefully by
security staff.
to intensive care
20 March
Clinical nurse specialist in familial Cafés, pubs, bars and restaurants in
hypercholesterolaemia, Laura England are told to close tonight.
Schools also close their doors
Davis, was redeployed to the
except for children of key workers or
intensive therapy unit (ITU) at those who are deemed vulnerable.
Harefield during the pandemic.
She shares her story about what it A programme begins to provide all
was like working in full personal staff with hot meals and sandwiches
protective equipment (PPE). free of charge while they are
working on-site. Several companies
offer discounts on food and drink to
“Before the COVID-19 pandemic, I NHS staff.
had worn PPE but the donning and
doffing procedure was a new term 23 March
for me. We had to be trained on The first UK lockdown is announced
exactly how to do it and be very by the Prime Minister on national
precise about the order everything television who says: “From this
evening I must give the British
went on. I started to worry that I’d
people a very simple instruction –
get it wrong and endanger my you must stay at home.”
colleagues and patients. Then,
shortly after the training, it felt like Following guidance from NHS
the pandemic suddenly landed in England, Royal Brompton’s
our laps and we were sent for our paediatric intensive care unit
first shift in ITU the next week. prepares to start caring for adults.
Our paediatric team works with
colleagues at Evelina London and
“I was so nervous before that first Great Ormond Street Hospital so the
shift, I didn’t know what to expect. necessary support for specialist
How sick would patients be? What children’s referrals is available.
would be expected of me? I hadn’t
been in ITU for a long time. I able to recognise anyone. But the 24 March
remember thinking, ‘How am I Over 300 clinical staff have now
hardest part was the effect the long undertaken specialist training on
going to work in PPE? Even just shifts had on my family, having to how to safely manage patients with
breathing is difficult,’ and working in tell my kids that I wouldn’t see COVID-19.
ITU is a physically intense job. You them until the next day was tough
have to turn patients (known as when they were not used to that. 26 March
proning), move and change National lockdown measures legally
equipment constantly. come into force in England and
“The biggest respect goes to those
Clap for our Carers starts.
in ITU full-time, I was lucky,
“Then there were simple although redeployed and having to Tighter visiting restrictions are
practicalities that made everything adjust, I am part-time and dealing introduced at the Trust. Visitors are
more difficult. You couldn’t see with the PPE on part-time hours now only allowed in exceptional
properly through the visors and I was more than enough. There was circumstances.
don’t think I realised how much I a certain camaraderie among staff
rely on lip-reading to understand Work to reconfigure services across
though, everyone seemed grateful
the Trust is on-going. This includes
people in normal everyday life. So that we were there to help, even if moving Fulham Road inpatient
speaking with colleagues and you didn’t know everyone or services and staff to the Sydney Street
patients was hard. I had to focus on recognise them from one day to site at Royal Brompton Hospital.
one task at a time, ‘If I can get the next with PPE on. Shifts where
through this next task then I’ll be a you just didn’t know anyone else All staff annual leave is cancelled
bit closer to taking the PPE off,’ and were hard. for April.
I would always look forward to
getting the mask off for good at the “It feels strange to think back on it, I
end of the day. almost can’t explain it.
“Little irritations become big “Even after I went back to my
irritations in PPE, wanting to scratch normal role, I’d think about the Continued
your face, getting hot, not being patients that I’d left behind in ITU.” overleaf
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FROM THE FRONTLINE
Beccy Lytton, paediatric intensive care matron, redeployed to adult
intensive care
Beccy Lytton, Royal Brompton
deputy matron on the paediatric
intensive care unit (PICU), was
redeployed to the adult intensive
care unit (AICU) during the
pandemic. She shares what it was
like treating adults after 23 years of
being a paediatric nurse.
“I’ve worn personal protective
equipment (PPE) before, but there
was definitely a heightened sense of
anxiety about putting on PPE for
COVID-19. The first time I put it on
for a shift I was terrified. I could hear
every breath I took, as the masks
originally had a valve that would click
as air went in and out. This was
equally reassuring and terrifying – to
know that it was working, but
whenever you couldn’t hear it you’d
worry it was broken. The weight, both Beccy, pictured above right, working in her role as a deputy matron
in paediatric intensive care
literally and metaphorically, of the
PPE was overwhelming. It felt like a whatever I could to make it easier for “But it was intimidating going to
costume, I had to put my face mask them; to make them feel safe. But other departments where at first you
on as well as my metaphorical nurse the whole time I feared that I didn’t didn’t know anyone or any of the
mask and act brave while I treated have the answers, none of us did. processes in place. I was totally out
patients as best I could. of my comfort zone.
“When you eventually take PPE off
“Opening the doors to the Covid after a shift, no matter how hot the “There was joy to be found though,
ward was like walking through the weather is, you feel freezing. I really such as meeting new colleagues.
doors to another world, it was so appreciated the staff who helped take Sometimes I pass them now in a
surreal to see an entire ward dressed off our PPE (doffing) though, they corridor and I can tell they recognise
in PPE. Not that you could see much, would give us such a morale boost, I me but without the PPE they aren’t
the masks and hoods muffle all your hope they know how much they quite sure who I am!
senses – your vision becomes blurred helped build people up after difficult
and your hearing is distorted. You feel shifts. But immediately after you were “Communicating with the few
entirely disconnected from reality, like out of ICU, the anxiety would start patients who were well enough to
you’re in a bubble. back up, knowing you had to go back be awake was also frustrating in PPE.
eventually. I have scars on my face One patient spent an entire shift
“Once the novelty wore off, I came to from the PPE that won’t heal. trying to tell me something, but with
hate it. The donning stations (where a tracheostomy (a tube inserted into
you were helped to put the PPE on) “When we were first told that we the windpipe to help patients
felt like a production line. It almost might be redeployed my initial breathe), even understanding one of
felt de-humanising, I’d lose all identity reaction was ‘I don’t want to do it’. I his sentences was hard. When I did
and just be given a role, such as just couldn’t imagine how to do that finally understand what he was trying
runner or staff nurse. job, treating adults is much more to tell me, I was overcome with
physical than caring for children and emotion. He gave me a smile and a
“During shifts I’d be sweating and babies. But I knew I had to step up. thumbs-up. It just felt so great to
stressing that I couldn’t get out or Once I came to terms with it a sense finally have a positive interaction
even take a breath of fresh air. But I of peace settled. The first shift in full with a patient.
knew that I couldn’t show any PPE almost felt like a rite of passage, I
weakness as I was in a position of was proud to be helping my AICU “Looking back, I am so proud – both
responsibility, so I felt a huge sense of colleagues. I learned a lot from them, personally and for the whole of my
pressure to be a role model to the they are so slick and professional. It team who were exhausted but got
rest of my team. I wanted to do was inspiring. through it. Everyone was amazing.”
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FROM THE FRONTLINE
26 March (continued)
Trust chief executive Bob Bell
Louise Croft, Macmillan lung nurse specialist, announces that Harefield, along with
St Bartholomew's Hospital, will
redeployed to help look after COVID-19 patients become responsible for London’s
emergency cardiac surgery, should
“My entire face would be sore to do this over a screen was so other cardiac surgery units in
every day because of the PPE – hard, hearing families sobbing, so London become unable to provide
nothing felt comfortable. I’d be desperate to comfort their relatives their usual services.
counting down the hours till each was just heartbreaking. You so
He says the Trust is also increasing
shift was over. desperately wanted to comfort
the availability of critical care beds
them but nothing we could say to around 80 ventilated beds at
“Wearing PPE was hard, but I always could make it any better. each hospital.
thought that it must be hard for
patients too – waking up in that “I hated not being able to speak to The Trust is asked to identify staff
environment with people dressed patients’ families and relatives face- who will temporarily be ‘seconded’
like that, not being able to see their to-face. We would try using video to the NHS Nightingale Hospital at
the Excel Centre to help deal with
faces or hear them properly. And calls so they could see their loved the expected surge in demand for
then not seeing anyone without ones in ITU, but then they would ventilated critical care beds in
PPE on until they left the hospital. It get upset. How was I supposed to London.
must have been disturbing. comfort someone over a video call,
especially with a mask on? A range of support tools, processes
“The nurses that have never worked and training are put in place to ensure
outpatients’ telephone appointments
in ITU before did such a fantastic “I’d also be worrying about my
can run smoothly, including
job, it was a challenging time for normal job. I’d go and see my reconfiguring online technology
everyone so to come to such a manager during breaks to see if (MedChart) to allow our clinicians to
busy and unfamiliar environment everything was okay. I could never prescribe medication remotely.
during such a difficult time must switch off, I’d always been thinking
have been very hard. As an about what needed to be done for Staff are offered free access to NHS
experienced ITU nurse who had both jobs. And, of course, we digital wellbeing services.
also been redeployed it was were all scared about catching
27 March
important to me to help support Covid ourselves. The Prime Minister tests positive for
these nurses. coronavirus.
“The pandemic became all too real
“Not having any visitors in ITU was when we had a couple of nurses 28 March
really strange. I can only begin to from another hospital in ITU with The number of seriously ill
imagine how hard it was for the Covid. They worked together and COVID-19 patients being cared for at
the Trust has risen to 41 at Royal
families. The video calls that we all I could think was, ‘That could Brompton and 10 at Harefield.
were able to facilitate were great have been me or my colleagues.’
but not without their challenges. We didn’t know if they would 30 March
Communicating face-to-face in survive, so many didn’t, but I was so COVID-19 testing for Trust NHS
PPE was difficult enough but trying relieved to find out that they did.” frontline staff is offered at Wembley.
APRIL 2020
louise Croft, left, pictured with colleague laura davis
1 April
Royal Brompton & Harefield
Hospital’s Charity launches a
COVID-19 Emergency Appeal to
raise money for the Trust’s fight
against coronavirus.
5 April
The Prime Minister is admitted to
hospital with coronavirus. He leaves
hospital a week later.
Continued
overleaf
Photo courtesy of Jack Hill for The Sunday Times
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| CoVId-19 – tHe fIRSt WaVe
Staff volunteers step in to help run new
family liaison service
The sudden rise in COVID-19 patients
being transferred from other
hospitals for specialist treatment
prompted a flood of phone calls from
relatives, desperate for news about
their loved ones.
Calls were initially routed through to
critical care wards, putting huge
pressure on frontline staff, and it
became clear early on that additional
support was needed.
Experts from the rehabilitation and
therapies teams quickly organised a
family liaison service to provide the
support needed.
Lauren Berry, associate director patient
services, explained: “We had to close
our hospitals to visiting to protect our
patients and staff from increased risk
of infection, which put considerable
pressure on relatives at an already
stressful time.
“Not being able to see a very sick
relative or have a good understanding
of the illness and the current care in Rosa osborne, palliative care co-ordinator, with some of the knitted hearts and teddies sent by
place is very difficult. This was resulting volunteers in the community and shared with patients and their relatives
in a high volume of calls, which was
adding to the pressure on our staff.”
information about the intensive care therapies, said: “Working as part of the
The service was co-ordinated by the their relatives were receiving. service was a very rewarding and
supportive and palliative care team positive experience all round. As a
together with their lead nurse, Rosa Osbourne, the palliative care remote worker I felt I was really able to
Mary Williams, and outpatient sister co-ordinator, monitored messages and help support my colleagues and to
Claire Denney. photographs sent by families to a give family members much more time
dedicated email address. These were to talk and process what was
A call for volunteers resulted in 39 then printed, laminated and taken to happening to their loved-ones.
staff members supporting the service bedsides. To help people feel more
– all were contributing support within connected, a matching pair of knitted “On many occasions, my phone calls
their current roles, and on days off hearts was offered with one put beside to families were answered with
and weekends. They included a range each patient and the other sent to the statements such as ‘I have been
of nurses, allied health professionals family. Knitted teddies were sent to looking forward to your call’. I was
such as physiotherapists and children. also asked if I could just explain things
speech and language therapists, such as what ‘inflammatory markers’
and chaplains. Service volunteers were also able to were because relatives didn’t want to
refer families who needed additional ask the doctors as they knew they
Members of the service worked on a help to the Trust’s welfare advisor, were so busy. There were some
seven-day rota contacting families as psychology or chaplaincy teams. difficult and challenging
soon as possible after their relatives conversations with families, but the
came into one of our hospitals. Each Lauren said: “The number of calls to staff working in the service were
family was sent a letter explaining wards quickly dropped taking pressure wonderful at supporting each
there would be a daily call from the off frontline doctors and nurses.” other and we had regular online
service to provide an update about the Volunteer Cathy Bindoff, governance meetings to share and discuss
last 24 hours, together with general and safety lead in rehabilitation and feedback from calls.”
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Volunteers helped us 9 April
The number of COVID-19 patients
make our own PPE continues to rise at the Trust. There
are now 58 patients at Royal
Brompton and 37 at Harefield.
In response to a shortage of surgical Trust staff develop and launch a new
gowns across the country at the start family liaison service for inpatients in
response to the restrictions on
of the pandemic, our clinicians took
visiting. The service accepts referrals
matters into their own hands and from the critical care family liaison
developed a blueprint which could be team and wards, and can offer
made from operating theatre drapes. psychological support, spiritual
support, welfare advice and end of
Caroline Gration, director of The life and bereavement support.
Fashion School in Chelsea, south west
16 April
London, took up the challenge of
Lockdown is extended for ‘at least’
producing the gowns, sourcing a three weeks. The government sets
factory location, sewing machines and out five tests that must be met
a team of more than 300 volunteers. shortage of gowns, challenged before restrictions are eased.
themselves to find a solution."
Helped by the Trust’s finance team and 17 April
the Friends of Royal Brompton charity, Volunteers for the project came from In response to a shortage of surgical
gowns across the country, our
a slick production line occupying six all walks of life and even included
clinicians develop a blueprint to
rooms was up and running within a fashion designer Michael Halpern, who create a supply chain for the Trust
week at nearby Kensington and commented: “It’s been amazing to see and a team of more than 300
Chelsea College, to transform surgical how people whose job this isn’t volunteers help to transform surgical
drapes into more than 30,400 normally are able to produce really drapes into more than 30,400
surgical gowns. amazing things in times of need.” surgical gowns.
18 April
Finance manager, Tom Bennett, who His enthusiasm was shared by COVID-19 patient numbers continue
project managed production, said: two other volunteers from the to increase with 72 critically ill
“Without doubt, this was initially a fashion world: patients at Royal Brompton Hospital
daunting task. However, the energy and 45 at Harefield Hospital.
and motivation from all of our Creative director Michael Holloway
volunteers has been amazing. said “I think it’s one of the few 27 April
Staff who require a COVID-19 test
We have been overwhelmed by opportunities in life where fashion can
can now request one at one of our
people’s support.” actually be a skill that can contribute to hospital sites rather than externally.
helping people stay safe, so it was
Joy Godden, director of nursing and really a no brainer to come and join 28 April
clinical governance, said: “This is an this group of volunteers.” A one-minute silence is held
excellent example of how people nationally to honour all key workers
Stylist Kenny Ho said “Having read who have died from coronavirus.
across the Trust are responding to the
challenges of this pandemic by getting about the shortages of PPE, I feel that
30 April
involved in areas where they have little it’s really great that we are able to offer The Prime Minister says “we are past
or no experience. I would like to give what is necessary. Literally everything the peak” of the pandemic.
big thanks to everyone for their that we are making here is going
support, and to our very brave frontline straight from the workshop into a MAY 2020
staff who, when told about the hospital ward.”
5 May
The UK surpasses Italy to become
the country with the highest
declared death toll in Europe, with
more than 32,000 fatalities.
8 May
The number of COVID-19 patients
being cared for at the Trust is
gradually falling with 41 at Royal
Brompton and 10 at Harefield.
Continued
overleaf
Joy Godden, director of nursing and clinical
governance
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| CoVId-19 – tHe fIRSt WaVe
Innovations transforming the way we work
Our dedicated staff rolled out an patients’ bedsides in intensive care to ITU, or a whole family getting together
astonishing number of new initiatives enable frontline clinicians to get on a smartphone to dial into the virtual
to keep services running for patients on-demand access to virtual support system – has been incredibly uplifting.”
during the pandemic. from consultants any time they
needed it. A member of one patient’s family
Nick Hunt, executive director for echoed her comments, explaining: “My
Harefield and director of service The system also allowed patients in mother, sister and I have taken
development, said: “Emergency intensive care to see and talk to family tremendous comfort from the video
situations often bring out the best in members who were unable to visit due calls that the ITU team at Harefield
people and that’s certainly been the to infection risks. Hospital have been able to arrange
case for us. Some initiatives that we’d with my father. This incredible system
talked about for months, or even years, For the wife of one patient, the has allowed us to see Dad, to tell him
materialised in weeks. webcam was an opportunity to how much he is loved and means to
comfort and connect with her husband each of us, and to encourage him to
“As a Trust, we’re well-known for our by singing to him, alongside their two remain strong and recover.
innovation, but the speed at which children. For other families, it allowed
these solutions were found was them to spend precious time speaking "We have also been able to see and talk
remarkable; we have literally to their loved ones to support recovery. to some of the incredible doctors and
transformed the clinical landscape.” nurses that have been so attentive,
Laura Rowlands, senior staff nurse on dedicated and professional. The
A new virtual communication system Harefield Hospital’s intensive therapy system has even allowed them to
was set up in just 14 days to give unit (ITU), said: "What started as a way monitor Dad’s responsiveness to our
frontline teams round-the-clock remote of helping staff communicate with voices while they are reducing his
access to specialist colleagues at the each other, evolved into a way of sedation and slowly waking him up.
Trust. letting families onto the ward as if they When all we want to do is be by Dad’s
were physically there. bedside and will him on to a full
The equipment for the system was recovery, the system has given us the
crowdsourced via social media and “A huge part of my role is to look after
opportunity to be a little closer to him.”
through the Royal Brompton & the families of patients, so seeing what
Harefield Hospitals Charity. this has meant to them and for their Other examples of innovation
morale – whether it be individual accelerated by the pandemic include:
Using a simple set-up, high-resolution patients speaking to their husband or
webcams were linked to computers at wife for the first time since entering the Offering many of our outpatients
the opportunity to attend ‘virtual’
a new communication system enabled frontline clinicians to get on-demand access to virtual appointments by video using a
support any time they needed it secure web-based platform called
Attend Anywhere, which is now
available as part of a national
programme (see page 26).
Introducing home testing kits that
allow patients to carry out certain
tests at home rather than in hospital.
Examples include a capillary blood
test and a cough swab test.
Launching Microsoft Teams to
enable many more staff to work
from home, with easily accessible
technology to allow meetings both
across the Trust and with external
organisations.
Launching smartphone applications
(apps) through which patients on
cardiac surgical waiting lists and
with long-term chronic diseases
such as asthma can record and
report symptoms, enabling better
prioritisation of treatment according
to clinical need.
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annual ReVIeW 2020-21 |
Trust estate’s team 10 May
The Prime Minister announces a
produces 1,500 visors conditional plan for lifting
lockdown, and says that people who
cannot work from home should
return to the workplace but avoid
When our hospitals began to run plastic, elastic and special foam, then public transport.
perilously short of protective face cut the plastic and attached the foam
20 May
visors for frontline staff, the estates sending 500 visors back to the Trust
We continue to try and provide the
team rose to the challenge within 12 hours of the order. The best care for patients with a wide
manufacturing 1,500 visors over the estates team then created an efficient range of complex heart and lung
course of a weekend. production line to finalise the visors conditions. Many patients are
within 18 hours. concerned about visiting for surgery,
Members of the team were initially or scans and tests, that can only be
asked to produce 500 visors within A further 1,000 visors were then carried out in hospital. Our teams
work hard to provide information
24 hours. Undaunted by the task at completed for use across the hospital. and reassurance – calling patients to
hand, interim estates manager Billy book appointments and explaining
Retter dismantled an existing visor Commenting, Jan McGuinness, chief all the measures we have in place to
and made a sketch of the various operating officer, said: “This was such create the safest possible
parts to create a makeshift design an incredible effort involving many environment.
which was sent to London-based people from across the Trust. We
contractor RFP. often talk about having a ‘can-do’ JUNE 2020
attitude, but I’ve never seen anything 1 June
The contractor sourced all the on this scale before. This effort has Phased re-opening of schools in
necessary materials: polycarbonate humbled many of us.” England.
4 June
Our chief executive Bob Bell says that
over the last three months Trust staff
have performed 225 cardiac surgery
and 474 catheter laboratory
procedures, six transplants, and
carried out 25,000 outpatient
appointments (via telephone or video)
– despite the pandemic.
15 June
All staff entering hospital buildings
have to wear surgical face masks to
comply with new government rules.
21 June
As the first wave subsides across the
country, the number of COVID-19
patients at the Trust continues to fall.
Now there are 11 cases at Royal
Brompton and five at Harefield.
23 June
The Prime Minister says the UK’s
“national hibernation” is coming to
an end – and announces relaxing of
restrictions and the two-metre social
distancing rule.
25 June
Members of Harefield Hospital’s lung
transplant team invite patients to join
them for their first ever live webinar
to discuss COVID-19.
Continued
overleaf
Billy Retter, interim estates manager, with a box of the new visors
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| CoVId-19 – tHe fIRSt WaVe
Providing life-saving surgery during
the pandemic: the Cardiac Hub
During the COVID-19 pandemic, met virtually seven days a week to critical conditions, and the Cardiac
Harefield Hospital was designated review and discuss patient cases from Hub process helped to clarify who
one of only two hospitals in London across the capital and the South East needed treatment and when.”
to perform emergency cardiac – to decide if urgent surgical
(heart) surgery. intervention was needed. Mr Petrou said: “With the Cardiac Hub,
patients were not just getting a
Two of our clinicians, Mr Mario Petrou, Dr Rahman Haley explained: “When second opinion from one doctor,
consultant cardiac surgeon, and COVID-19 hit, we had to come up but maybe 20-plus doctors, which
Dr Shelley Rahman Haley, consultant with a new way of working to ensure is incredible.”
echocardiologist, jointly set up and cardiac patients still received the best
chaired a ‘Cardiac Hub’ to ensure that treatment, despite the strain the Dr Rahman Haley added: “Heart
priority cardiac procedures could still pandemic was having on the NHS. surgery during a pandemic is risky, but
“
go ahead. sometimes the risk to patients of
“People didn't stop having heart doing nothing is worse, and we must
The Cardiac Hub ran through the first attacks and people were still living make difficult choices. This way of
and second COVID-19 waves and with serious heart conditions that working, where surgeons work with
involved bringing together an expert required urgent attention to prevent and take on work from other surgeons
team of consultant cardiologists and permanent damage. Time is an in a real collegiate manner,
surgeons from across London who important currency for patients with showcased the best of the NHS.”
Care for transplant patients
Teams at Harefield’s transplant unit informed about the latest COVID-19 seeing you guys! This has been really
continued surgery throughout the developments and how these might useful. Stay safe and well at Harefield.”
pandemic. Normally 40 to 50 lung impact them. The first webinar was
transplants are carried out each year, hosted by respiratory and transplant “Brilliant, really informative and
and between 25 and 30 heart medicine consultants Dr Martin reassuring.”
transplants. Over the past year, Carby, Dr Anna Reed and Dr Vicky
”
focusing on patients with the very Gerovasili, consultant pharmacist
greatest need, the teams still Haifa Lyster and psychologist Dr
transplanted 25 lungs and 13 hearts. Melissa Sanchez, and attended by 117
participants.
Like many other teams across the
Trust, the lung transplant team had to It included a comprehensive question
adapt how it delivered services. Many and answer session covering topics
patients who were shielding benefited such as face masks, vaccination and
from having their appointments socialising.
virtually (see page 26). The media has
Explaining the rationale for the concentrated on the
The move to ‘virtual’ appointments – webinar, the team said: "The media
by phone or video – is one of the has concentrated on the obvious obvious negative aspects of
positives to have emerged from negative aspects of the pandemic but the pandemic but we
the pandemic. we wanted to provide our patients wanted to provide our
with some balanced information for
Vanessa Tedbury, who had a lung reassurance, along with education
patients with some
transplant nine years ago, needs and a message of hope as balanced information for
regular check-ups. Now instead of government advice about emerging reassurance.
them taking place in person at from lockdown changes."
Harefield, they are virtual
appointments, but she says: “I prefer The session was very well received
it. I used to have to write off a day.” with positive feedback from patients
including:
Vanessa also benefited from new
regular online webinars organised by “Thank you very much! I am sure I
the transplant team to keep patients speak for all of us when I say I miss
20 | Royal BRompton & HaRefIeld nHS foundatIon tRuStYou can also read
