Annual Review 2019 A lifetime of specialist care - Royal Brompton Hospital
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RBH annual review 2019-FINAL.qxp_Layout 1 24/01/2020 11:05 Page 1
A lifetime of specialist care
Annual Review
2019
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Contents
Introduction from the chair and chief executive 04
About us 07
Professor Tim Evans – in memory 08
Our vision and values 09
CQC report 10
Performance and achievements 13
Evolution of Darwin 14
Our clinical expertise and specialist services 16
A dedicated service for children and young people 24
Rehabilitation and therapies 28
Research highlights 30
Sharing our expertise 32
Listening to our patients 34
The healing arts 36
Our charities 38
Our profile in the media 40
Governance 42
Royal Brompton & Harefield NHS Foundation Trust accounts 44
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Introduction from the
chair and chief executive
We are pleased to present this annual Royal Brompton Hospital and returning to work within four weeks.
review. It reflects a year that has seen Professor of respiratory and sleep Traditional aortic valve surgery entails
the Trust’s commitment to excellence medicine at Imperial College, was cutting through the chest with an
in patient care recognised across elected President of the European incision of up to 30cm, and a recovery
many platforms. Respiratory Society (ERS). ERS brings time of up to six months.
together physicians, healthcare
In its 2018 inspection of our services, professionals, scientists and other At Royal Brompton, doctors have
the Care Quality Commission (CQC) experts working in respiratory treated the largest number of
awarded a rating of ‘Good’ and medicine. It is the largest respiratory premature babies in Europe with
identified several areas of outstanding society in the world – covering not pioneering catheter interventions.
practice; recognising our “systematic only Europe, but forging strong global Babies with patent ductus arteriosus
approach to continually improving the links, particularly across Asia and (PDA) – a life threatening congenital
quality of services, and safeguarding Australasia. heart defect – have benefited from a
high standards of care by creating an new procedure that takes just 20
environment in which excellence in Dr Nick Hopkinson, honorary minutes and avoids the need for open
clinical care flourishes”. consultant chest physician at Royal heart surgery, a complex procedure in
Brompton Hospital and reader in tiny babies. Babies were referred by 20
Commending our clinical teams for respiratory medicine at Imperial different neonatal intensive care units
the compassion shown to patients, College, was appointed medical across the country, as the Trust is the
the CQC reported that: “Feedback from director of the British Lung Foundation only centre in the UK to have a
patients confirmed that staff treated (BLF). The Trust has close links with the specialist referral team.
them well and with kindness…staff BLF – the leading national umbrella
involved patients and those close to charity that funds research into, and Our experts joined forces with the west
them in decisions about their care and supports people affected by, lung London cancer alliance, hosted by
treatment…and provided emotional disease. cancer centre The Royal Marsden, to
support to minimise their distress”. diagnose patients with lung cancer
Dr Sonya Babu-Narayan, consultant earlier, by using mobile CT scanners in
Three of the four core services cardiologist at the Trust and clinical the community. They recruited 2,284
inspected were rated good (Children’s senior lecturer at Imperial College, was patients to over 200 research
and Young People’s Services, Critical appointed associate medical director programmes that will contribute
Care and Surgery at Royal Brompton for the British Heart Foundation (BHF). towards better patient care and
Hospital) and one, Surgery at Harefield The BHF funds over £100 million of outcomes. They were awarded funding
Hospital, was rated outstanding. research each year into heart and from the National Institute for Health
circulatory conditions. Research Invention Innovation (i4i)
The Trust’s ECMO service for adults Programme to study how artificial
with severe acute respiratory failure Many others were recognised by intelligence can diagnose a rare
(SARF), was highly praised at the professional associations, medical inherited lung condition, and launched
Extracorporeal Life Support colleges and national charities. the UK’s first international postgraduate
Organisation (ELSO) awards for course in heart failure; and received a
Excellence in Life Support. Harefield But our clinicians are not motivated by 95 per cent recommendation score in
Hospital was presented with the silver accolades. Across both our sites, the annual Friends and Family Test.
award, and Royal Brompton Hospital talented teams of doctors, nurses and
received the prestigious platinum allied health professionals strive every So it is not news to us that we have
award. This certification is the highest day to offer patients the very best some of the most talented, skilled and
distinction given by ELSO, and Royal specialist care that is available, committed teams in the NHS within
Brompton was the only centre in anywhere in the world. our Trust. We know that clinical
England to achieve it. leadership is vital if we are to move
This year saw pioneering innovation in forward and continue to break new
Several of our talented colleagues minimally-invasive heart valve surgery ground in treatment and research, and
were recognised for their expertise at Harefield Hospital transform the it is particularly encouraging to see the
and clinical leadership. lives of patients. Using a small 6cm enthusiasm shown by clinical
incision between the ribs, minimally- colleagues for our planned
Professor Anita Simonds, consultant in invasive techniques mean a quicker collaboration with King’s Health
respiratory and sleep medicine at recovery time with many patients Partners (Guy’s and St Thomas’ NHS
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our clinicians join teams from King’s Health partners to discuss how patients describe what they would like to see in a new partnership
best to work together
FT, King’s College Hospital, South Being part of a wider network will Our plans will take time to develop
London and Maudsley NHS FT, and provide the opportunity to do things and deliver; transformation on this
King’s College London University). differently, to design new models of scale requires detailed planning and
care using the best of the best from engagement. But whatever else
We already work closely with each partner organisation. Working as changes in the environment around
colleagues at Guy’s and St Thomas’ in one team, at scale, our combined us, it is patients who remain our focus,
particular, and over the past 12 months capability will place us in the global and our commitment to them will
it has become apparent that there is a top five for world-leading heart and continue to guide everything that
very real appetite among clinical teams lung research and personalised care. we do.
to investigate closer ways of working.
Although central to our vision is the
development of a new purpose-built
clinical academic facility on the St
Thomas’ Hospital and Evelina London
Children’s Hospital site, which will take
Baroness Sally morgan Bob Bell
around 10 years to complete, clinical
Chair Chief executive
and research links with colleagues
across King’s Health Partners are 22 January 2020 22 January 2020
growing stronger by the day, with joint
clinics and services developing in
several areas.
We are confident that the greatly
enhanced opportunities that this
collaboration offers, and the strength
of our brand, will attract clinicians and
researchers from other countries to
this new hub of expertise and
opportunity. Training and education
opportunities, in particular, will be
world-leading, supporting not only
recruitment but retention.
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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 life. Over the years our experts have
hospitals – Royal Brompton in been responsible for major medical
Chelsea, West London, and Harefield, breakthroughs including performing
near Uxbridge – which are each the first successful heart/lung
known throughout the world for their transplant in Britain, implanting the first Our values guide and
expertise, standard of care, and coronary stent, founding the largest
support every decision we
influential research. centre for cystic fibrosis in the UK, and
pioneering intricate heart surgery for make to ensure our care is
We are a specialist trust, providing newborn infants. safe, of the highest quality
treatment for people with heart and and available to everyone
lung disease only. This means our We treat patients from all over the UK who needs it.
doctors, nurses and other healthcare and other countries, many of whom
staff are experts in their chosen field, are unique in their medical needs, and
with many of them moving to us from demand for our services continues to
around the world so that they can grow year-on-year.
develop their skills even further.
By recruiting the best clinical and non-
We carry out some of the most clinical staff and investing in their
complex surgery and offer some of development, we maintain our
the most sophisticated treatment that position as the leading UK provider of medicine through research, and by
is available anywhere in the world. respiratory care and a national leader sharing what we know through
in the specialist areas of paediatric teaching, we can help patients
Our fetal cardiologists can perform cardiorespiratory care, congenital everywhere.
scans at just 12 weeks, when a baby’s heart disease and cystic fibrosis.
heart valve is just over a millimetre in Our values (page 9) guide and support
size, and our clinical teams regularly We work closely with academic and every decision we make to ensure our
treat patients well into their 90s and industry partners to play a leading role care is safe, of the highest quality and
help them maintain a good quality of in pushing forward the boundaries of available to everyone who needs it.
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Professor Tim Evans
“
Professor Tim Evans, former medical director, deputy chief
executive and director of research, passed away in November 2018.
The news of his death was greeted with immense shock and
sadness throughout the Trust.
Chief executive Bob Bell paid tribute Care Society, and more recently and
”
to a greatly missed colleague who importantly in founding the Faculty of
was also a mentor, an inspiration and Intensive Care Medicine.
a friend to many.
“A large number of doctors in critical
“As a physician Professor Evans was care the world over have been
respected throughout the world and influenced by him. Some rotated
was a major driver in the maturation of through Royal Brompton’s adult
critical care as an independent intensive care unit or respiratory
specialty in the UK, through influences medicine division, some had the benefit
at Royal College level, the Intensive of him as research supervisor. Many of
them have gone on to have successful professor tim evans, former
medical director, deputy
careers in the UK and internationally, chief executive and director
counting him as one of the most of research of the trust
important influences in their lives.
“Professor Evans won many accolades and the reason why the Trust is now a
Put simply, men like for his clinical expertise. His interest in major ECMO (extracorporeal
Professor Tim Evans acute lung injury and acute respiratory membrane oxygenation) centre.
come along once in a distress syndrome, ARDS, which
started in the mid-1980s, led to him “The respect of his peers pales into
generation. insignificance when compared to the
rapidly becoming a world authority in
ARDS. Research collaborations which regard in which Professor Evans was
followed were the start of Royal held by his patients. The relationship
Brompton’s role as a national referral he had with many of his ‘long-term’
centre for severe acute lung failure patients was the envy of colleagues.
“It was this genuine focus on patients
that, in my view, made him such a
brilliant medical director. Tim would
never compromise on putting patients
first and providing safe and high-
quality care.
“It is difficult to summarise the
immense contribution he made to the
Trust: his clinical expertise and
leadership, his passion for research
and education, the significant
contribution he made over several
years on the Trust Board and other
management bodies. He was also a
highly valued and popular Trustee of
the Royal Brompton & Harefield
Hospitals Charity.
“Put simply, men like Professor Tim
Evans come along once in a
generation.”
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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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| CQC RepoRt
CQC report: good
overall with some
excellent highlights
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”
The Trust won praise for excellence in clinical care
and compassion for patients, in a report by the
health regulator.
In its 2018 inspection of our services, “Feedback from patients confirmed
the Care Quality Commission (CQC) that staff treated them well and with
awarded the Trust a rating of ‘Good’ kindness…staff involved patients and
and identified several areas of those close to them in decisions about
outstanding practice. their care and treatment…and provided
emotional support to minimise their
The CQC recognised our “systematic distress.” The CQC recognised our
approach to continually improving the “systematic approach to
quality of its services and safeguarding Three of the four core services
high standards of care by creating an inspected were rated good (Children’s
continually improving the
environment in which excellence in and Young People’s Services, Critical quality of its services and
clinical care would flourish.” Care and Surgery at Royal Brompton safeguarding high
Hospital) and one, Surgery at standards of care.”
Commending clinical teams for the Harefield Hospital was rated
quality of specialist care they provide outstanding. Overall, the Trust was
and for the compassion shown to rated safe, effective, caring, responsive
patients, the CQC reported that: and well-led.
Trust chief executive Bob Bell welcomed
the CQC report
“This remains an impressive and well-
deserved achievement, especially for
the surgery teams at Harefield
Hospital which were commended for
their approach to a number of issues
around safety, culture and innovation.
I am pleased that their continued
commitment to providing exceptional
care for patients was recognised in
this way.
“‘Outstanding practice’ was also
identified in Critical Care and Children’s
and Young People’s services at Royal
Brompton Hospital. Overall, the Critical
Care team: ‘demonstrated excellent
multidisciplinary working practices
which enabled collaboration in
improvement projects and enhanced
patient care,’ and the accredited
intensive care course for nurses was
praised for enabling 63 per cent of
nurses to gain the qualification,
significantly exceeding national Surgery at Harefield Hospital was rated outstanding
guidance.
“It was a similar story for Children’s and highly of the culture of the service and one thing above all else; delivering the
Young People’s services: ‘The service the staff survey results were consistently best possible specialist care. Whatever
went above and beyond for its patients high for workplace satisfaction.’ else changes in the environment
and patient families; there was clear around us, patients will remain our
evidence of research, innovative and “It was clear to the CQC that we are an focus, and our commitment to them
outstanding practice; staff spoke very organisation that steadfastly prioritises will guide everything that we do.”
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ANNUAL REVIEW 2019 |
Performance and
achievements
During 2018/19 we:
Maintained one of the
fastest arrival to
Cared for more than Cared for nearly
treatment times for UK
210,000 patients in our 40,000 patients of all
heart attack patients –
outpatient clinics. ages on our wards.
23 minutes compared with
a national average of 56.
Received more than
Received a 95%
1,000 patient referrals
recommendation
for our pulmonary
rehabilitation programme at
score in the annual Friends
Harefield Hospital. and Family Test.
Reduced the average Received 100 per cent
length of time children wait positive feedback about
in outpatient clinics by Harefield's new day of surgery
15 per cent. unit in a patient survey.
Produced 889 peer-reviewed
Recruited 2,284 patients
publications, with our academic
Welcomed a rating of onto over 200 research
partner, Imperial College, London,
'Good' in our Care Quality making the Trust a leading centre
programmes that will
Commission inspection. contribute towards better
for cardiovascular, critical care and
patient care and outcomes.
respiratory research.
Joined a new genetic
testing network that is Attracted more than
set to revolutionise the way
£10 million in external
rare genetic diseases are
grants for research.
identified across South
London and the South-East.
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Evolution of Darwin
During 2018/19 a Trust-wide transformation
programme, Darwin, continued to make progress.
The programme has ambitious goals ensuring that resources were going into
DARWIN
to transform the productivity and the things that matter most for patients: PROGRAMME
efficiency of clinical services and this
year results were encouraging. In surgery, reorganising pathways
FIT FOR THE
to reduce the length of stay in our FUTURE
As a global leader in cardiothoracic hospitals saved £2 million, and
and respiratory care, clinical teams at resulted in very encouraging
the Trust deliver excellent patient feedback from patients.
outcomes, while also investing in
cutting-edge innovations and In theatres, overhauling the
infrastructure. It became apparent in approach to scheduling surgery
2015/16, that without transformational saved money but also ensured
change to make operational patients were seen faster.
improvements and stabilise the Trust’s For non-patient facing functions, such
financial base, this position was at risk. By the end of March 2019 – two years as a procurement review and
after the launch of Darwin, the Trust modernising back office services, a
Transforming patient-facing clinical had over 50 improvement initiatives saving of £6 million was achieved by
services has clearly focused on underway. the end of 2018/19.
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Some examples of initiatives delivered under Darwin:
Two new day case facilities were set up in cardiology
at both hospitals which between them have allowed
patients to spend 4,350 more days a year at home
with their families – rather than in hospital.
New one-stop lung clinics are improving patient
care. Interstitial lung disease and asthma patients can
now get all their care in one visit meaning patients
spend 1,950 fewer days in hospital each year.
As one patient explained: “I used to have to stay on
the ward once every month. Now I stay for a couple
of hours and go home… it really does make a
difference.”
Implementing new theatres software has increased
capacity to enable 65 more major cardiac cases to
be undertaken. Clare denny, senior sister outpatients, talks to a patient at one of
the trust's new cardiology day case facilities
Reviewing bed capacity in intensive care helped grow
our ECMO service (extracorporeal membrane
oxygenation) – a highly specialised service for
“
critically ill patients. The Trust is one of only five
commissioned ECMO centres in the UK (read more
about our ECMO service on page 17).
A review of bed capacity in intensive care increased
bed utilisation from 66 per cent to 80 per cent,
meaning 1,200 more critically ill patients can be
supported each year.
Re-designing cardiac surgery processes has meant
that:
• over half of patients now come in on the day of
surgery
• £1 million has been saved.
patient George Coldrake at one of the new one-stop lung clinics
Once again patient feedback has been positive.
This is a really good new service
provided by the hospital – it helped
with the process to prepare myself
before the op. First class treatment
fully explained. Nothing was a
problem.
using the new theatres software, mr toufan Bahrami, consultant
cardiac surgeon, can view scheduling for all the operating theatres at
Harefield on one screen at the same time
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Our clinical expertise
and specialist services
Teams at Royal Brompton and Harefield are world-leaders in diagnosing and
treating a range of conditions, and recently won two major awards for the
Trust’s life-saving ECMO service (extracorporeal membrane oxygenation).
ECMO supports recovery after major life-saving surgery or life-threatening
illness by oxygenating blood outside the body and returning it – effectively
doing the work of a patient’s lungs, or both heart and lungs, until theirs can
resume to normal functioning.
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ECMO (extracorporeal membrane
oxygenation) service recognised
as ‘platinum’ centre of excellence
“
”
Vicky Scollen, staff
nurse on the adult
intensive care unit, using
the eCmo equipment
The Trust’s ECMO services were inform decision-making which,
highly praised at the Extracorporeal ultimately, benefited patients. This led
Life Support Organisation (ELSO) to a 60 per cent increase in referrals
awards for Excellence in Life Support. within the first year alone, offering
highly specialised life support
It’s fantastic news that our
Harefield Hospital was presented with techniques to more patients than ever
ECMO programme has the silver award, and Royal Brompton before.
been recognised with this Hospital received the prestigious
award. This is thanks to the platinum award. This certification is Having gone from strength to
team’s hard work the highest distinction given by ELSO, strength, the service has expanded
with Royal Brompton being the only even further to provide more cardiac
developing our services commissioned centre in England to ECMO for patients suffering
over the last few years to achieve it. cardiogenic shock (a condition where
deliver the best possible the heart is suddenly unable to pump
care for our patients. The Trust’s ECMO service, one of only enough blood to meet the body’s
five ECMO centres for adult severe needs).
acute respiratory failure (SARF) in
England, also provides paediatric care Dr Stéphane Ledot, consultant in
and both were recognised as critical care and anaesthetics, and
outstanding by ELSO. Royal Brompton’s severe acute
respiratory failure and ECMO lead,
A redesign of the service in 2016/17, said: “It’s fantastic news that our
supported by colleagues at Guys and ECMO programme has been
St Thomas’ NHS Foundation Trust, recognised with this award. This is
increased capacity and encouraged thanks to the team’s hard work
greater multi-disciplinary collaboration developing our services over the last
across sites. Such a range of expertise few years to deliver the best possible
and streamlined planning helped to care for our patients.”
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Bringing services to patients
Trust experts lead the way in alliance hosted by leading cancer the lowest one-year lung cancer
diagnosing and treating diseases of centre The Royal Marsden, to survival rate.
the lungs. Patients from the UK as diagnose patients with lung cancer
well as overseas are treated for the earlier. Under the initiative, people in
full range of respiratory conditions Hammersmith & Fulham are invited to
including: asthma and allergy, cancer The initiative, which includes patients a lung health check at Royal Brompton
services, lung inflammation and having access to a mobile CT scanner, Hospital, while those in Hillingdon are
cystic fibrosis, lung infection and is the first of its kind in London and invited to a mobile CT scanning unit in
immunity, lung failure (including means people in Hillingdon and in Tesco or Sainsbury’s car parks. The
transplant, COPD – chronic Hammersmith & Fulham who have mobile CT unit uses a novel wireless
obstructive pulmonary disease – and been identified as being at increased technology developed in the UK
sleep and ventilation), and lung risk of lung cancer will be invited for a which, for the first time, allows scans
assessment (including sleep studies, lung health check. If appropriate, they to be transmitted for remote diagnosis
lung function and physiology). will then be offered a CT scan in a within minutes, rather than being
convenient place on the same day. couriered on CDs.
Our teams run the largest interstitial
lung disease clinic in the UK, the Lung cancer is by far the most Professor Anand Devaraj, consultant
largest asthma clinic in London and common cause of deaths from cancer thoracic radiologist at Royal
the south east, and the biggest in the UK because the majority of Brompton, is leading the work. He
occupational lung disease service in people are diagnosed in its late stages, said: “Early detection of lung cancer
the UK. We are also home to the when treatment has a more limited saves lives, but often people are
largest cystic fibrosis clinic in the UK, impact. diagnosed at a late stage of the
and the largest centre for surgical disease, having been unaware of any
treatment of lung cancer. Twenty GP surgeries across the two signs or symptoms in the earlier
London boroughs are taking part in stages. The earlier someone is
Our specialists joined forces with RM the pilot and over 7,000 current or ex- diagnosed, the more effective the
Partners, the west London cancer smokers between 60 and 75, are being treatment they can be offered.
invited for a lung health check.
Hammersmith & Fulham has the “This pilot is a real opportunity to help
highest lung cancer improve people’s lung health. Those
incidence and mortality who smoke will be offered help to
across west London, stop and, where we find people who
and Hillingdon has do not have lung cancer but a
different condition, we can make sure
they are referred for the
appropriate treatment.”
The initial pilot ran for a
year, with the study into
the outcomes and
results for patients
ongoing for a
further year.
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National recognition for Trust experts
Many of our specialists hold research and training the society Dr Hopkinson said: “Lung disease is the
important positions in professional focuses on. third biggest killer in the UK, so it is
organisations and win national and important that we are able to support
international recognition for their “We want to see the society become the delivery of the best possible care,
work. During 2018/19 examples even more international, fostering links ensure timely diagnosis, and take the
include: with low-income necessary preventative steps to deliver
countries, for example, and good lung health – cutting smoking
Professor Anita running international rates further, addressing air quality and
Simonds, exchange programmes for challenging child poverty.”
consultant in clinicians and researchers.
respiratory and Welcoming Dr Hopkinson as medical
sleep medicine at “I’m also very keen to director, Dr Penny Woods, chief
Royal Brompton encourage executive of the British Lung
Hospital and multidisciplinary team Foundation said: “Nick has supported
professor of members to take active the BLF as an honorary medical
respiratory and roles in the society: nurses, adviser, health information expert and
sleep medicine at clinical scientists, media spokesperson for many years.
Imperial College’s physiotherapists and We are very glad that he is joining our
National Heart and speech and language team on a formal basis, to continue his
Lung Institute, was therapists, have such vital tireless work on behalf of the people
elected president of professor anita Simonds roles in affected by lung
the European treating disease that he sees
Respiratory Society (ERS). patients with respiratory every day.”
ERS brings together physicians, conditions and carrying
healthcare professionals, scientists and out research.” Dr Sonya Babu-
other experts working in respiratory Narayan, consultant
medicine. Its mission is to promote Professor Simonds has cardiologist at the
lung health to alleviate suffering from been instrumental in Trust and clinical
disease and drive standards for developing respiratory senior lecturer at
respiratory medicine globally. and sleep medicine at Imperial College, has
Royal Brompton since been appointed
It is the largest respiratory society in the she joined in the 1990s, associate medical
world – covering not only Europe, but including leading the director for the British
forging strong global links, particularly first team in the UK to Heart Foundation
across Asia and Australasia. use non-invasive (BHF). The BHF funds
ventilation in children over £100 million of
dr Sonya Babu-narayan
Professor Simonds said: “I see this as a and young people with research each year
real opportunity to forge closer ties inherited neuromuscular into heart and
with our respiratory colleagues in disorders, in turn influencing the care circulatory conditions.
Europe, at a time when many delivered to patients all over the world.
conversations seem to be about the Dr Babu-Narayan said: “It’s a real
UK going in the opposite direction. It is Dr Nick Hopkinson, honorary honour to be joining the BHF. I know
critically important to maintain our EU consultant chest physician at Royal how the charity is trusted and valued
research links, which are hugely Brompton Hospital and reader in by the heart and circulatory disease
productive. respiratory medicine at Imperial research community, as well as
College, was patients and their families’, who are at
“The ERS genuinely effects appointed medical the very centre of everything we do.”
change – it has a director of the
compelling voice on the British Lung Dr Babu-Narayan is internationally
environment, on smoking Foundation (BLF). recognised for her research to improve
and chronic respiratory the care and quality of life of adults
disorders for example, The Trust has who were born with congenital heart
which has acted as an close links with the disease. Associate medical directors
important lever on EU BLF – the leading provide leadership and strategic
policy-makers. It works national umbrella direction to the vital research mission
closely with the European charity that funds of the BHF, helping to ensure every
Lung Foundation and has research into, and pound donated is used to support
strong engagement with supports people research with the potential to make the
patients, working alongside affected by, lung maximum impact for those affected by
them to prioritise the disease. heart and circulatory diseases.
dr nick Hopkinson
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| ouR ClInICal eXpeRtISe and SpeCIalISt SeRVICeS
“
Transplant patient hits the
high notes on national TV
”
Harefield Hospital transplant patient after his lung collapsed while he was
Charles Michael Duke debuted his on stage performing in a Christmas
new lungs on BBC1 – by singing a show in 2014.
spellbinding version of Ella
Henderson’s Yours. Charles said: “I was still recovering at I’ve met people who have
the time of recording the song, but had heart transplants over
The 23-year-old, who has cystic considering it was only 12 weeks 30 years ago.
fibrosis (CF), starred on This Is My post-transplant, I’m really happy with
Song, a two-part TV series that gives the way it turned out. And, it was
members of the public a chance to more about marking the end of this It makes me think if these
make a record of a song that’s special journey for me than sounding like people have managed to
to them. Beyoncé.” keep going over three
decades with a transplant, I
At the time of filming, Charles had just He added: “Singing with my new
should feel optimistic.
received a double lung transplant at lungs was amazing, I could reach the
Harefield after three years on the end of sentences and hit notes I
waiting list. couldn’t before.”
He learned to play the song Yours on Charles continues to visit Harefield
his guitar while recovering in hospital. Hospital for regular check-ups. He
Charles wanted to record his own commented: “I’ve met people who
version to celebrate the moment he have had heart transplants over 30
was given a new lease of life. years ago.
The Southampton-based singer and “It makes me think if these people
actor has always tried to live life to the have managed to keep going over
full despite having CF. But he three decades with a transplant, I
accepted that he needed a transplant should feel optimistic.”
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Innovative surgery attracts
national attention
Experts at Royal Brompton and recovery time, because the 6cm 6cm incision. Because the new
Harefield hospitals care for patients incision goes between the ribs. With Edwards Intuity valve doesn’t need
with a wide range of complex cardiac the new valve, no stitches are required suturing, patients spend just 15 to 20
conditions, both congenital (present and many patients are back to work minutes on a heart-lung machine, so
at birth), inherited and acquired later within four weeks. the risks are lower.”
in life.
The operation takes 90 minutes to two Mike said: “Three weeks after the
Pioneering innovation in minimally- hours, around an hour faster than the surgery I could walk 15km and by four
invasive surgery was highlighted in the usual procedure. weeks, I was able to go for my first
national media this year. gentle jog, which was amazing. Now
Mr Bahrami told the Daily Mail: “At just three months after the operation I
Secondary school teacher Mike Harefield we now implant most valves, can run 10km non-stop with no ill-
Adamson, 62, enjoyed an active including mechanical ones, minimally effects — and I was back at work after
lifestyle of cycling and jogging, but invasively — usually we only need a six weeks.”
sought medical advice after he
experienced breathlessness and a dull
ache when out running.
Doctors discovered Mike’s aortic valve
had stiffened due to a build-up of
calcium. Not enough oxygenated
blood was being pumped around the
body – hence the shortness of breath.
The valve would need replacing, or
Mike would risk heart failure.
Traditional aortic valve surgery entails
cutting through the chest with an
incision of up to 30cm, and a recovery
time of up to six months. Minimally-
invasive techniques mean a quicker
the theatre team at Harefield
Royal Brompton hosts heart charity
conference
Congenital heart charity The by Professor Michael Gatzoulis and of my 50 years. I’ve benefited from the
Somerville Foundation held its included talks by Drs Natali Chung and fantastic care they provide and their
annual conference at Royal Harith Alam, consultant cardiologists at adult congenital heart disease (ACHD)
Brompton Hospital. Guy’s and St Thomas’. unit is cited as the most influential in
the world.”
More than 120 delegates from across Opening the conference, new Trust
the UK attended the event and one patient governor Paul Murray, said: Speakers from Royal Brompton
travelled from Canada. The event was “Having The Somerville Foundation at Hospital included Professor Gatzoulis,
designed to bring people with Royal Brompton Hospital brings two Dr Kostas Dimopoulos, consultant
congenital heart conditions together organisations that are so close to my cardiologist, Richard Grocott-Mason,
to share their experiences and provide heart, metaphorically and literally, medical director and consultant
them with a range of expert together. cardiologist, Lynda Shaughnessy,
information, including treatments and clinical nurse specialist in ACHD,
future models of care. “If you’re able to meet people with the Professor Wei Li, consultant in
same conditions, or who face similar echocardiography, and Professor Alain
It was supported by leading members issues, it’s beneficial. I have attended Fraisse, consultant and director of
of the Trust’s congenital heart team led Harefield and Royal Brompton for 47 paediatric cardiology.
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”
| ouR ClInICal eXpeRtISe and SpeCIalISt SeRVICeS
Harefield team shortlisted
for leadership award Genetic testing for
FH was almost unknown in
A prevention programme that involves GP practices and hospitals England before we started
identifies people at high risk of across Hillingdon and Slough. this programme. We
coronary heart disease and Programme lead, consultant couldn’t have got to where
intervenes early to save lives, cardiologist Dr Mahmoud Barbir, said: we are without the support
was a finalist in the UK’s leading “Early prevention is by far the best way
medical awards. to manage this condition – treating the we had from management
underlying problem before the person – who also encouraged us
Familial hypercholesterolemia (FH) is a experiences a serious cardiac event, to put ourselves forward for
common genetic condition that and preventing premature deaths. Yet this award.
causes an increase in harmful LDL FH is vastly under-diagnosed and
cholesterol in the blood, causing under-treated.
narrowing of the arteries – even in
healthy and active people. It is one of “When someone comes to us with a
the major causes of cardiac events, heart attack that we treat, we offer
and it is estimated that more than a their siblings and other family the Trust decided to make it a
quarter of a million people in England members a test to see if they have FH, permanent service, with FH clinics at
are living with the condition but this is the tip of the iceberg. We Royal Brompton as well as Harefield,
undiagnosed. knew we could identify and treat more and various community hospitals.
people by getting out into the Jane Breen, clinical nurse specialist in
Celebrating its 10th anniversary this community.” FH cascade, said: “Genetic testing for
year, Harefield’s FH team spearheads a FH was almost unknown in England
prevention programme using a The team works closely with GPs to before we started this programme.
combination of detective work and identify, from blood tests and other We couldn’t have got to where we are
genetic testing technology, to find evidence, people who could be at risk without the support we had from
people who are at risk, test them and of FH and offer them genetic testing. management – who also encouraged
their family, and get treatment started When someone is found to have the us to put ourselves forward for
early to reduce the chance of condition, their siblings and children this award.
premature cardiovascular disease in are offered a test. This “cascade”
later years. approach has enabled the team to “It’s especially rewarding when you see
identify young children with FH and three generations of the same family
The project, which was shortlisted as a start their treatment as early as coming to clinic: we’ve identified
finalist in the BMJ awards’ “clinical possible. something that could have had a
leadership team” category, started by serious impact on these families
offering testing to heart attack patients The programme first expanded into across the years, but with the right
and their families, but has since the community in 2014 with British treatment they can all expect to live
expanded into the community and Heart Foundation funding, after which longer and healthier lives.”
members of the familial hypercholesterolaemia team whose project was shortlisted in the BmJ awards
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| a dedICated SeRVICe foR CHIldRen and younG people
A dedicated
service for children
and young people
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Royal Brompton doctors treat the largest
number of premature babies in Europe
”
with pioneering catheter interventions
More than 80 premature babies The large number of babies treated
with patent ductus arteriosus at the centre has been facilitated
(PDA) – a life threatening with help from Royal Brompton &
congenital heart defect which Harefield Hospitals Charity, which
causes a leak between blood funded the purchase of a new Our success has been a real
vessels from an opening in the incubator, allowing the team to team effort, combining the
heart – have been treated at treat twice as many babies. talents and expertise of
Royal Brompton Hospital using a cardiologists, anaesthetists
pioneering catheter procedure. Gill Raikes, chief executive of the
charity, said: “It’s wonderful to be
and nurses. It’s thanks to this
Professor Alain Fraisse, consultant able to support the work Professor that we have been able to use
paediatric cardiologist, carried out Fraisse and his team are doing for this pioneering procedure to
the first of this type of catheter premature babies and their treat the largest number of
intervention at the Trust. families, as without their
premature babies in Europe.”
interventions many of these infants
The procedure involves inserting a would not survive.”
small device made from wire mesh
into the heart (through a catheter Professor Fraisse added: “We’re
inserted via a vein in the baby’s leg) extremely grateful to the charity for
to block the opening in the heart to
stop the leak. It is guided into place
using echocardiography imaging,
More than 80
which uses sound waves to capture
moving images and is the most premature babies with
widely used technique for non- patent ductus
invasive imaging of the heart. arteriosus (PDA) have
been treated at Royal
The procedure takes just 20
minutes and avoids the need for Brompton Hospital
open heart surgery – a complex using a pioneering
procedure in tiny babies. catheter procedure to
treat the largest
Professor Fraisse said: “This
procedure offers young paediatric number of premature
patients and their families hope babies in Europe.
through a less invasive treatment
than surgery, with a shorter
hospital stay with no chest scar.”
providing funds for another
Babies sent to Royal Brompton for incubator, allowing us to treat
treatment were referred by 20 more babies.
different neonatal intensive care
units across the country, as the “Our success has been a real team
Trust is the only centre in the UK to effort, combining the talents and
have a PDA referral team, which expertise of cardiologists,
was set up and is led by paediatrics anaesthetists and nurses. It’s thanks
matron Claire Buckle. to this that we have been able to
use this pioneering procedure to
Claire said: “The numbers show treat the largest number of
that we really are leading the way premature babies in Europe.”
for the treatment of patent ductus
arteriosus and we have professor alain fraisse, consultant paediatric
successfully treated infants cardiologist, examining the small device
weighing as little as 800g.” inserted into a baby’s heart to stop a leak
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| a dedICated SeRVICe foR CHIldRen and younG people
Using artificial intelligence professor Claire Hogg (right)
and research associate
to diagnose rare conditions andreia pinto with
CoSmonio nouS
Professor Claire Hogg, paediatric prevent lung damage in childhood and technology, known as COSMONiO
respiratory consultant, is leading a to keep the lungs working as well as NOUS, that allows clinical experts to
study to enable artificial intelligence possible. train the self-learning systems in real-
to diagnose primary ciliary dyskinesia time. If successful, such technology
(PCD), a rare, inherited condition. Diagnosis of the disease is complex could revolutionise diagnosis and
and relies on expert scientists looking medical research.
The Trust has been awarded funding at cilia with a powerful electron
for the project from the National microscope, together with other tests. Professor Hogg said: “We hope that the
Institute for Health Research Invention Professor Hogg’s study aims to use technology will enable us to confirm or
Innovation (i4i) Programme, which artificial intelligence computing exclude a diagnosis of PCD in the vast
aims to cultivate new techniques or techniques to identify both healthy majority of patients who are referred to
technologies into innovative and abnormal cilia from electron within one month – it currently takes
interventions for the NHS. microscopy images to provide a faster, around three or four months for a
more accurate diagnosis. diagnosis. As well as producing more
In patients with PCD, the microscopic rapid diagnosis, our aim is to create a
hairs found in the nose and airways – Artificial intelligence is increasingly more accurate system.
cilia – fail to adequately remove used in medicine and self-learning
bacteria and particles from the systems and has already been trained “PCD is an excellent model disease for
respiratory tract. to recognise a range of medical testing this technology and success in
conditions. this field may pave the way for other
This leads to recurrent infections in the rare diseases where time-consuming
nose, ears, sinuses and lungs which, if Professor Hogg and her team hope to and expensive diagnostic pathways
left untreated, can cause lung damage. be among the first in the world to use often lead to delays in starting
Early diagnosis is important to help a new interactive machine learning treatments."
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”
First information day for young
heart patients
Young patients with inherited cardiac from the charity Hope UK, which
conditions (ICC) face greater provides drug and alcohol education,
challenges than many other teenagers explained the effects of legal and
during adolescence. Among them are illegal substances, and led a group
moving from children’s to adult There is a lot of pressure discussion on why people use alcohol
services and taking greater from peer groups and and drugs.
responsibility for their own health and
wellbeing.
wider society to drink, or Rachael said: “There is a lot of pressure
even try drugs. We try and from peer groups and wider society to
Recognising this, our specialist ICC give young people the right drink, or even try drugs. We try and
nurses help young people to plan and information to equip and give young people the right
prepare for the move to adult services, empower them to make information to equip and empower
and for the first time this year (2018), them to make the right decision.”
held an information day offering them the right decision.
support and breakout sessions for Sessions included exercise and lifestyle
family members or guardians. advice, and an opportunity for young
people attending to separate from
The goal of event held at Chelsea their parents and carers to quiz experts
Football Club with the support of The on topics such as mental and sexual
Brompton Fountain charity was to health.
educate and inform young people aged that wasn’t too formal, where they
between 14 and 19 years old about would get to meet other people facing Anita Kolawole, 17, was among those
how lifestyle choices can affect heart similar issues. We thought we’d make it who attended. She said: “It’s been a
health. feel less hospital-like by getting out of fantastic day. I have a dilated
the clinic and into a more fun setting.” cardiomyopathy (a condition where
Lucy Green, paediatric ICC nurse the heart is enlarged and function is
specialist, explained: “The idea came After a talk on the ‘normal heart’ by impaired) and it’s not always easy as
out of a research project I did. Patients paediatric clinical educator Dan my friends don’t have to think about
with inherited heart conditions – such Fossey, which gave everyone an their health in the same way as I do.
as cardiomyopathy and arrhythmias – insight into the workings of the Meeting people with similar issues
said they would really appreciate a day cardiovascular system, Rachael Duthie is great.”
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| ReHaBIlItatIon and tHeRapIeS
Rehabilitation and
therapies
Daily activities can prove challenging for people with heart and lung conditions.
As well as helping with recovery after a procedure, our expert therapists
support patients to manage long-term conditions, cope with their symptoms
and boost their independence and confidence.
Our rehabilitation and therapies The Trust’s experts in recovery and Working collaboratively as multi-
services are designed to provide care therapy include physiotherapists, professional teams, our experts are
for the ‘whole’ patient, from exercise occupational therapists, dietitians, able to consider all the needs of
rehabilitation to psychological speech and language therapists and patients as they recover from
therapies and dietetics. clinical psychologists. treatment and tackle daily life.
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Patients with persistent
Harefield
coughs find support at cardiac
Royal Brompton Hospital rehabilitation
programme
ranks highly in
national audit
An independent national audit
awarded Harefield’s cardiac
rehabilitation (CR) programme a
coveted ‘green’ certification,
placing it in the top 20 per cent
of services in the UK.
Cardiac rehabilitation is a
comprehensive exercise,
education and behavioural
development programme.
Introduced to patients at an
appropriate stage of their
recovery, it aims to improve not
only their physical, but also their
social and psychological
the Voice of upper airway’ group meets several times a year to hear the about the latest
treatments and advice on managing conditions condition.
The National Audit of CR is an
A new support group was launched “GPs can often misdiagnose these annual joint project between the
at Royal Brompton Hospital this year patients’ conditions as they can vary British Heart Foundation and the
for patients with conditions that so much. Patients can end up feeling British Association for
affect the upper airways – such as confused, and isolated or alone with Cardiovascular Prevention and
persistent coughs. their condition. To be able to meet up Rehabilitation. For the first time,
and discuss their experiences with the audit adopted a new
Hosted by Dr Julia Selby, clinical lead others is hugely beneficial. approach to give a national
speech and language therapist for the picture on the quality of CR
upper airway service, and speech and “I am hugely pleased that we’ve been delivery for 229 UK programmes.
language therapists Beth Tidmarsh and able to get this project off the ground:
Emma Bailey, ‘The Voice of Upper these patients are central to our care, National standards of care were
Airway’ group meets several times a and it’s been amazing because we’ve analysed under seven key
year to hear the about the latest been able to include them in shaping performance indicators (KPIs),
treatments and advice on managing how the group is run.” including how quickly the service
conditions. gets patients into rehabilitation
Group member Florest Cambran from after their cardiac event, how
Members are also able to share and Wallington, South London, said: “I find thorough the assessments are
potentially learn from each other’s myself gasping for breath and I’ve and the length of time spent
personal experiences, and provide ended up hospitalised on numerous using the service. To achieve
feedback about their care. occasions. Even though I am an green status, services must meet
intensive care nurse and used to all seven KPIs.
Dr Selby said: “Most of the patients in helping others, when you can’t
the group have incredibly debilitating breathe yourself it is absolutely Heather Probert, specialist
coughing fits on a regular basis. These terrifying. physiotherapist in cardiac
can make it hard to carry out even the rehabilitation, said: “The team is
most basic daily tasks. Some even end “I have been following prescribed incredibly proud. This certification
up in hospital requiring urgent care – speech and language exercises, which is proof that our patients are
with clinicians unsure about the have really helped, but I’m looking receiving the best possible level of
proper method of treatment for their forward to getting more support from cardiac rehabilitation.”
condition. this group.”
Royal BRompton & HaRefIeld nHS foundatIon tRuSt | 29You can also read
