The North Middlesex Hospital turns down the Royal Free

The board of North Middlesex University Hospital Trust has decided not to pursue the proposal that the trust become a full member of the Royal Free London group, basing its decision on the absence of a sufficient clinical or economic case and the lack of support from either stakeholders or the public served by the hospital.

Unanimous decision

The idea that the North Mid should join the Royal Free group dates from the time of the crisis in the North Mid's A&E department, and in March 2016 a memorandum of understanding was signed which envisaged that the Edmonton-based hospital would join the Royal Free group "within 12 months".  However, at the board's meeting on 4th October the decision not to proceed was unanimous.

The board's decision was preceded by a period of consultation about the "Case for Change" with stakeholders, hospital staff and members of the public in both Enfield and Haringey.  According to trust chair Dusty Amroliwala, quoted in a press release, "What we consistently heard is that, although they are supportive of the existing clinical partnership, they do not want us to move into full membership of the Royal Free London group.

“We also examined carefully the clinical and economic cases, and we found that neither supports closer convergence. On this basis, the Board resolved not to pursue full membership of the group.”

"Risks to stability, local accountability and highly valued services"

The words quoted above in the press release are in fact a very mild reflection of the conclusion of the report that the board considered at its meeting and which evidently formed the basis of their decision not to proceed.  The paper, entitled The Case for Change, concludes

...[W]e have received a significant weight of evidence that becoming a full member of the RFL group could risk the stability, local accountability and highly valued services particular to our local communities, and that the advantages of RFL membership would be substantially dwarfed by the disadvantages it would have on North Mid and its local populations.

The Case for Change paper is available on the North Mid's website, though buried in the middle of a file with all the paperwork for the meeting. It was written by the trust's strategic development and finance directors and its 80 pages contain a useful survey of the population served by the North Mid, the specifics of their health needs, the availability of primary health care, the high prevalence of mental health problems, the recent history of the North Mid since the closure of the Chase Farm A&E department, progress in recovering from the crisis in the North Mid's A&E in 2015/2016, the trust's poor financial position, recruitment and retention problems, the hospital's particular medical specialisms and other relevant information.

The report goes on to provide information about the Royal Free London Hospitals Foundation Trust - foundation trusts enjoy a greater degree of autonomy than NHS trusts such as the North Mid.  The Royal Free London has 20 sites in all, the three main ones being the Royal Free in Hampstead, Barnet Hospital and Chase Farm Hospital.  It has set up wholly owned subsidiaries, including one that manages outpatient pharmacy dispensing at Chase Farm and is set to operate also at Barnet and the Royal Free in Hampstead. 

A section analysing the (very poor) financial position of both trusts includes the conclusion that "Evidence / assurance from Royal Free has not been of adequate depth for a closer convergence to be recommended from an economic perspective".

"Of significant detriment to the population served by the North Mid"

A section about feedback from the consultation processes describes a pretty damning reaction across the board. 

MPs "clearly articulated their opinion that services must continue to be delivered and developed around the needs of the patient population which is quite specific to NMUH. They want the hospital to be accountable for delivery in this locale." 

Both Enfield and Haringey clinical commissioning groups had "significant concerns about North Mid developing a closer partnership with Royal Free London group. These concerns related to finance, staff and organisational stability, and the scale of clinical benefits which would be delivered by a closer relationship." 

Among local stakeholders "there was a very clear and strongly held view" that the proposal "would  be of neutral assistance at best, unnecessarily disruptive with insufficient positive return on investment at next, and of significant detriment to the population served by NorthMid at worst".

Facilitating discussion

Among the appendices are reports from Healthwatch Haringey and Healthwatch Enfield about the consultation events organised by both.  The Healthwatch Enfield report is particularly thorough.  Its staff have clearly done an excellent job in facilitating discussion and in capturing the ideas that were generated.  Many people are sceptical about "consultations", sometimes justifiably so, but in this case it has been done well and has contributed towards the final decision.