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north middlesex hospitalThe 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.


Press release on the NMUH website

Papers for the NUMH board meeting on 4 October 2018 (The Case for Change report and its appendices buried about a third of the way through this large PDF file)

Healthwatch Enfield report on the Case for Change consultations

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Julia Mountain's Avatar
Julia Mountain posted a reply #4100 08 Oct 2018 08:44
Excellent summary and a good decision by the NMUH board. I took part in one of the Healthwatch Enfield consultation events and it was clear that stakeholders present did not see significant advantage to the local community in NMUH becoming a full member of the Royal Free London Hospital group.
Sue Davies's Avatar
Sue Davies posted a reply #4103 09 Oct 2018 09:35
Very pleased to find that the NMUH took a local decision after a thorough review of the options
PGC Webmaster's Avatar
PGC Webmaster posted a reply #4104 09 Oct 2018 14:37
Healthwatch Enfield have today issued a press release about the North Mid decision and the report on consultation with Enfield residents and stakeholders.

Royal Free will not be taking over North Mid

At its meeting on 4th October 2018, the Board of North Middlesex University Hospital NHS Trust considered the case for proceeding to full membership of the Royal Free London (RFL) group. The Board unanimously decided not to pursue this option, but reconfirmed the Trust’s commitment to continuing as a clinical partner in the RFL group.

Throughout June and July 2018, Healthwatch Enfield involved local residents and stakeholders in conversations about the future direction of the hospital, including the option of North Middlesex University Hospital NHS Trust becoming a full member of Royal Free London NHS Foundation Trust such as Barnet and Chase Farm Hospitals, which were acquired by Royal Free in 2014.

Enfield residents agreed that North Mid faces significant challenges. These include (but are not limited to): inappropriate use of A&E and the ability to deliver high quality care through services that meet local needs, whilst providing good patient experience, recruitment and retention of staff and addressing the financial deficit of the trust. Although there was no consensus on the best way forward to address these, local people said that:

  • opportunities for closer working with other organisations such as primary care and community services, including the possibility of sharing resources and budgets to improve patient care, could be explored

  • the option of a full membership of the Royal Free London NHS Foundation Trust to address the hospital’s challenges could not be agreed on as an appropriate assessment could not be undertaken due to insufficient information being available.

Enfield residents were however in agreement on their expectations of any partnership North Mid considers. The criteria include: bringing additional money and resources; an ability to clearly demonstrate benefits and how services could be improved for local people; understanding of the local population’s needs and how to deliver services effectively; guaranteeing that North Mid remains accountable to local people and stakeholders and demonstrating what additional support would be provided to staff working at North Mid.

The findings from Healthwatch Enfield’s engagement and outreach activities were analysed and presented as a report, ‘Informing the future direction of North Mid’, which formed part of the evidence base considered by the directors at North Mid on 4th October 2018.

Patricia Mecinska, Chief Executive of Healthwatch Enfield, said: ‘We would like to recognise the leadership at North Mid for delivering on their commitment to involve patients in conversations about the future direction of the hospital. At Healthwatch Enfield, it is our job to bring the voices of local people to decision-makers and the report we presented does just that. We will continue to work with our residents and listening to their experiences to ensure North Mid develops in a way that responds to local needs as it looks towards the future and any potential partnership models’.

The Healthwatch consultation report is at the following link:

See also...

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