Case Study

1
Building a hospital for the 21st century Andrew
Woodhead Chief Executive Royal National
Orthopaedic Hospital
Case Study
2
Andrew Woodhead

• Director Appointed
• West London Partnership Forum May 1999
• Strategic Director
• Royal Brompton Harefield NHS Trust June 2000
• Project Director
• Paddington Health Campus October 2002
• Chief Executive
• Royal National Orthopaedic Hospital NHS
  Trust June 2003

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Controversial plans for hospital closure
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Three Specialist Hospitals
London
H
Royal National Orthopaedic Hospital (RNOH)
H
H
Harefield Hospital
Royal Brompton
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Royal Brompton Hospital
280 Bed Heart Lung Hospital (adults children)
Mr Anthony de Souza performing robotic endoscopic
surgery as developed by Professor John Pepper
(inset)
Major research programme in heart and lung
medicine

• Cardiac Surgery
• Lung Surgery
• Cardiological Investigations
• Respiratory Medicine
• Cardiovascular Research

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Harefield Hospital
190 Bed Heart Lung Hospital (adults children)
Professor Sir Magdi Yacoub and Derrick Morris, 20
years after heart transplant
Artificial Heart implantation as a bridge to
transplantation

• Cardiac Surgery
• Lung Surgery
• Cardiological Investigations
• Cardiovascular Research
• Transplantation programme

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Royal NationalOrthopaedicHospital (RNOH)
Major strength in post-operative rehabilitation

• 200 bed specialist orthopaedic Hospital

• Spinal deformity surgery
• Spinal injury surgery
• Bone tumour service
• Peripheral nerve injury
• Joint reconstruction
• Rheumatology rehabilitation

Expertise in complex orthopaedic surgery
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Concerns about our current hospitals

• Are some clinical teams too small?

Clinical teams are often small and reliant on a
few key individuals

• Are our resources stretched too thinly?
• Do we have unfulfilled research potential?
• In some areas we have a poor standard of
  accommodation
• Many of out buildings are not fit-for-purpose

Harefield Hospital - originally built as a TB
hospital. Buildings old and in need of
investment
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Fragmented expertise old buildings

• Complex cardiac surgery at four hospitals
• Complex surgery and complex investigations on
  children at five hospitals
• Research spread across many hospital sites and
  the main Imperial College campus
• Many buildings old and not designed for modern
  health care delivery

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Innovation !
CD ROM Training programme For GPs and hospital
doctors
National Cartilage transplant programme
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Old buildings not fit-for-purpose
Harefield Hospital
Royal National Orthopaedic Hospital
Royal Brompton Hospital
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Proposed solution

• Close the Royal Brompton and Harefield Hospitals
  and move services into new Paddington development
• Keep Royal National Orthopaedic Hospital on
  current site, with new buildings

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Two hospitalsto close
London
H
Royal National Orthopaedic Hospital (stays
open) Harefield Hospital (closes) Royal
Brompton Hospital (closes)
H
H
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Paddington Health Campus

• A 800m development in central London

A new Royal Brompton and Harefield
Hospital alongside a multi-specialty Teaching
Hospital
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Royal National Orthopaedic Hospital to be
re-developed

• 125m development
• New buildings
• Redesigned models of care
• Integrated diagnostic treatment centre

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Are large multi-specialty centres better than
single specialty centres?
.the Joint Consultants Committee has
recommended to the Department that all acute
medical services (like cardiac surgery) should
normally be provided on a multidisciplinary acute
medical site such as a teaching hospital or a
large district general hospital. You will, I
trust, understand why concerns have been
expressed about the adequacy of the Harefield and
Papworth sites (among others) in this respect for
some years. Letter from NSCAG December 2000
Does the greater distance to travel due to
concentration deter patients from attending?
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Do larger volumes of activity lead to better
outcomes?

• Yes up to a point
• - individuals and teams
• able to specialise
• only relevant for very
• small centres

Are larger hospitals more efficient?
Yes but over 1000 beds introduces diseconomies
of scale
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Is the outcome of such a change worth the cost in
terms of disruption to current care?
Is it ever possible to convince the public that
it is best to close a hospital?
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Conclusions

• We cannot continue to undertake complex surgery
  in old and inadequate buildings

• We need a more rationale distribution of
  specialist services and expertise

• We must address the fragmentation of specialist
  services and associated research

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Conclusions

• Single specialty hospitals do have a
• future role in the NHS eg RNOH

• Complex surgery on patients with multi-organ
  failure needs to take place on a multi-specialty
  site eg Paddington Health Campus

• Must take into account the cost of the
• change staff morale and patient confidence

• Need to find ways of engaging with the public and
  maintaining their confidence in planned changes