| Royal Brompton Hospital | |
| Royal Brompton and Harefield NHS Foundation Trust | |
|---|---|
| Geography | |
| Location | Brompton, Kensington,, London, England, United Kingdom |
| Organisation | |
| Care system | Public NHS |
| Hospital type | Specialist |
| Affiliated university | Imperial College London |
| Services | |
| Emergency department | No Accident & Emergency |
| Beds | Roughly 350[1] |
| Speciality | Heart and lung hospital |
| History | |
| Founded | 1847 |
| Links | |
| Website | http://www.rbht.nhs.uk/ |
| Lists | Hospitals in England |
Royal Brompton Hospital is the largest specialist heart and lung centre in the United Kingdom (UK).[2]
The hospital is part of Royal Brompton & Harefield NHS Foundation Trust is a national and international specialist heart and lung centre based in Chelsea, London and Harefield, Middlesex. The Trust helps patients from all age groups who have heart and lung problems and is the country's largest centre for the treatment of adult congenital heart disease.
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In the 19th century, consumption was a common word for tuberculosis. At the time consumptive patients were turned away from other hospitals as there was no known cure. Hospitals that dealt with such infectious diseases later came to be known as sanatoriums. The prospectus for the Hospital stated that for the last 6 months of 1837 out of 148,701 deaths from all causes, 27,754 were from consumption.
The hospital was founded in the 1840s by Philip Rose, the first meeting to establish the Hospital was on 8 March 1841. It was to be known as The Hospital for Consumption and Diseases of the Chest. It amalgamated on 25 May 1841 with The West London Dispensary for Diseases of the Chest, which was based at 83 Wells Street, near Oxford Street. Little is now known about the Dispensary. On 28 March 1842, an out-patients branch of the hospital was opened at 20 Great Marlborough Street. Later that year they acquired a lease on their first building for in-patients at The Manor House, Chelsea, which held space for 20 beds and the first in-patients were admitted on 13 September 1842. Admittance was to be by the then customary method of recommendation by the Governors and subscribers. Manor House remained in use as a convalescence home after the hospital had moved to the Brompton site.
In common with other hospitals at the time, the hospital was to be financed entirely from charitable donations, legacies and fund raising. Rose travelled the country to explain the aims of the hospital, setting up 14 provincial associations, 157 churches promised to preach special sermons as a means of fund raising. The famous singer, Jenny Lind also gave concerts, including one at Her Majesty's Theatre in July 1848, which raised £1,606.
Besides Philip Rose, the early supporters included William Augustus Guy, Charles Dickens, and Queen Victoria, who became a patron, with an annual subscription of £10.
The area known as Brompton was no more than a village surrounded by market gardens, but quickly developed in the 1840s. The hospital acquired a market garden site there from a charity to erect a new hospital, with the architect being Frederick John Francis. The stone laying for the west wing was on 11 June 1844 by Prince Albert, the Prince Consort, the building being described as a beautiful Elizabethan building with red brick and blue diapering with Portland stone mouldings. One of the features of the building was the inclusion of ventilation by forced warm air in an attempt to create a temperature more commonly found in more southern latitudes. The total cost for the west wing and part of the centre was £11,762. The first admission of patients was in 1847. Whilst the east wing was completed in 1849.
The hospital acquired houses on the south side of the Brompton Road in 1868 with a plan to connect to the main building with a tunnel, which was completed in 1873. The hospital continued to purchase houses on the south side and eventually developed the site to become the south block of the Brompton, which was formerly opened by the President of the Corporation, The Earl of Derby on 13 June 1882. Without the bequest of Miss Cordelia Angelica Read of some £100,000 the hospital may never have been built. The building was in an "E" shape and constructed of red brick and Ancaster stone. The basement contained a compressed air room and a Turkish bath[3] (both of which were considered beneficial to tuberculosis sufferers at the time. There were also facilities for a large outpatients department, rooms for resident staff and a lecture room and ten wards holding from 1 to 8 beds. The total cost was said to be £65,976.
On 13 September 1900 the Hospital acquired 20 acres (81,000 m2) of planted forestry at Chobham Ridge (which is 400 feet (120 m) above sea level), two miles (3 km) from Frimley Railway Station for £3,900. The architect, Edwin T. Hall, designed a two-storied stellate block, rising to three-stories for the centre, the four radial pavilions would contain the majority of wards, most of which would be single bedded and the ability to wheel the beds onto a terrace to "be under the full influence of the sunshine and the atmosphere." A second group of buildings was to contain dining rooms, recreation rooms, kitchens and offices and accommodation for medical staff. Besides accommodation for staff, 2 houses and a nurses block, no further buildings were erected on the site until its closure in 1985.
The formal opening of the sanatorium was on 25 June 1904 with the ceremony performed by the Prince of Wales (later King George V), but because of unresolved problems regarding heating, plumbing and staff the first patients weren’t admitted until March 1905.
Marcus Paterson, who had been a house physician at the Brompton from 1901, accepted a post at Frimley in 1905, becoming the Medical Superintendent in January 1906. Paterson was known to say, “it would make them (the patients) more resistant to the disease by improving their physical condition.” To this end he introduced what was one of the first attempts at systematic rehabilitation.
At an International Congress on Tuberculosis held in 1908 in Washington, USA the $1,000 first prize was shared between Frimley, for a model of the sanatorium, which had partly been made by patients, and an American institution,. Further awards of $500 went to Paterson for his essay on Frimley and $1,000 to Arthur Latham, an assistant-physician at The Brompton for his paper on the treatment of more advanced cases of tuberculosis.
In 1850 The Medical Committee decided to build a small sanatorium in Bournemouth, to be financially independent, to "receive those cases where convalescence has been established." Although more of a convalescent home, rather than a sanatorium as the word was understood later, it was the first of any such establishment anywhere in the world. It was specially built, the architect being E B Lamb, who had previously built the chapel attached to the Hospital in Brompton Road. The sanatorium opened in October 1855. Later to become independent of the hosptial and known as The Royal National Sanatorium : Bournemouth. The site has now been re-developed into a retirement complex known as "Brompton Court," but the chapel has been retained.
The Hospital paid for the passage of 20 patients with tuberculosis to be taken to Madeira on the ship, Maria Pia, which set sail on the 7 November 1864. When the patients returned some months later it was discerned that there had been no noticeable improvement in the patients and the experiment was discontinued.
Towards the end of the 19th Century the idea that sea air could be beneficial grew in popularity in medical circles and the Hospital, with help from the London Samaritan Society sent people to Bournemouth and Sandgate. This was discontinued in 1900 with the future development at Frimley in mind.
The hospital erected a hut at St. Andrew's Home, Hayling Island in 1922, to receive "the most miserable, undersized and debilitated children" attending the dispensary, 37 children were sent the first year. The children were chosen from the poorest homes, no lessons were given but "organised games and eurythmics" were the order of the day. Later another hut was built for children not living in Chelsea. St. Andrew's Home closed in 1932.
Harefield Hospital is a national and international leader in the treatment of heart and lung disease and is renowned for its pioneering transplant unit.
Harefield Hospital is one of the largest and most experienced centres in the world for heart and lung transplants. In 1983, a team of doctors led by the eminent Prof Sir Magdi Yacoub performed Britain’s first heart-lung transplant.
In 2005 the trust took on a new CEO, Bob Bell, who had previously been president and CEO at the William Osler Health Centre in Canada.[4]
In 2009 Royal Brompton & Harefield became a foundation trust inside the NHS, giving it new freedom to run its own finances and borrow money."Foundation trust". Royal Brompton & Harefield NHS Foundation Trust. http://www.rbht.nhs.uk/about/our-work/foundation-trust/. Retrieved 2009-09-27.
On Monday 5 July 2010, the new National Institute for Health Research (NIHR) Respiratory Biomedical Research Unit (BRU) Clinical Research Facility opened at the Royal Brompton Hospital. Funded and supported by the NIHR and the Royal Brompton Hospital Charitable Trustees, the Respiratory BRU puts the Trust and its academic partner Imperial College London at the forefront of international research into the most challenging lung conditions. It aims to:
On Monday 15 November 2010, the new National Institute for Health Research (NIHR) Cardiovascular Biomedical ResearchUnit opened at Royal Brompton Hospital, a joint initiative with academic partner Imperial College London.
As part of the NIHR, the cardiovascular BRU puts the Trust and Imperial at the forefront of international research into the most challenging heart conditions.
Research at the cardiovascular BRU will concentrate on increasing the understanding of poor heart function in people living with cardiomyopathy (inherited heart muscle disease), arrhythmia (irregular heart-beat), coronary heart disease and heart failure. This will be achieved by:
In November 2011, Royal Brompton Hospital was named as one of only five hospitals in the country that will offer extracorporeal membrane oxygenation (ECMO) to adults in an initiative that positions England as one of the leading countries in the world for the provision of this treatment. The other hospitals are: Guy’s & St Thomas’ NHS Foundation Trust, Papworth Hospital NHS Foundation Trust, University Hospitals of Leicester NHS Trust and University Hospital of South Manchester NHS Foundation Trust. Read more about Royal Brompton's ecmo and severe respiratory failure service.
Congenital heart disease is an abnormality in the heart that develops in the womb and is present at birth. Around one in every 133 children is affected[6] . It is a life-long, and potentially life-threatening, condition.
Children’s heart surgery is complex and becoming increasingly specialised. It is currently provided in 11 centres across England. Following longstanding concerns that some congenital heart services for children are too small to be able to deliver a safe and sustainable service, the National Specialised Commissioning Team undertook a review into the future of children’s congenital heart services in England led by the Safe and Sustainable Team.
In February 2011, the recommendations from the review were agreed by the Joint Committee of PCTs (JCPCT), and the National Specialised Commissioning Team then began a public consultation on the options, which recommend that the number of specialist centres in England is reduced from 11 to six or seven.
It is proposed that despite Royal Brompton Hospital’s exceptional performance, size and safety record, the service is closed because London only requires two centres to develop a congenital heart network and that Great Ormond Street Children’s Hospital and the Evelina Children’s Hospital are the preferred options for this.
• The Trust’s performance is rated ‘excellent’ by the Care Quality Commission and its record in children’s heart services is particularly strong: the Trust has an aggregate mortality rate of 0.94% for congenital interventions and surgery, against a national average of 2%.
• The pre-business case review recognised the hospital's excellence, ranking its service joint third with Great Ormond Street out of all 11 centres in England.
• Royal Brompton Hospital has an international reputation for its specialist paediatric services. Its experts sit on, and chair, international advisory panels and professional bodies throughout the world and share their knowledge through teaching both in the UK and abroad. Their research collaborations cross international boundaries.
Royal Brompton & Harefield NHS Foundation Trust argues that closing cardiac services for children will have a negative impact on other services and disciplines such as intensive care and anaesthesia. The Trust believes the consultation neglected to take account of the wider implications that removing children’s cardiac surgery will have on the Trust and its patients, particularly adult congenital heart disease patients and respiratory patients. Both anaesthesia and intensive care are needed for many respiratory procedures, such as high-risk bronchoscopy.
The hospital hosts the largest service for children with cystic fibrosis in the country and together with the adult CF unit, it is considered one of the leading centres in Europe.
In response to these concerns, the JCPCT commissioned an independent panel, led by Adrian Pollitt, to investigate the viability of children's respiratory services at hospital. In its report, which was published in September 2011, the panel concluded that respiratory services would remain viable at the Royal Brompton Hospital if children’s heart surgery services were moved. The Trust strenuously disagreed with this conclusion and quoted directly from page 4 of the report: "the removal of paediatric cardiac surgical services from the RBH site would render the PICU (Paediatric Intensive Care Unit) unviable. The panel further agrees that anaesthesia provision is essential to maintain paediatric respiratory services, and that a reduction in paediatric surgical activity would affect the ability of the RBH to provide anaesthesia services for children in their current form"[7]. The Trust believes the suggestions in the report equate to a downgrading of its services and expressed new concerns that the reports suggestions may not meet minimal safety requirements. Read statements from both Safe and Sustainable and Royal Brompton & Harefield NHS Foundation Trust in regard to this independent report.
In March 2011, Royal Brompton & Harefield NHS Foundation Trust issued legal proceedings against the Joint Committee of PCTs (JCPCT) in respect of the proposal to end paediatric cardiac surgery at Royal Brompton Hospital, as part of the ‘Safe and Sustainable’ review. The Trust’s board believed that the recommended options put to public consultation were fundamentally flawed, such that a consultation based on them would be unlawful. Two separate approaches were made to the JCPCT in order to avoid legal action but were rejected. Thus the Trust applied for judicial review, challenging the legality of the consultation.
On 15 July 2011 the Trust was granted permission for a judicial hearing regarding the Safe and Sustainable consultation.
More information about the Safe and Sustainable review and the Trust’s response to it is available on both the Safe and Sustainable website and the Trust's website.
On 7 November, Mr Justice Owen concluded that the consultation on the ‘Safe & Sustainable’ review of children’s heart surgery was unlawful. Justice Owen stated that Royal Brompton & Harefield NHS Foundation Trust’s challenge to the consultation succeeds on the grounds that the consultation process was unfair to the Trust: "…the unfairness being of such a magnitude as to lead to the conclusion that the process went radically wrong". He concluded: "…in my judgement the consultation exercise was unlawful, and must therefore be quashed." Read the hospital's press release here.
The JCPCT lodged an application to appeal Justice Owen's decision on 24 November 2011.
The Seven Ages of The Brompton (A Saga of a Hospital) by P. J. Bishop, B. D. B. Lucas And B. G. B Lucas. Published by the Board of Governors, Royal Brompton National Heart and Lung Hospitals, 1991. ISBN 0-9506669-3-9
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