September 2026
The brief brings together key monthly updates from across the trust. The ‘golden thread’ highlights how each story connects to our objectives – linking our work, our people and the care we deliver. Key to abbreviations: Barnet Hospital: BH Chase Farm Hospital: CFH Group clinical services: GCS North Middlesex University Hospital: North Mid Royal Free Hospital: RFH Royal Free London: RFL the brief: the golden thread for RFL conversations 2 • BH and CFH see page 9 • GCS see page 10 • North Mid see page 11 • RFH see page 12 • Essential figures see page 13 • Highlights, challenges and mitigations see page 14 • Temporary staffing expenditure see page 15 • Backing breakthroughs in kidney care see page 16 • Medicine for Members event see page 17 • Our shared commitments see page 3 • Staff survey see page 4 • Flu vaccination see page 6 • Latest national results see page 7
Our shared commitments: supporting the conversation We're making great progress in embedding our new shared commitments across our trust If you have been identified to be a conversation leader, support is now available to help you prepare for and facilitate your team’s shared commitments conversation. Available support includes: • Bite-size learning and a confidence check-in • A practical toolkit with planning resources, facilitation guides and team charter templates • Online learning clusters to share experiences and ask questions • In-person workshops to build confidence and facilitation skills All conversation leaders are asked to complete the essential learning before holding their team conversation and submitting their team charter. For full details on the support available and how to access it visit the shared commitments Freenet page. 3 Watch our shared commitments film
Shaping the workplace: the NHS Staff Survey Every minute of every day colleagues from across the RFL are making a difference to thousands of patients and families. Whether you are on the ward, in a patient’s home, in a clinic or working behind the scenes, your skill, compassion and commitment are helping us improve care and give more patients access to pioneering treatments and research. We want colleagues to have the support, information and opportunities you need to do your best work, and feel valued, safe and respected. The newly launched NHS Staff Survey plays an important role in understanding your experience of working at the trust. Alongside conversations within teams and other opportunities to share feedback throughout the year, it helps build an honest and balanced picture of staff experience across our hospitals, services and health units. By taking part, you can help us understand what enables colleagues and teams to provide great care and where we should focus our efforts next. Find it on your email – search ‘iqvia’ – and have your say now. Watch our staff survey film. 4
You said. We listened. We acted. Feedback from the staff survey, alongside listening events, staff networks and other channels, helps us understand what matters most to colleagues and where we need to focus our efforts. 5 Creating a more inclusive organisation • We have strengthened our work on equality, diversity and inclusion through Freedom from Racism. We have also introduced our shared commitments, setting clear expectations for how we treat and support one another. Creating a safer workplace • Staff feedback has shaped our sexual safety programme. We have introduced training and resources, anonymous reporting routes and specialist support, while expanding our Freedom to Speak Up service so colleagues can access confidential advice and raise concerns. Supporting you to do your best work • We have continued to invest in wellbeing support, leadership engagement and practical improvements to working environments. Your feedback also shaped how we embedded our clinical operating model, and the upcoming people strategy. Keep an eye on Freenet for further changes that have come about from staff completing the survey, and improvements and updates from across our health units.
Get ready to give flu the cold shoulder Our vaccine clinics will be open across our sites from Thursday 1 October, offering the flu vaccine for free to all our staff. As the days get colder, flu will spread more easily and cases will increase across our hospitals. It’s important to get vaccinated as soon as possible to make sure you’re able to protect yourself, your colleagues and your patients this winter. Take our quick quiz to make sure you have the information you need to help fend off flu. Estimations found flu vaccinations prevented around 104,000 hospital admissions and 7,100 deaths last winter. By getting vaccinated, you can help protect staff, patients and visitors from the virus and help ensure our services can run smoothly throughout our busiest season. For further information go to Freenet. Details of how you can book your vaccine will be available there soon. 6
RFL continues to deliver strong improvements in latest national results The RFL has made progress in the latest national oversight framework (NOF) results, with strong improvements across a range of key areas including operational and financial delivery as well as quality and safety metrics. We continue to perform well particularly in cancer care, clinical outcomes and patient experience. We are ranked 15th nationally for the percentage of patients treated within 62 days of an urgent cancer referral. We also rank 5th nationally for reducing delays in patient flow. NHS England has published the quarter 1 NOF results, which measure rank and support the performance of trusts across the country. Our average score for this period is 2.30, where 1 is high performing and 4 is low performing. The trust ranks 49th out of 134 acute providers nationally, climbing from 52nd in the previous quarter. Group chief executive, Peter Landstrom, said: "This is a strong set of results and I can see how everyone’s efforts are paying off. We know there is more to be done but by continuing to focus on quality and timeliness of the services we provide we are ensuring patients are at the heart of everything we do." The RFL remains in segment 3 overall. Although our underlying performance would place us in segment 2, a forecast financial deficit for 2026/27 means we are unable to move to a higher segment despite robust clinical and operational performance. 7
National oversight framework results 8 Access to services: 3 Over 80% of patients were seen within four hours in urgent and emergency care (23rd out of 123). We also achieved a top score for the proportion of patients wating less than 18 weeks for community care, with over 78% of patients seen within the national standard. Effectiveness and experience of care: 1 Our score has jumped from the bottom quartile to the top. We are ranked 3rd nationally for delayed inductions, reflecting a strong maternity performance. There was also excellent progress made in supporting patients to improve their health through tobacco dependence treatment services. Patient safety: 2 Our clinical safety ranked in the top quartile and work is ongoing to strengthen infection prevention and control including reinforcement of hand care hygiene. People and workforce: 3 While we continue to score strongly in this domain with regards to staff sickness levels we are looking to engage more with staff in relation to improving the flu vaccination rate this winter. Finance and productivity: 3 Our productivity performance places us 52nd among all acute trusts nationally.
9 Championing frailty research Two consultant geriatricians have been appointed to support the delivery of frailty research, marking an exciting development for BH’s clinical strategy priority of ‘ageing well’. Their work aims to establish an integrated research model, strengthening frailty research infrastructure and build collaborative partnerships across our research networks. They will focus on current National Institute of Health and Care Research (NIHR) priorities including dementia, long-term conditions and community care. Creating a newly expanded multidisciplinary team who care for older people and are able to carry out research is another key goal for colleagues. They hope to embed a culture where frailer and older patients are proactively included in clinical research across the hospital. BH treats one of the largest elderly populations in London and currently older adults (aged 65+) make up 14% of Barnet’s population. New discharge lounge set to double capacity A new discharge lounge is opening at BH this month, aiming to improve patient flow within the hospital and patient experience. The new space which doubles the previous offer is based near the front of the hospital. It has four trolleys, four recliner chairs and eight high-backed chairs for patients. The lounge becomes the first to facilitate patients on trolleys within a discharge area at BH. Staff will also be able to administer intravenous medications, insulin and oxygen therapy (for those on long term oxygen therapy) to patients waiting in the lounge. The refurbished area is also set to improve patient dignity as the new location has its own exit into the transport and parking bays. The dedicated space will enable patients to be moved from inpatient beds earlier in the day, improving capacity, as well as providing a safe and positive patient experience before leaving hospital.
10 Staff survey 2025: You said … we did Staff feedback from the staff survey leads to meaningful change. Since last year’s survey the Community Diagnostic Centre introduced a monthly staff newsletter sharing employee and team successes and updates. In addition, BAME staff in the CDC pharmacy team completed the WITH:STAND programme. Plus, the September audit day in admissions is being used to introduce new inter team buddy systems. Pharmacy have improved consistency and equity of access to development opportunities. Pathology have established dedicated team meetings and supported more flexible working where possible. Radiology nursing has introduced daily team huddles, roster redesign and staff listening sessions. Imaging workshops are championing key actions important to staff. HPB and liver transplant inpatients test change An audit on 9 West ward at RFH identified the routine use of coagulation screens in HPB and liver transplant inpatients where a full coagulation profile was not always clinically required. Following a review of practice, the team has implemented a change to order INR/PT testing only, unless a full coagulation screen is clinically indicated. The change was communicated to clinical teams and embedded into routine practice. As a result, coagulation screen requests have reduced by over 50%, improving the appropriateness of testing while reducing unnecessary investigations. Given the cost of an INR/PT test is approximately one third that of a full coagulation screen, the initiative is expected to deliver annual savings of £32,000. Five-year milestone for the Community Diagnostic Centre Finchley Memorial Hospital Diagnostic Centre (CDC) has celebrated its fifth anniversary. Since it opened in the summer of 2021 the CDC has carried out more than 619,000 tests and scans and seen more than 540,000 patients. In the past year alone – to July – 158,000 patients were seen and 191,000 tests or scans were done. That’s equivalent to approximately 432 patients every day. Five years ago the CDC launched with just seven staff and equipped to carry out seven different kinds of test. Now it has approximately 169 staff who carry out 25 different tests. The most recent additions to the roster include audiology, additional echo, plus transnasal endoscopy and capsule sponge tests. Orderset review While ordersets are valuable tools that support efficient and consistent test requesting, they also require regular review to ensure alignment with current clinical practice. A review of Emergency Department ordersets across BH and the RFH led to the refinement of six ordersets, This work has improved the quality and appropriateness of test requesting, reduced waste, and supported more effective use of laboratory services. The initiative is projected to deliver annual savings of more than £500,000 across the trust. Similar orderset reviews have also been undertaken in other specialties, including gastroenterology, hepatology and respiratory medicine, helping to embed high-value, evidence-based care organisation wide.
11 Operation Zero Staff from across the trust joined forces with partner organisations in north London as part of a new project aimed at reducing corridor care across the hospital earlier this month. Operation Zero encompassed eight days of intense activity which saw directors, the transport team, estates, domestic staff, porters and discharge teams work closely with colleagues from Enfield and Haringey councils, London Ambulance Service and North London Foundation Trust to ensure as many patients as possible could be discharged in a timely manner and reduce the need for corridor care. Meetings were stepped down and a "command and control" structure was put in place in a bid to improve patient flow and reduce waiting times in the emergency department The project came to a close at 4pm on Monday 14 September and all the data from the week is being collected and analysed to establish the impact of Operation Zero and to learn any lessons which could be used to improve patient flow across the trust. Doctor’s learning course earns praise A consultant who helped create a postgraduate course on learning disability medicine has had her brainchild recognised by the World Health Organisation (WHO). Dr Charly Annesley was the first consultant learning disability physician and geriatrician in the country when she joined North Mid in 2019. She quickly decided she wanted to give others the opportunity to develop the same skills and knowledge she had, which set her on a remarkable journey that has culminated in the WHO describing the postgraduate certificate she helped establish as an exemplary example of disability-inclusive health. “It’s insane,” reflected Dr Annesley. “I’m just a normal person working at a district general hospital and to see this recognition is massive.” The one-year learning disability medicine postgraduate certificate Dr Annesley codesigned is delivered jointly by the Royal College of Physicians and Edge Hill University, with funding from NHS England. Asthma-friendly school leads the way Bowes Primary School has become the first school in Enfield to achieve 'Asthma Friendly School' status, following close partnership work with our community school nursing service and Enfield Council. At a celebration event during Ask About Asthma week, headteacher Rebecca Moore and pupils were presented with their Asthma Friendly School certificate by representatives of the council and nursing team. Eunice Chigwanda, community clinical service lead for babies, children and young people 0– 19, said: “Our school nursing service has been working closely with Enfield Council and schools across the borough to strengthen asthma awareness and ensure that pupils with asthma receive the right support." "We are pleased to celebrate Bowes Primary School’s achievement and look forward to supporting more schools to meet the standards.” Thirteen more schools in Enfield are working towards accreditation.
12 First patients receive treatment as part of worldwide pancreatic cancer drug trial The first two UK patients recruited and randomised to a worldwide study for a pancreatic cancer drug received their initial treatments at the RFL this month. The RIVER study aims to establish the best dose for a drug, Ponsegromab, which may prevent extreme weight loss, known as cancer cachexia, during chemotherapy. Patients with pancreatic cancer often find it difficult to continue treatment because a stressinduced hormone is released which diminishes their appetite, leading to weight-loss and muscle wastage. Consequently, they become too frail and weak to tolerate chemotherapy. By suppressing this hormone, it is hoped patients can remain strong enough to continue treatment, which can extend their lives. The trial is being led at the RFL by oncologist Robert Goldstein. Royal Free Hospital celebrates Southeast Asian Heritage Month Teams at the RFH celebrated Southeast Asian Heritage Month in the atrium. The event brought together people from different backgrounds to celebrate the richness of East and Southeast Asian cultures within our NHS community. What makes this event special is that it’s been driven by staff volunteers – people giving their time, talents and passion to make it happen. The celebration commemorated the rich and diverse backgrounds of our colleagues with cultural fashion shows, performances and food. The event took place ahead of National Inclusion Week, celebrating the power of togetherness, encouraging us to create environments where everyone feels valued, respected and included. New art donation for children's emergency department Children visiting the RFH’s paediatric department can now escape into a world of colourful characters thanks to new art from the Royal Free Charity’s collection. Research shows that art can reduce anxiety, offer moments of escape and help patients, staff and visitors feel comforted in clinical environments. The colourful artwork will help make the hospital environment a little brighter, giving young patients a distraction during their visit. The Royal Free Charity’s curated collection of 1,900 pieces across the RFL helps support wellbeing. With support from an expert advisory board made up of trust staff, members of the north London community, artists and collectors, Royal Free Charity art curator Joss Blake oversees a collection that lines eight miles of corridor walls.
13 RFL's four-hour ED performance was 80.4% in August, below the 26/27 standard of 82%. BH 82.0%, North Mid 73.8%, RFH 79.7% and CFH UTC 99.9%. 75.1% of cancer patients started treatment within 62 days in July, below the 26/27 target of 80%. Faster cancer diagnosis (FDS) performance was 80% and achieved the 80% FDS target. 62.6% of patients were treated within 18 weeks from referral in August, down slightly from 62.7% in August, although the patient waiting list reduced by over 1,700 pathways. The trust reported 52-week breaches reduced by over 200 patients from 1,546 to 1,334. 11.3% of ambulances were seen within 15 minutes in August (BH 10.2%, North Mid 11.7%, RFH 12.1%); this is a decrease from 12.9% in June. 79.2% of patients waited under six weeks for diagnostics in August. The trust remains in the third quartile nationally for benchmarking. Hospital deaths remain lower than expected, with a summary hospital-level mortality indicator (SHMI) of 0.87 for May 2025 – April 2026 (latest data). In August, the Friends and Family Test (FFT) positive response rate exceeded 90% across inpatient, outpatient, and maternity services. The Emergency Department achieved a positive response rate of 79.1%, showing an improvement compared with July. In August, there were 17 C. difficile cases, an increase from 14 in July. There were 35 E. coli bacteraemia cases, increased from 24 in July. There was one MRSA bacteraemia case in July and none in August .
14 Highlights • Group cancer 62-day performance in July was 75.1% and just below the 26/27 national standard of 80%. • In August, 80.4% of patients across the RFL’s EDs and UTC were admitted, streamed or discharged within four hours. This is just below the 26/27 national standard of 82%. The trust has achieved over 80% in six consecutive months. The trust has maintained its position in quartile one for four-hour performance. • Complaint response performance improved in August, with 63.1% of complaints responded to within 35 days, up from 62.0% in July. Friends and Family test results for both inpatient and outpatient, as well as maternity services, continued to meet the 90% target. Emergency Department (ED) services recorded a positive response rate of 79.1%, a slight decrease from 79.8%. Challenges and mitigations • For referral to treatment, all health units remain focused on eliminating waits over 52+ weeks, particularly where additional funding is in place. • High attendance in EDs continues to have an impact on patient flow. A new isolation and bed management policy has been implemented, and infection prevention and control teams are undertaking case-bycase risk assessments to optimise flow while maintaining safety.
15 £13.5m deficit Month 5 (August) deficit of £13.5m against a planned deficit of £13.5m. This is on plan. Temporary staffing expenditure • NHS England has set phased temporary staffing reduction targets from 2026/27 to 2028/29, with RFL committed to reducing agency spend by 52% and bank spend by 13%. RFL usage: This financial year the top five drivers making up approximately 80% of temporary staffing for RFL are vacancy cover, sickness, short term demand, extra sessions, and enhanced care. Current Improvement focus: Data quality, workforce planning, and spend control: • Ensure request reasons are accurate & specific when booking temporary staffing • Strengthen HealthRoster recording and use consistent coding How budget holders can support: 1. Review your establishment regularly 2. Challenge the need for cover. Does every gap require cover? Discuss options with your finance business partner and HR business partner 3. Prioritise roster compliance; set aside dedicated time each week to review 4. Understand your spend drivers; identify the key reasons for spend and take action to address recurring issues where possible Where to get support: • Email the rostering team via rf-tr.erosteringsupport@nhs.net if you need general help or call ext 51005 • For vacancy approval enquiries, speak to your HR business partner • Bank and agency Freenet page
16 • Interested in finding out more about how the immune system could help fight kidney cancer? • Meet the Peppa Lab team and discover how Royal Free Charityfunded research is exploring the potential of natural killer (NK) cells in future cancer treatments. • Watch to find out more: myrfc.co/peppalabfilm Backing breakthroughs in kidney cancer care
17 Join us for an evening of celebration, insight and conversation at our 2026 Annual Members Meeting. This special event is your opportunity to hear first-hand about the difference you and your colleagues have made over the past year, discover how we are improving care for patients and communities, and find out what lies ahead for the RFL. It will take place on Wednesday 4 November, 6pm to 7.30pm, in Sir William Wells Atrium at the RFH. On the evening you will be able to: • Celebrate some of the trust's key achievements from the past year • Hear about the challenges we have faced and how we are responding to them • Gain insights into our operational and financial performance • Explore interactive displays showcasing the breadth of services we provide • Meet governors, colleagues and members of our local community • Put your questions directly to our trust board during a live Q&A session Book your place at our 2026 Annual Members Meeting Reserve your place Attendance is free, and refreshments will be provided. Places are limited, so we encourage you to register early to avoid disappointment. To book your place, please contact our membership office by 5pm on Friday 27 October: rf-tr.membership@nhs.net. We hope you'll join us for an engaging evening to celebrate our successes, hear about our plans for the future, and help shape the next chapter of the RFL.
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