David Probert Chief Operating Officer The Royal Marsden NHS Foundation Trust

2. The 2008 Fire at The Royal Marsden Hospital – Business continuity and coping with a major incident David Probert Chief Operating Officer The Royal Marsden NHS Foundation Trust

3. The Royal Marsden NHS Foundation Trust • The Worlds first Cancer Hospital • Europe’s largest Cancer Centre • Based on three sites (Chelsea, Sutton and Kingston – SW London) • First Wave Foundation Trust – Double Excellent • Service, Academic, and Research driven

4. The Royal Marsden NHS FT • RMH and Institute for Cancer Research designated the UK’s only Biomedical Research Centre for Cancer (NIHR) • International reputation for research and service delivery • Annual Budget of £250m, approx 5000 staff

5. 2nd January 2008 – 1.15pm…………

15. Evacuation • Obvious from the start – serious fire • Commenced horizontal movement of patients immediately away from the smoke entering a surgical ward at the top of the building • As that completed – Critical Care Unit next floor down started filling rapidly with smoke – horizontal evacuation of the critically ill to the Transitional Care Unit

16. Evacuation….. • Chief Nurse and Lead Intensivist contacted Emergency Bed Bureau, Royal Brompton Hospital (RBH) and Ambulance Service • All six critically ill patients strapped into their ski sheets and taken one by one down the stairs straight into an ambulance and to the Intensive Care Unit at the RBH • Chief Executive Officer took command position at front desk (Gold Commander) • Chief Nurse and Medical Director went down to theatres to start evacuating patients recovering and to stop operations

17. Evacuation….. • Two operations being undertaken: • The first a two stage complex major – first stage complete and finished there – patient woken up and transported to the RBH to theatre recovery • The second operation – complex major surgery – half way through surgeons anxious to complete second stage – tried to continue a bit longer: smoke starting to enter theatre complex –directions to close immediately – patient kept intubated and sedated and transferred to RBH ITU

18. Evacuation…… • Meanwhile all ambulant patients evacuated • Senior Staff Nurse a member of St. Paul’s Church Onslow Square contacted the church and requested to use it as a triage centre • Houses / public houses / used immediately as a refuge until the church available (within 10 minutes)

19. Evacuation…… • Nurses, Rehab therapists, Medical Oncologists, Anaesthetists in teams dispatched to St. Paul’s Church • Continuous transfer of inpatients to the Royal Brompton from the Royal Marsden or from the Church • Senior Fire Command discussed with The RMH that the last part of the roof may be in danger – agreed to evacuate the last patients –transferred to the Royal Brompton.

20. Evacuation complete • The whole evacuation took about 28 minutes • Lists of staff and inpatients kept by every Sister and Senior Staff Nurse • Senior Nurses nominated to coordinate all lists every hour • 79 inpatients evacuated, 143 outpatients, day patients, 250 staff

21. Aerial View of the 4th Floor, Chelsea Wing

22. Immediate Business Continuity • Immediately after the fire: Command & Control centre organised opposite the hospital • Executive Directors coordinated • Link with Royal Marsden Hospital - Sutton • Helpline from Sutton– Clinical Nurse Specialists • Media and Press involvement: CEO gave regular personal updates

23. Immediate Business Continuity • Regular communication with the emergency services especially the fire service and the Borough • Security of the site • Communication with our staff, patients and their families • Media Management

24. Communication with our Staff • CEO and Executive Team very visible – on site all the time / 24 hr on site rota • With our staff – no email immediately – Chief Nurse’s office used as staff centre – huge notices placed every 6 hrs around the perimeter of the site for staff to read • Chief Nurse and Medical Director held large clinical meetings in the School at 07.30 and 18.00 every day • Executive team held large non clinical meetings at 09.00 and 16.30 every day

25. Short Term Business Continuity • Chief Nurse & Medical Director visited every patient at the Royal Brompton Hospital (RBH) every morning and evening for the next few days. • All RMH patients cared for by RMH staff at the RBH • Arrangements made for clinical teams to call all RMH patients to assure them that their care would continue

26. Short Term Business Continuity • Radiotherapy recommenced at the Chelsea site 2 days later • Outpatients and day chemotherapy clinics commenced 5 days after the fire

27. Medium Term Business Continuity • Major challenge: the provision of major and complex surgery as the plant to the theatres and Critical Care Unit destroyed • Executive team worked with clinicians to rapidly design a 2 part solution - A modular theatre delivered to Sutton - A theatre, 6 CCU beds and 10 ward beds leased from the Cromwell Hospital

28. Medium Term Business Continuity • May – 1 Modular Theatre back at Chelsea, 2 T&T Beds • Working on three sites surgically • Activity Capture, invoice management • Staff morale………

29. Disruption for our clinical teams • Surgeons and Anaesthetists having to work completely differently • Nurses who live in North London having to travel to Sutton to work • Major input to listening to all teams, occupational health and counselling, “can do” attitude, make things happen – transport, financial help – immediacy of support

30. Longer Term Business Continuity • July 2008 – Three Theatres back at Chelsea, Another 16 bed ward open • 8 Bedded CCU at Chelsea • No presence at The Cromwell • Three session theatres, 24/7 Hospital • 18 month re-build programme

31. Business continuity – Lessons Learnt • Quality of care maintain absolutely key • Immediate and regular communication with insurance assessors • Income reduction minimised • COMMERCIAL INSURANCE COVER • Communication is rapid, accurate and reaches all staff

32. Business continuity – Lessons Learnt • Rebuilding projects in the midst of existing capital projects – new project structure, INSURANCE • Major programme of fire debriefings, feedback and lessons learnt • Reflections and redesign wherever relevant • Using disaster as a major opportunity

33. Major rebuilding schemes

34. Business Continuity – Going Forward • A major fire is a major disruption • Much functionality has had to alter – although many very positively • A real need to support all staff during the rebuilding programme • To be receptive and responsive to all our colleagues • To ensure all polices, process and systems are fully operational for dealing with Major Incidents

36. Conclusion We were very lucky • 2nd January 2008 • High Quality local emergency services • RMH staff who were trained in major incident planning • Incredible help and collaboration from the NHS especially the Royal Brompton Hospital

37. Conclusion • Commercial Insurance critical • Business Continuity Insurance equally important • Fire does not feature in the top three list of potential British Major Incidents • Preparation and local planning is key

38. David.Probert@rmh.nhs.uk0207 811 8127