Since our foundation in 1828, the Royal Free London has had a pioneering history, leading the way in many areas of healthcare: advancing our understanding of illness; taking advantage of the latest technology; developing new and better therapies; and tackling health and social inequalities.
That pioneering spirit continues to be central to our approach today, and contributes to our record of delivering some of the best clinical outcomes for patients across our local and specialist services.
As a large NHS foundation trust, we employ more than 12,000 staff from 120 countries, serve a population of more than 1.6 million people across 70 sites in north London and Hertfordshire and are one of the biggest providers of cancer care in the UK.
We want to bring the best of the NHS to every patient, no matter which of our hospitals or services they visit.
We aim to achieve this through our three-fold mission of delivering world class treatment and local care, underpinned by groundbreaking research and the very best in class for learning and education.
From our three main hospitals and at various other satellite sites and hospital trusts, we offer local services for local people.
We attract patients from across the country and beyond to our specialist services in liver, kidney transplantation, haemophilia, renal, HIV, infectious diseases, plastic surgery, immunology, vascular surgery, Parkinson’s disease, cardiology, amyloidosis and scleroderma.
The Royal Free Hospital has a world-leading high-level isolation unit for the care of patients with the Ebola virus and similar infectious diseases. We were one of the first four trusts to treat UK patients for COVID-19 at this centre in February 2020.
We are also immensely proud of our leading role in research, undertaking more than 200 research projects a year involving more than 13,000 patients, and our strong tradition in educating, developing and training both the future NHS workforce and our current staff.
Our mission
Our mission is to be world class in terms of our healthcare services, clinical research and teaching excellence.
This tripartite mission underpins everything we do, from the care we deliver to our patients to the way we develop and give opportunities to our staff.
Our clinical strategy
Our five-year clinical strategy is an ambitious plan that will transform how we deliver world class care and the way people access our services.
Published in June 2024, it sets out our clinical vision for how we deliver world-leading healthcare for all our patients, meet growing demands on our services and create a healthier future for our local communities.
Local clinical priorities
Each of our hospitals has new clinical priorities which reflect the needs of the patients we care for. These are:
Barnet Hospital
Supporting the needs of an ageing population and transforming same day and integrated care.
Chase Farm Hospital and group clinical services
Developing different types of surgery and focusing on early diagnosis and prevention through our group clinical services.
Royal Free Hospital
Establishing a national centre of academic and clinical excellence for rare diseases, and working with our partners to reduce chronic diseases and improve patient outcomes.
Group clinical priorities
We’ve also identified three group-wide clinical priorities:
cancer
cardiovascular
organ failure and transplantation
We play a leading role in these areas within north central London and beyond, and they have a significant impact on the health of our local populations.
All of our staff are expected to treat our patients, visitors, and each other, in line with our world class care values which expect us to be positively welcoming, actively respectful, clearly communicating and visibly reassuring.
Our trust values were chosen by our patients and staff and underpin all we do.
Our objectives
Our governing objectives inform the direction and decision-making of the Royal Free London group, setting out how we will achieve our mission. They are:
Excellent health outcomes
Consistently deliver excellent and equitable care that provides access to research for all our patients.
Outstanding experience of care
Ensuring the experience of our patients and carers is among the best in the country.
Outstanding experience for our people
Where colleagues feel a strong connection to their work and organisation and are enabled to deliver and to realise their potential.
Be a sustainable organisation
Financial: contribute to the elimination of the north central London system deficit on a recurrent basis. Environmental: reduce carbon emissions towards net zero by 2040.
Read more about how we are achieving these objectives in our annual report.
Alongside our governing objectives, our clinical strategy outlines our group-wide clinical priorities, focusing on cancer, cardiovascular, and organ failure and transplantation with individual priorities for each of our hospital sites and partnerships to be developed in 2023-2024.
Our research and education strategies are also linked to our objectives, helping us achieve our tripartite mission of globally recognised clinical expertise with local and friendly hospital care.
As part of our group model, we not only oversee our three hospitals and satellite sites, but we lead and share services and resources with a group of NHS providers in north central London.
This allows us to work collaboratively, forging partnerships to deliver the best care possible and operate at scale to get the best investment and quality services.
Our current clinical partners are North Middlesex University Hospital NHS Trust, West Hertfordshire Hospitals NHS Trust and Royal National Orthopaedic Hospital.
We are also working more closely with our non-hospital partners in the NHS and social care to help people to live longer in good health, rather than just treating people when they are sick. Our group helps us to deliver this aspiration.
Foundation trusts are NHS organisations which are free from central government control but who are accountable to the communities they serve and the commissioners who contract their services.
They continue to strive to exceed the standards that NHS trusts must achieve, including complying with the requirements of the Care Quality Commission — the independent regulator of healthcare services in England.
As a foundation trust, the Royal Free London is led by a board of directors and, with our governors and members, we have greater freedom to decide our own strategy and the way services are run.
1828 — The Royal Free Hospital was founded by William Marsden, a newly qualified surgeon who was shocked he could not find treatment for a penniless young woman. He founded the hospital on the principle that it would provide free healthcare to those who could not afford medical treatment — the first hospital in London to do so.
1837 — The title ‘Royal’ was granted by Queen Victoria in recognition of the hospital’s work with cholera patients (it was the only London hospital to stay open during the cholera epidemics).
1838 — Barnet Hospital first provided healthcare in an infirmary in the Barnet Union Workhouse.
1884 — Chase Farm Hospital began as a home for pauper children.
1887 — The Royal Free Hospital was the first hospital in London to accept women medical students.
1900s
1916-18 — 6,000 wounded and sick soldiers received medical care at Barnet Hospital.
1939-1945 — Casualties of the Second World War are cared for at Chase Farm Hospital under the emergency medical scheme.
1991 — In April 1991, the Royal Free became one of the first NHS trusts.
2000s
2004 — European history is made at Chase Farm Hospital when the first total hip replacement procedure is carried out, with the patient leaving hospital in just 27 hours. At the time, the UK average length of stay was 11 days.
2012 — The hospital was authorised as a foundation trust under the name the Royal Free London NHS Foundation Trust.
2014 — In July 2014, Barnet and Chase Farm Hospitals NHS Trust became part of the Royal Free London.
2017 — The Royal Free London group is established, and North Middlesex University Hospital NHS Trust joins us as our first clinical partner.
2018 — The new Chase Farm Hospital opens, and West Hertfordshire Hospitals NHS Trust joins the group as our second clinical partner.
2020 — The Royal Free London is one of four trusts to admit the first UK COVID-19 patients. Royal National Orthopaedic Hospital joins the group as our third clinical partner.
2021 — Chase Farm Hospital is awarded HIMMS level 7, making it one of the most digitally- advanced in the country and one of only four hospitals to receive this accolade.
Following several years of closer working, North Middlesex University Hospital NHS Trust (North Mid) will merge to become part of the Royal Free London group on 1 January 2025. We believe it will enable us to go further and faster in improving services for patients and improving the health of our local community.
North Mid has been a clinical partner with the Royal Free London group since 2017 and we have been in a formal partnership since 2021. Our experience has shown that we can achieve more together than we can apart, delivering better care for local people and more opportunities for our staff.
North Mid and its community services will join the Royal Free London group alongside Barnet Hospital, Chase Farm Hospital and the Royal Free Hospital.
All our hospitals will continue to provide the same local services. At North Mid, these include A&E, maternity, intensive care, paediatrics, acute surgery, acute medicine and community services.
By coming together as one, we expect to be able to deliver:
reduced waiting times
improved access to specialist care locally
better joined-up community services
greater opportunities to benefit from the latest medical research and trials of new treatments
more coordinated action to help people stay healthy, with screening and early intervention services tailored to our different communities
We have identified the first four services that we will prioritise for early integration. These are areas where, as a group, we will be able to achieve greater benefits for patients, staff and our communities. Read more about them below.
In north central London, the number of people with cancer is rising and is expected to increase 42% by 2030 with the Royal Free London currently caring for the largest number of patients with suspected cancer in London. At North Mid, the picture is similar. Meeting our cancer targets is a challenge against this backdrop.
Oncology services are a critical part of the cancer pathway, providing treatments such as radiotherapy and chemotherapy.
Through the merger we can change how we work to provide care where it is needed the most, reducing time to treatment and ensuring all our patients can access the latest, most effective advances in cancer care, no matter where they live.
What you can expect
increased access to specialist advice and cancer treatments
more care closer to home
greater opportunities to take part in clinical trials and research
We will work to establish ourselves as a bowel cancer treatment centre focused on innovation through the use of robotic technology, early screening and 24/7 specialist care close to home.
Through our current partnership some North Mid patients already have their colorectal surgery at the Royal Free London. However, by removing organisational barriers, such as different processes and systems, we can reduce the time people have to wait between diagnosis and treatment and improve outcomes by increasing the numbers of patients who are diagnosed early.
What you can expect
more care closer to home
more specialist nursing care, with a focus on recovery, so you can go home from hospital earlier
greater opportunities to take part in clinical trials and research
We know from our joint work to establish the elective orthopaedic centre at Chase Farm Hospital in 2021 that separating planned, non-complex surgery from emergency treatment can be hugely effective in reducing waiting times and preventing cancellations.
We will draw on the success of our existing surgical hubs to create a network of centres
of surgical excellence.
We will create additional hubs for general surgery, gynaecology, urology and ear, nose and throat where we know we have a large number of patients needing planned procedures. Here patients will be seen more quickly for common procedures and receive consistently excellent care.
What you can expect
outpatient appointments at whichever of our hospitals is closest to your home
less risk of surgery being cancelled
shorter hospital stays
Evidence from across the world shows that hospitals that undertake research provide better care and outcomes overall. By tackling the current inequalities in access to research trials, where legal and regulatory barriers limit the collaboration that is possible at present, we will enable greater access to potentially life-changing innovative treatments for North Mid patients and a more diverse patient base for Royal Free London trials.
Our merger will open up different areas for potential research, such as sickle cell and thalassemia, heart failure, lupus, liver and renal disease, urgent and critical care and older people’s health.
What you can expect
more choice of trial opportunities
earlier access to new drugs and interventions
more clinical trials designed to meet the needs of local patients
service improvements driven through our greater understanding of our population’s health
We announced our intention to come together in January 2024 and developed a full business case for merger. This was approved by the boards of both trusts in July 2024. It was reviewed and approved by NHS England during the autumn. The boards of both trusts ratified their decision to merge in December 2024 and this was followed by the approval of the RFL council of governors and the Secretary of State for Health and Social Care.
Frequently asked questions
By merging, we aim to improve the quality of services, celebrate the expertise of our individual hospitals and community services, and provide an excellent patient experience.
The range of services provided from each of our hospitals will remain the same, but patients will be treated more quickly and able to access more specialist care in expert hubs, with convenient local follow-up and more joined-up community care.
There will be more opportunities to benefit from the latest medical research and trials of new treatments and there will be more support to help keep people healthy, with tailored screening and early intervention services for our local communities.
Patients will still be referred to their usual local hospital or community service, which will continue to provide the same routine services for their populations. At North Mid, these include A&E, maternity, intensive care, paediatrics, acute surgery, medicine and community services.
Our merger is driven by our shared aim to provide better, more joined-up and sustainable services for our patients and communities.
The merger is not about cutting costs. Where it does enable us to be more efficient in our use of resources, any savings made will be retained within the organisation to be reinvested in further improved services.
The way healthcare is provided has changed significantly in recent years. Local health and care partners are increasingly working together to tackle shared challenges and to improve health and care for their local populations.
We were proud of what we achieved through working in partnership, including:
improving care through redesigned pathways known as clinical practice groups (CPGs)
reducing waiting times and providing more access to specialist treatment and elective care through the establishment of surgical hubs
sharing some corporate support services to be more efficient in staffing, estates, facilities, training and research
enabling more co-ordinated action on reducing inequalities, environmental sustainability, employment pathways and supporting healthy lifestyles
However, given the scale of challenge that health and care services face, and our shared aim of improving the health of our local communities, we believe that joining together as one will enable us to go further and faster in achieving our ambitions.
No. We have been working in ever closer partnership for several years now and our plans to come together are driven only by our shared aim to improve services for patients and the health of our local communities.
Our work to bring our organisations together is not linked with the Start Well maternity proposals.
Last updated: 19 December 2024
We work with our partners across the North Central London Integrated Care System to ensure our services are patient-focused, based on best practice and good value for taxpayers’ money.
This includes collaborating with other NHS trusts, primary care, local councils, voluntary and community organisations, and a wide range of patient groups, such as Healthwatch.
Commercial partners and services
We work in partnership with two wholly-owned subsidiaries of the trust — Royal Free London Property Services Limited (RFLPS) and Royal Free London Dispensary Services Limited (RFLDS) — who offer expertise in their respective areas. RFLPS manages the provision of estates and facilities services to the trust and RFLDS delivers outpatient pharmacy services.
We provide sterilisation and decontamination services for all our hospitals, other NHS trusts and private hospitals from our state-of-the-art decontamination unit in Enfield. The Chalkmill Drive unit is the biggest and most advanced of its kind in the UK, decontaminating equipment safely and efficiently, 24 hours a day, 365 days a year.
In addition, we provide pathology services to NHS trusts across north central London as part of our venture with The Doctors’ Laboratory and University College London Hospitals NHS Foundation Trust.
The Royal Free Information Governance Consultancy provides support, assistance and documentation for information governance internally and to other NHS organsiations. You can contact them at rf-tr.informationgovernance@nhs.net.
Clinical partners
Through our clinical partnerships, we believe we can achieve more together, to improve health and care for the communities we serve. Our current clinical partners are:
West Hertfordshire Hospitals NHS Trust
Our clinical partnership with West Herts was established in 2018 and has recently been extended to 2025.
The collaboration involves reducing unwarranted variation in clinical practice and outcomes, successfully implementing a shared electronic patient record and RFLPS supporting West Herts with its successful bids to be part of the national new hospitals programme.
Royal National Orthopaedic Hospital (RNOH)
In 2020, RNOH joined us as a clinical partner. Our joint work on musculoskeletal services has so far helped patients access care more easily and directly reduced the number of people waiting for clinic appointments.
We are also exploring the potential for digital development and alignment between our organisations.
Our host services
We host the following clinical and non-clinical services, which provide support to the Royal Free London and other NHS trusts:
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