Insight Royal Liverpool Summer 2018

Summer 2018

www.rlbuht.nhs.uk

Warfarin project Looking at genetic testing to prescribe warfarin CQC report - Trust praised in CQC report for care of people aged 65 and older Artificial intelligence - New AI trial aims to reduce patient risk of a recurring heart attack

Exclusive:

Celebrating 40 years of the Royal and NHS 70

2 World class workforce

FM services secured Thank you to all our staff for your hard work, we continue to experience pressures throughout the Trust, but your professionalism and excellent patient care hasn’t gone unnoticed.

I also want to reassure the people of Liverpool and our staff that we are dedicated to ensuring the completion of the new Royal and that we will continue to work closely with The Hospital Company (Liverpool), and key stakeholders to get construction work on the new Royal restarted.

I would like to reassure anyone concerned about maintenance of the current Royal that funds have been set aside for ongoing maintenance and patients will have a safe environment for their care.

Staff recognition awards We love to recognise our staff and the amazing work they do around our hospitals, so each month we celebrate a nominated team, employee and volunteer.

The award is open to all staff including those working behind the scenes - either in support functions or non-clinical roles - or to those who work in the front line.

Staff, patients, carers, and visitors can nominate someone who they think deserves to be recognised for the excellent care and service they provide and the difference it has made.

Here are our latest award winners that have gone above and beyond and provided our patients with an excellent level of care.

Employee of the Month

November 2017 - Gwen Williams, ward clerk

December 2017 - Dr Don Lindop, A&E

February 2018 - Laura Grugel, therapy assistant

March 2018 - Eddie Doyle, ISS catering staff

In June, we were pleased to announce that facilities management staff at our hospitals, who used to be part of Carillion have now transferred to a new company, called Avrenim Facilities Management Ltd, which has been established to exclusively provide these services to the Trust.

We know that this has been a challenging and frustrating period for the staff involved and we would like to thank them for their efforts during this time. We are really pleased that jobs have been protected and that FM staff will be able to continue to provide a vital service for our hospitals.

Volunteer of the Month

Aidan Kehoe chief executive

November 2017 - Emergency Floor Therapy Team

December 2017 - St Pauls Eye Hospital

January 2018 - A&E Department

February 2018 - CT-MRI team

Improving the quality of life for our patients

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Trust praised in CQC report The Care Quality Commission (CQC) has published their report which looked at how health and social care systems in Liverpool are working together to care for people aged 65 and older.

A&E Delivery Board, praised for how organisations worked to support one another during a challenging winter and the Integrated Community Reablement and Assessment Service (ICRAS), which has helped to provide support for patients being discharged from hospital more efficiently.

The review, carried out in February, included interviews with those involved in leading and shaping services, reviewed care and treatment records and visited 14 services in Liverpool.

Although there is no overall grading, the CQC found that there is a clear strategic direction for services, with a commitment to work with wider partners and evidence of strong collaborative working in some parts of the city.

Staff were found to be committed, energetic and passionate about delivering high quality care.

The report highlighted areas of the Trust that were improving care for patients aged 65 and older.

The day ward at Broadgreen was described by one carer as ‘The NHS at its best.’

It highlighted the Day Ward at Broadgreen Hospital, which has a range

The work underway to establish shared electronic patient records with local partners was also cited as a positive way forward. of clinics including falls and dementia, that staff worked effectively with community partners to support patients outside hospital.

The care provided on the Frailty Unit and the system behind this was highlighted as an area of good practice. Located besides the emergency department, the unit provides rapid assessment and treatment to frail elderly patients aimed at getting them medically fit as soon as possible to avoid staying in hospital any longer than necessary.

A number of partnership working programs were also cited as having a positive impact on the delivery of patient care. These included the work of the

However, there were a few areas were the services needed to improve and the experiences of people using health and social care services varied. People were not always seen in the right place, at the right time by the right person and there were inconsistencies in commissioning and provision of services.

Efforts to cut the bureaucracy in discharging patients from hospital had led to some improvements in delayed transfers of care. They also noted that partners had learned how to build resilience for services at times when there is most demand, such as over winter, but that more work is required to reduce the pressure on emergency departments.

Guide dog at Broadgreen creates a positive experience The Ward 5 Phoenix Rehabilitation Unit at Broadgreen Hospital has had a special guest staying alongside one of the patients recently – Ozzy the guide dog.

As the patient has a visual impairment the department worked with the Guide Dogs Liverpool Mobility Team to see how they could accommodate the dog which would allow the patient’s rehabilitation goals to be achieved.

The rehabilitation team liaised with different departments within the Trust, such as

facilities and infection control, to establish any current procedures or facilities in place to accommodate Ozzy the guide dog.

Katrina Casterton, physiotherapist, said; “The Guide Dogs Liverpool Mobility Team helped our department identify the most suitable place to have the toileting area. Plus, a daily timetable was created to ensure the patient was assisted in attending to Ozzy’s needs throughout the day, until she was able to complete this independently. All the different MDT members were involved in supporting this on the ward.

“Ozzy’s presence on the ward had a therapeutic effect on the ward environment, with the dog becoming a common talking point, improving morale, mood, behaviour and the socialisation between patients and staff.”

Katrina added: “This has been a positive and collaborative learning experience as the team

has been able to successfully address the patients’ individual rehabilitation and care needs. It has highlighted the need for future service development to support the use of guide dogs within the Trust.

“The team are keen to be involved in future work to develop this and are excited to look at the future potential of including animal therapy within treatment sessions to improve rehabilitation outcomes and patient experiences.”

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Improving the quality of life for our patients

Celebrating 70 years of patient innovation It was 40 years ago that the Royal Liverpool Hospital opened its doors on Prescot Street, so to coincide with the NHS’s 70th birthday we’ve been taking a look back at how patient care has evolved and improved over the years.

Marie Dewhurst, lead nurse for patient experience

Lee Papadopolous radiographer

We caught up with some of the staff around the Trust to find out what changes they had seen throughout their time here.

Jan Basey, consultant pharmacist said: “Around 20 years ago one pharmacist would provide a two-hour presence in the Acute Medical Unit, Monday to Friday, but we now have a team of pharmacists and technicians providing a pharmacy service 12 hours a day, seven days a week, to the emergency department supporting the patient journey.”

Sarah Burke, emergency department matron said: “Extended roles of nursing staff within the emergency department has improved outcomes for patients, improved experience and developed our nursing staff into such roles as emergency practitioners and advanced nurse practitioner.”

Discussing the changes in the radiology department, Lee Papadopolous, radiographer said: “The development of the flat panel detectors means we can achieve a higher diagnostic quality image with a reduced amount of radiation – meaning the patient receives less radiation but a better quality image. With the new imaging system this means patients get an accurate treatment and accurate diagnosis of the disease that they’ve got and then it also means that there are less complications that arise from that treatment.”

Stephanie Hanna, radiographer, said:

“Radiographers have a lot more responsibility now than we did when the NHS started.

We’re qualified to do more scans now, such as colon scans. Years ago these tests didn’t exist then they were done by a consultant and now we have that level of responsibility to give more drugs than we used to and decide whether that patient is suitable for the test.

“Plus if we spot any potential tumours we can do extra scans on the spot and that essentially speeds up a patient’s referral through the department.”

Maureen Gildea from the Cancer Wellbeing Centre said: “We now offer support to patients in the Cancer Wellbeing Centre, previously there wasn’t anything in the hospital to support patients with their physical and emotional needs once they’d had a cancer diagnosis. So, it’s a service that we really need especially when you think

about the advances in cancer treatments and earlier diagnosis our patients are now living longer which is fantastic news and fantastic progress.”

Marie Dewhurst, lead nurse for patient experience, said: “I think one of the big changes is the culture within the organisation, we are now much more attuned to patients’ needs and we listen very closely to carers and patients. When I started in 1982 that wasn’t always the case if I’m honest, and we understand the patient experience and we use that feedback to improve our services.

“Nursing is a very challenging profession, you work hard, but I feel the reward you get back from patients really make the difference.

What you get back from patients and carers and the knowledge that you’ve done a good job, and that you’ve influenced and changed somebody’s life is really key for me.”

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World class workforce

Staff enjoy NHS 70 party Staff celebrated NHS 70 in style with a special birthday event on July 5. The Royal, Broadgreen and Liverpool Dental Hospital all hosted celebratory events to mark 70 years of improving patients’ lives. The milestone also coincided with the Royal’s 40th birthday year.

At the Royal, there was a range of display stands and exhibitors in the foyer manned by staff from different departments and volunteers – showcasing just how the service they provide has changed over the years and how those improvements have made a positive impact to patient lives.

Entertainment was provided by the staff choir and school choirs from Alsop High, St Nicholas primary and St Mary’s primary, plus Atomic Kitten singer, Natasha Hamilton, visited the wards along with Liverpool Football Club. The celebrations also continued over in the Education Centre, Lecture Theatre and Ward 2017, plus there was a ‘photo booth’ for staff and cut-out cards to take

a fun selfie.

Staff were treated to afternoon tea in the canteen, where colleagues past and present could have a catch up over tea, sandwiches and cake, and R Charity hosted a Royal Cake Off where teams submitted NHS themed cakes for the chance to win the title of Royal’s star baker.

At Broadgreen Hospital, there was a barbecue catering for 200 staff along with branded cupcakes, an event which was held in collaboration with Liverpool Heart and Chest Hospital.

Patients at the Royal and Broadgreen also received a slice of ‘birthday’ cake, supplied by ISS, alongside their usual afternoon refreshments.

Our staff also supplied a range of archive photos ranging from 1930s images of the Liverpool Royal Infirmary to pictures of the current Royal Liverpool Hospital being built – which opened in 1978. See if you can recognise anyone.

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World class workforce

New equipment for Mersey School of Endoscopy Mersey School of Endoscopy (MSE) have been delighted to see the installation of a new 65” stateof-the-art Cleverboard that will enhance the learning of students from across the country.

MSE not only benefits patients in Merseyside but is a national training facility that maintains and enhances the endoscopy skills of over 350 health professionals across England and Wales every year.

Paul O’Toole, director of MSE said: “The Cleverboard has greatly enhanced the quality of the teaching we are now able to provide. It has allowed improvements in interactive teaching with visual aids that are now able to be saved and emailed out to the delegates on the courses, which provides a better learning experience.”

The purchase of this touchscreen teaching equipment has been made possible by the generosity of Norgine Pharmaceuticals and the workforce of Elanco/Eli Lily in Speke.

Ged Simpson, R Charity trusts and grants manager at the Royal said: “Both Norgine

and Elanco could see the local and national impact of MSE and the equipment they needed. When we applied they made the

process simple and were a pleasure to work with. We look forward to showing them the impact of their generosity.”

Combined care to support patients Our team of the month for March 2018 is The David Anderson Care Team.

This extraordinary team consists of a plethora of health professionals from physios to consultants, therapy staff and beyond, who came together to use their expertise to help a patient called David Anderson.

David was diagnosed with Charcot disease which severely impacted on his life, resulting in David being largely confined to a wheelchair, not being able to pursue hobbies, no longer able to drive and ultimately having to take early retirement.

He was also confronted with the prospect of a double below knee amputation and how that would further impact his life.

However due to this extraordinary team and their combination of treatments and expertise, David is facing a much brighter future.

who presented the team with their award, David said: “As I write this letter today, I have - following extensive surgery on both feet and the application of external frames to both legs - got to the position where both feet are now stable on the ground.

In his letter to chief executive Aidan Kehoe,

“I can stand unaided and I am making

progress mobilising on crutches and I anticipate that soon I will be able to walk unaided again. This is life changing stuff!

I hope to return to some light work and resume some of my hobbies but more than that, I realised that for the first time since they were born, I will be able to walk with my grandchildren.”

Improving the quality of life for our patients

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New set of wheels for the Royal If donating a kidney five years ago and volunteering each week wasn’t enough, now Paul Dixon has donated a wheelchair to the Royal Liverpool University Hospital’s Renal Transplant Unit as his 70th birthday gift!

around unnecessarily now as we have our own wheelchair to hand.

“We can’t thank Paul enough for all his hard work promoting organ donation and it is very much appreciated from everyone on Ward 9A and all of the transplant team.”

Paul turned 70 in March and to celebrate his birthday, as well as the fifth anniversary of his kidney donation to a stranger, he once again decided to help those around him.

Paul said: “At 70 you’ve pretty much got all the socks and jumpers you could need! So when my children asked me what I would like for my 70th birthday I wanted to pick something that was useful and would make a difference and I came up with the idea of a wheelchair.

“There’s lots of demand for wheelchairs at both the Royal Liverpool and at Arrowe Park Hospitals where I volunteer, I always see staff on the wards and porters looking for a wheelchair

Helen Machin, transplant co-ordinator at the Royal added: “Paul has done so much valuable work at the Royal Liverpool Hospital to increase people’s awareness of organ and tissue donation. when needing to move patients.

ensure it stays on that ward.”

“So I thought if we could get one for a ward then it would at least help the staff and patients on that ward.

Another massive achievement is that Paul has now exceeded 10,000 signatures on the Organ Donor Register, a task he volunteers for every Thursday in the Royal’s foyer.

“He has signed up so many people on the Organ Donor Register and is always there with a friendly face to answer people’s queries. He has also helped me out with education sessions for new health care professionals to improve awareness of this topic.

Debbie Rutter, renal transplant ward manager on 9A, said: “The wheelchair has already made a great difference to the ward and the patients don’t need to wait

“He is a truly inspirational person and I’m sure his hard work, if not already, will have a positive impact on donation numbers in the future.”

“My family and friends all chipped in and bought me two wheelchairs which I donated to the Renal Transplant Unit on Ward 9A at the Royal Liverpool and in the Dialysis Unit at Arrowe Park.

They each contain a brass plate to

Award-winning volunteers Each month we celebrate a nominated volunteer and present them with a certificate to show how much we appreciate their hard work and dedication around the Royal and Broadgreen.

November 2017 - Olwyn Weaver

December 2017 - Jim Walsh

January 2018 - Joyce Harper & Jane Mullen

February 2018 - Bob Giles

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World class workforce

NW Coast Research and Innovation award winners Two of our teams were celebrating in March after picking up the top awards at the North West Coast Research and Innovation Awards.

The awards were presented at a celebratory event at Preston North End, recognising research and innovation that has made a significant improvement to NHS and social care.

We collected the Patient Safety Innovation Award for the ‘Novel nurse-led pathway for commencing haemodialysis’ project.

This project reduced deaths in the first three months of treatment for patients with kidney failure. It reduced 90-day mortality from 5.1%, which is the national average, to

2%, which is a fantastic achievement. The changes also reduced patient distress from an average score of 4.3 to 2.4.

The work was undertaken with the primary aim of improving quality and safety, but has also released significant cost-savings of around £400,000 per year.

Advanced nurse practitioner Vicky Ashworth said: “We used a systematic approach, engaging staff and stakeholders, reviewing data and then revamping the pathway.

“The company 2Bio helped with project management and we used a business analytic software tool to look at data and see what was improving and what wasn’t.

Using this approach and the software was an eye opener for me and it has made me passionate about the importance of data.”

Consultant nephrologist Asheesh Sharma added: “We are now developing a toolkit, having attracted further funding support from the Health Foundation, to help spread the pathway to other trusts and we hope it will be adopted as best practice across the system.”

Our second award of the night was the Clinical Research Team of the Year collected

by St Paul’s Clinical Eye Research Centre.

Since opening in 2004, the Clinical Eye Research Centre (CERC) at St Paul’s Eye Unit has gone from strength to strength.

One initial major trial has blossomed into a total of 70 trials with 17 currently under way.

Staff have refined patient recruitment and participation processes, streamlined patient attendance pathways and upskilled staff. They have also developed new relationships with pharmaceutical companies and other hospital departments, and managed 100% increase in patient numbers. CERC’s reputation is now such that it is involved in most major ophthalmic trial being undertaken.

Mr Ian Pearce, consultant ophthalmologist and director of CERC, said: “St Paul’s is internationally renowned as a centre of excellence for the treatment and research of eye disease and we are all absolutely delighted to receive an award that celebrates our work.

“The award not only reflects the dedication, hard work and team spirit of all CERC staff, but also the huge amount of support we receive from our patients; without them so willingly getting involved in research here we would not have been able to achieve so much.”

Prof Toh aims to increase the voice of haematology nurses The Royal’s professor and clinical director of haematology Cheng-Hock Toh has become president of the British Society of Haematology after their annual meeting took place in Liverpool in April.

BSH for two years, and he aims to continue to integrate the practice of haematology into the very heart of medicine.

Cheng-Hock has been a member of the British Society of Haematology (BSH) for 26 years and was elected as the vicepresident in 2017.

Cheng-Hock said: “In my year as vicepresident, I have been most proud of making inroads into engaging nurses in haematology. I wanted to address the lack of nurse members in the British Society of Haematology and make sure that they have a strong voice in shaping the future of our specialty.

“Haematology nurses are so important in the major improvements that the specialty has made in improving patient outcomes.

Therefore, it is a no brainer that their greater involvement and partnership will bode well for improved quality of care.

“This theme of increasing the voice of haematology nurses will continue into my years as BSH president and I trust it will be a lasting legacy.”

After the annual meeting professor ChengHock Toh was announced as president of

Cheng-Hock added: “I want to be seen as an inclusive president who celebrates the achievements of a diverse specialty that is central to the practice of medicine. As haematologists, we integrate our clinical and laboratory skills into the breadth and depth of medicine, eg: from treating common anaemias to preventing lifethreatening blood clots and establishing safer transfusion practice as well as improving surgical outcomes.

“I will showcase the value that haematologists bring to the NHS in its important 70th year. BSH will be 60 years old in 2020 and we will be celebrating a specialty that is innovative and always pushing at the frontiers of science, such as gene therapy and gene editing.”

Improving the quality of life for our patients

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Innovative project wins AF Association Awards We have recently been involved in a ground-breaking project that aims to change the way warfarin is prescribed for patients with atrial fibrillation (AF).

Atrial fibrillation is a heart condition that causes an irregular heart rate. Warfarin is a well-established medication that is often prescribed to stop blood clots forming.

This innovative project has made warfarin medication personalised to each patient by using a DNA sample from a simple mouth swab. The dose was then provided based on your genetic test, in addition to other factors such as your age, height and weight.

This pilot project was recognised and announced as one of the winners in the AF Association – Healthcare Pioneers Report – showcasing ‘best practice’ in atrial fibrillation (AF) at the Arrhythmia Alliance Awards ceremony.

Gail Fitzgerald and Clare Prince, research nurses from our Trust and the Wolfson Centre for Personalised Medicine at the University of Liverpool have been working on the implementation project from the start, they said: “This is a great achievement for everyone involved in this project to be highlighted in the Healthcare Pioneers Report.

These changes could make a real difference to how we prescribe warfarin to patients with atrial fibrillation (AF) throughout the NHS.” “By using the latest technology the ParaDNA machine provides genotyping results in just 45 minutes. In the clinics we have been able to implement and evaluate whether genotype-guided dosing of warfarin is feasible in clinical practice.”

The Royal was one of six hospital trusts in the North West that took part in the implementation project, which ran between March 2016 and September 2017.

Warrington Hospital and the Countess of Chester Hospital also piloted this new method of dosing.

Two major genes can change the way your body responds to warfarin, with a 40% variability, so by testing your DNA first this could have a big impact in ensuring each person receives the right amount of anticoagulation medication.

Professor Sir Munir Pirmohamed, a consultant at the Royal, and from the Wolfson Centre for Personalised Medicine said: “This is a great a collaborative project between the University of Liverpool, the North-West Coast NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC), the Innovation Agency (NW Coast AHSN) and Laboratory of the Government Chemist (LGC).

“Warfarin remains an important anticoagulant, but there is wide variation in the dose required to anti-coagulate patients safely. We have previously shown that variation in warfarin dose requirement is due to a combination of genetic and clinical factors.

“We were able to show that genetic dosing was more accurate than current dosing used in the NHS.”

Dr Dutt awarded Researcher of the Year The Royal’s consultant haematologist Dr Tina Dutt was recently awarded a ‘NIHR-BSH Researcher of the Year’ Award – one of three national awards for consultants in the UK - at the Annual Scientific Meeting of the British Society of Haematology.

Awarded by Louise Wood Director of Science, Research and Evidence at the Department of Health and Social Care and Jonathon Sheffield CEO NIHR on 17 April 2018, Dr Tina Dutt said: “I feel honoured to have received this prestigious award

on behalf of our Clinical Research team.

Without an industrious and committed team alongside me, I would not have been able to transform the research opportunities available for our patients.

“They deserve to have access to high quality clinical research alongside excellence in their clinical care and with the very much valued support of the British Society for Haematology (BSH) and National Institute for Health Research (NIHR), I hope that we can continue to provide this.”

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Fundraising

What’s on Royal’s 40th birthday party On 5 August from 12pm R Charity is hosting a Royal 40th birthday party at St Luke’s ‘bombed out church’.

This family fun-filled afternoon will have entertainment from Maghull Wind Orchestra and Ted Russet, a kids play area, food stalls and a tombola.

Kids go free, get your tickets from ticketquarter.co.uk

Mt Kilimanjaro Trek Climb 5,895m to the summit of Mt Kilimanjaro in September 2018 with Big World Treks.

The Machame route is suited to all levels of adventurous trekker, offering splendid scenery and views. Big World Treks use experienced expedition leaders and paramedics who have summited Kilimanjaro several times.

R Charity lunch Join R Charity on Wednesday 24 October for an afternoon of fine dining at 60 Hope Street.

From 12pm to 3pm enjoy a drinks reception, canapes, a two-course lunch and coffee for £35pp.

Pink Parties During October, which is also Breast Cancer Awareness month, R Charity is looking for people to host a Pink Party in order to raise money for the Linda McCartney breast cancer unit.

The money will be put towards new equipment that will be able to help diagnose breast cancers earlier.

Scouse 5K The Scouse 5k takes place on Sunday 28 October and starts at 9.30am. All participants wear a silly curly wig and are rewarded with a lovely colourful medal at the finish.

The route starts and finishes by St Georges Hall and includes Hope Street, Bold St and Mathew St. Call 0151 706 3150 or email events@ rlbuht.nhs.uk for all event details.

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Joining forces to support the breast cancer unit FOUR years ago three fabulous R Charity fundraisers joined forces to form the fundraising group ‘One For All’ to raise money for the Linda McCartney Centre.

Gail Sneddon, Margaret Shields and Rosie McShane all have close links with the breast cancer unit, having been treated or know someone who has received care at the centre, so they wanted to give something back to the hospital.

Gail said: “Originally we all raised money individually for R Charity, I had abseiled, skydived and walked through the aquarium with the sharks at the Blue Planet in Ellesmere Port. By joining together to form a team, each one of us would support the other with their events or projects, and so One For All was created.”

Since starting, One For All have raised a spectacular £13,000 through organising and hosting Pink Parties, charity walks, tombolas and raffles. Their most recent event an Afternoon Tea Dance at the Adelphi raised a fabulous £1,900.

Gail said: “The tea dance at the Adelphi was a lot of fun and really well attended helping us raise a good amount. I think for me it was one of the most enjoyable events we have organised, as well as our first Pink Party they have been the most memorable as they demonstrated the value of teamwork.”

She added: “Some of the events we have coming up include a charity walk on 13 July, a delicious afternoon tea at 60 Hope Street on Wednesday 15 August, a Pink Party in October and a New Year tea dance at the Adelphi. So we have plenty of fun events where people can get involved.”

Discussing why she loves to raise money for R Charity, Gail said: “I love to fundraise in the belief that I will be helping others to deal with some of the challenges I faced. I was very lucky to have had the best treatment to overcome my cancer. I want everyone to have the same opportunity.

“It is also lots of fun working with people who are your friends as you share a common goal and everyone you meet is generally so lovely in their support of your aim.”

Fundraising 11

Thanks to R Supporters

Diane Armstrong skydived and raised £715

Julie Bell who ran the Birmingham 10k

Catherine Jones ran the Rock n Roll marathon and raised £370

Weekly Lottery Congratulations to Penny Young who won £1,000 after signing up to R Charity’s Lottery.

You can play the weekly lottery for a chance to win £25,000 while also raising money for R Charity.

Liverpool International Tennis Tournament picked us as the official charity

Margie and Gail for volunteering at Liverpool Food and Drink Festival

For every £1 you play 50p will go towards R Charity. These funds will help us improve the experience of our patients and visitors at the new Royal.

Visit www.unitylottery.co.uk/charity/ display/r-charity for details.

To everyone that done the Snowdon Champagne Sunset Challenge on 9 June

Natalie skydived from 15,000ft and raised over £400

Barclays’ Wavertree team skydived in May

Volunteers for bucket collections at Everton FC raising £755

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Developing a sustainable health system

3D prints to innovate and inspire Described as the heart of Liverpool’s Health Campus and a space to bring together academics, clinicians and industry, the Liverpool Life Sciences Accelerator officially opened its doors in March.

The £25m joint project between the Royal Liverpool and Broadgreen hospitals and Liverpool School of Tropical Medicine will generate new treatments and products for Liverpool and beyond by attracting a broad spectrum of small and medium-sized global companies.

One of the companies taking up office in the 70,000 sq ft space, which boasts state of the art laboratories, is 3D Life Prints, a medical 3D printing and technology provider to over 20 NHS and private medical institutions across the UK and Europe.

“As an external company separate from the NHS, we embed a Hub into a hospital and then we don’t really know until we get there exactly what we will be doing for that hospital. It’s good to be on site as we can

be part of providing an improved service for patients,” said Nick Turner, who is part of the 3D medical modelling team.

Nick does hold the time record at the Royal for creating a print for an A&E patient admitted with lower leg trauma.

He added: “Our three main branches are pre-surgical planning, where in complex cases surgeons and consultants can better plan with models; surgical simulation, in which surgeons can practice prior to an invasive procedure on a patient; and education and training, where trainee surgeons and medical students can use simulation models and we also go into schools.”

Nick said: “From the scan to delivering the print was 26 hours! The surgeons were unsure on the extent of the damage and how to operate, but the model helped to guide them. Within two days the surgery was completed.”

It’s an exciting prospect to think of all of the amazing things that these 3D prints will be able to do and how that will help our patients here at the Royal. For Nick and the team, it’s all about exposure and acceptance of this new form of medical technology – one which they are hoping will become part of a standard of care not only here at the Royal, but across the NHS.

The 3D prints can be manufactured to the particular specification of each patient. In general, 48 hours is needed to produce a print, as in some cases the likes of a heart can take about 18 hours to create. However,

Healthy hospital lunches Bite Club, which offers a variety of healthy meals, opened its doors in the Accelerator building last year and has since opened two more stands within our hospitals.

Based in the foyer of the Royal and in the main entrance at Broadgreen, Bite Club has a mission to provide delicious and nutritious, quick and easy food on the go to staff and visitors.

You can even pre-order your meal through their app for collection or delivery.

such as obesity and Type 2 diabetes shows more than ever the importance of following a healthy and balanced diet. Our food contains tons of superfood ingredients that are specially chosen for their ability to boost your vitality and keep you happy and healthy!”

Bill Shotton, Bite Club director, said: “Bite Club’s focus is on health and wellbeing, with our nutritious food being a medicine to combat modern-day illnesses. The increased coverage about health conditions

What’s even better is that Bite Club has partnered with R Charity to help raise funds for equipment within our hospitals, so from the sale of every ‘Big Bite’ dish Bite Club will donate 20p to R Charity.

Developing a sustainable health system 13

Digital Liverpool success The Trust’s Digital Liverpool Programme has recently been shortlisted for a number of national awards.

The programme, which is all about transforming digital care for staff and patients, includes a move to a ‘digital first’ new hospital, the implementation of 100% electronic health records and a life-saving e-sepsis programme.

Alongside being awarded ‘Best Global Digital Exemplar’ last year by the e-Health Insider Awards in recognition of progress so far, Digital Liverpool has also been shortlisted for Digital Leaders 100’s ‘Digital Public Service Innovation of the Year’ award and the Future NHS award at the NHS 70 Parliamentary Awards – winners will be revealed this summer.

The NHS 70 Parliamentary Awards recognise the massive contribution made by the individuals who work in and alongside the NHS. Launched in February, it asked the region’s MPs to find and nominate individuals or teams they thought have made the biggest improvements to health services in their constituencies across 10 categories.

The Digital Liverpool team, who were nominated by Liverpool Riverside MP Louise Ellman, were chosen as the northern champion in the Future NHS award by the NHS in the North.

“We are delighted that the Digital Liverpool team has been nominated to go forward for the national NHS 70 Parliamentary Awards. I am incredibly proud of the work

Did you know?

•D igital Liverpool have removed 30 million pieces of paper, which when stacked together is the size of the Radio City Tower ten times •D own 46% in cardiac arrests through introduction of Medical Emergency Team and e-NEWS system •O ver 200,000 case notes have been fully digitised that has been delivered by our talented staff and the outcomes that we are seeing in improvements in patient care,” said Aidan Kehoe, chief executive at Royal Liverpool and Broadgreen NHS Hospitals Trust.

He added: “Being shortlisted for the Future NHS Award is testament to the breadth and depth of the ambition of Digital Liverpool and our commitment to developing the future of patient care in Liverpool.”

In regards to being nominated for a Digital Leaders 100’s award, chief information officer at the Trust, David Walliker, said: “We are delighted to be shortlisted. The Digital Liverpool programme is being nationally recognised for our commitment to developing the future of patient care here in Liverpool.

“We are passionate about improving patient care and are immensely proud of what we have achieved. Our doctors and nurses want the very best technology to support the amazing work they do and have been the driving force behind many of the innovations created by the Digital Liverpool programme.”

Using artificial intelligence to provide pioneering treatment In a pioneering pilot project, the Trust is using artificial intelligence (AI) to help improve care for heart attack patients.

The artificial intelligence will help doctors make decisions about a patient’s care by rapidly accessing published data, evidence and guidance and making recommendations tailored to an individual patient’s medical needs. This provides patients with the most effective treatment, helping them get better quicker.

The software is being trialed during summer 2018 on the acute cardiac unit at the Royal Liverpool Hospital and will help doctors decide the best treatment for patients to reduce their risk of a recurring heart attack.

Dr Mike Fisher, consultant cardiologist and chief clinical information officer at the Trust said: “Similar to a ‘sat-nav’ which helps a driver navigate the roads, the AI software helps clinicians navigate vast amounts

on this innovative AI pilot.

Guy Wood-Gush, CEO of Deontics, said: “It is very exciting to be working with the Trust on realising the possibilities of using AI to enhance clinical treatment decisions using Deontics technology.

of information to find the right route to recovery for the patient.

“This will help us to provide the treatment that is most effective in meeting an individual patient’s medical needs according to established guidelines. For the patient this means they have the best chance of getting better quicker.”

As a Global Digital Exemplar, the Trust is pioneering a number of IT projects for the NHS and is working with Deontics, an award-winning health technology company

“We have shown how our healthcare AI technology can increase patient safety, reduce unnecessary clinical variation, and deliver high-quality, cost-effective care and we look forward to bringing these benefits to patients in Liverpool.”

David Walliker, chief information officer at the Trust added: “Deontics is another element of the Trust’s award winning Digital Liverpool Programme.

“If successful it is hoped that Deontics could be used in a number of areas across the hospital to provide high quality care for a range of serious conditions.”

14

World class workforce

Prof Kaye awarded Researcher of the Year St Paul’s Eye Unit’s Professor Stephen Kaye has been awarded the prestigious National Institute of Health Research (NIHR) and The Royal College of Ophthalmologists Researcher of the Year award.

The award was presented at the Royal College of Ophthalmologists annual congress held in Liverpool this year.

It is awarded annually to a clinician in recognition of their outstanding contributions to research. This is based on their research leadership in the wider NHS community with successful delivery of research studies translating and leading to patient benefit.

The award was given in recognition of Professor Kaye’s research into diseases of the cornea and ocular surface, corneal transplantation, corneal infections and refractive disorders.

On receiving the award, Professor Stephen Kaye said: “I am delighted and honoured to receive this award which is testament to the strong and passionate team of scientists and research active clinicians in Liverpool with whom I have the pleasure of working with.”

Professor Kaye has been a consultant ophthalmologist at St Paul’s Eye Unit since 1994 and is an honorary professor of ophthalmology in the department of Eye and Vision Science at the University of Liverpool.

White flashes turned out to be ocular melanoma After Sharon Wood started to experience white flashes in her left eye, she just put it down to stress and it was over six months later that she was diagnosed with ocular melanoma.

The flashes had started in July 2016, just days after her husband, Jon, was involved in a bike accident, breaking four bones, and they were in the process of launching a B&B. Months later on Christmas Day morning, Sharon woke with blurry vision and bruising.

She assumed she had caught her eye on something overnight, and with the excitement of the festivities with her young son, Thomas, she brushed it aside. However by late January 2017 the bruising hadn’t gone and the problem had become worse.

Jon said: “She described it as an oil slick at the top of her peripheral vision, she could see an arch of distortion and it never left. Sharon had once taken hydroxychloroquine sulphate for arthritis, and had to have annual eye tests because of it.”

The doctor referred her to an optometrist, who filed an emergency triage form to get her into the local hospital’s eye clinic the next day.

“She was then referred to St Paul’s Eye Unit hinting that it could be anything, including malignant. It was frightening, a great big unknown, and all the signs were pointing to it being more than just a scare,” said Jon. Sharon was diagnosed with ocular melanoma in February 2017 and had surgery less than 24 hours later. She was then an inpatient on Ward 9Y for eight days. The couple describe the team at St Paul’s as fantastic, saying that the support and care they were given was priceless, and still is: “Every member of staff, in every department (including behind the scenes Sharon loved the fresh linen and meals there!), are worth their weight in gold,” said Jon.

He added: “Everyone we came across in our whirlwind at the hospital was so supportive.

Sharon fondly remembers a lady who was carrying out a test and realised that she was upset. She talked with Sharon about our son and our local area. ‘Can you tell I’m trying to distract you’, she had said. It was quick thinking, selfless.”

After a tough year, the outlook is looking great. Jon has also been raising money for research into eye cancer. In May he rode The Fred Whitton Challenge, a 112 mile sportive around the Lake District.

Jon said: “I was riding to raise money for those who supported Sharon during the biggest challenge we’ve faced as a family. The money raised is for The Eye Tumour Research Fund, which provides funding for equipment such as the new ophthalmic ultrasound machine that will help monitor Sharon’s tumour in the coming years.” The fund also supports staff with their research into the diagnosis and treatment of eye tumours.

Their work will positively affect people for generations to come.

“Please take time to visit the optometrist, just as you visit the dentist routinely. Also remember to flip the negative, turn it on its head, and reach for the positive.”

Developing a sustainable health system 15

Two winners at the Unsung Hero Awards Our Recruitment Team are celebrating after winning the Corporate Functions Team of The Year Award in the national Unsung Hero Awards, which celebrates the achievements of non-medical and non-clinical NHS and healthcare staff and volunteers, who go above and beyond the call of duty.

The winners were announced at an awards ceremony in Manchester on 23 February 2018.

The judges selected the Royal Liverpool and Broadgreen Hospitals’ Recruitment Team as they have considerably reduced the amount

of time it takes to hire new staff.

The team have displayed creative ideas when looking at better ways of working, and support the Trust in making sure all new employees are appropriately suited to their environment.

Additionally, IT programme manager Jaki Allen-Free also picked up a Special Recognition award after delivering the Paper Free Programme in the Trust.

Jaki said: “I was totally amazed to be nominated to receive this Special Recognition. I accept this on behalf of my team as we were immensely successful in

this delivery of Paper Free and I am very proud to have an engaged team whom kept the end goal insight at all times.

“We have got our teams using the electronic PENs and Unity systems and perform electronic consent for procedures.

In addition we moved our Health Records into a digital team, we have scanned over 1million case notes onto the Unity system.

“It has taken a long time to achieve what we set out to implement but with the engagement of clinicians, managers and staff across the Trust it has come to fruition.”

How ICRAS helps patients across North Mersey Over the last year our Trust along with other partners across north Mersey have been working together to develop a streamlined community health and social care system.

The Integrated Community Reablement and Assessment Service (ICRAS) is improving access to community and social care services across Liverpool, Sefton and Knowsley (north Mersey), with health and social care organisations working as one.

By streamlining services provided by local NHS services and councils, ICRAS is supporting greater continuity of care and faster access to services for patients.

ICRAS aims to see less social workers based in hospitals and more based in the community. Plus within 24 hours of a hospital admission patients should be set an Expected Date of Discharge (EDD).

Changes like these are helping to create smoother transitions of care and swifter

discharges from hospitals to community and social care services, which helps to reduce hospital lengths of stay and support greater independence for patients.

ICRAS also takes into account different patient scenarios, for example when people are leaving hospital care – where they need to go and what additional care they need.

There are four levels (or lanes), for example if a patient has a simple discharge then they will go straight home, whereas if a patient needs ‘supported discharge’ from hospital then they might need a district nurse referral or an outpatient appointment set up.

There is also ‘intensive supported discharge’ so a patient could require an increased care package at home or equipment and finally with a ‘complex discharge’ a patient might need nursing care or access to a complex rehab network.

By looking at all patients on one system throughout north Mersey there are more services available to help patients receive the best care without remaining in hospital – which often isn’t the best place for them to recover.

Did you know…

Between October 2017 and January 2018 the ICRAS team has supported 23 stepup bed base patients, and prevented 196 acute admissions.

As well as improving the patient’s journey, these improvements have proven invaluable to the health economy as whole.

An average length of stay in hospital until the patient is medically fit, is nine days with an average cost of £300 per day. ICRAS has made a virtual saving of 1,764 bed days, which provides a virtual financial saving of £529,200 in around three months.

16

Developing a sustainable health system

Right first time The Right First Time programme is a clinically-led scheme that is helping to improve the quality of care within the NHS by reducing unwarranted variations, improving patient outcomes and delivering operational productivity improvements that lead to benefits.

A regional team will inform local trusts of national recommendations and how best to put them into practice. They will also match up trusts that might benefit from collaborating in selected areas of clinical practice.

A number of specialities in our hospital are already taking part in the programme including; spinal, orthopaedics, ENT, ophthalmology, urology, vascular, general surgery and the Emergency Department.

An ophthalmology review took place in March 2017, and they observed that St. Paul’s Eye Unit is a large and very good, comprehensive provider of ophthalmology services.

They said that the unit has adopted and developed several innovative approaches to meeting the demands on its services including: meeting the demand by developing Health Care Professionals with expanded role; nurse injectors and innovative glaucoma virtual clinics.

Nationally this project has helped trusts save between £20m and £30m for 2014/15 in orthopaedics alone.

Furthermore, these trusts forecast a further £15m to £20m of savings for 2015/16, estimated at £30m to £40m if replicated across all the orthopaedic trusts.

Some recommendations for orthopaedics included: • Adopting cemented hip replacements for patients aged over 65, which has led to a 10% increase in the use of this method, saving an estimated £4.4m per annum • A reduced length of stay for hip and knee operations has freed up 50,000 beds annually • Greater awareness of costs has led to reduced use of expensive “loan kit” • A “pricing letter”, providing transparency of the prices different orthopaedic trusts pay for prosthesis, is now used by consultants selecting implants.

Staff get ready to tackle flu As we begin to plan for the flu season, a number of nurses in the Trust have signed up to become vaccinators.

received the flu jab were 22 times less likely to go off sick with influenza after vaccination than those who were not vaccinated.

Staff who volunteered attended face-to-face flu vaccination training sessions during June and July, where they learnt how to administer flu vaccines and received a certificate that can be used as part of their revalidation process.

It was also reported that staff who received the flu jab were four times less likely to be absent with common colds and coughs after vaccination, than those who were not vaccinated.

Last year a fantastic 87% of our frontline staff were vaccinated, which was reported as an impressive 6th best compliance rate in England. Workforce analysis of sickness data from last year showed employees who

These trained nurses will be administering flu vaccines to staff from September in wards and departments across the Trust.

Vaccinations will also be delivered in the hospital main entrance for a six week period for staff who are not ward based.

Protecting the NHS against fraud Virginia Martin is our Trust’s Anti-Fraud Specialist and assists NHS organisations across the North West in combating fraud, bribery and corruption.

Employed by Mersey Internal Audit Agency (MIAA), Virginia explains: “It’s estimated that the loss to fraud in the NHS is over £1.25 billion every year – enough money to pay for over 40,000 staff nurses. NHS fraud, bribery and corruption can be committed by anybody, such as staff, health professionals, contractors, suppliers, patients and visitors.

“Examples of fraudulent activities include, staff falsifying their timesheets or travel expenses; working elsewhere whilst on

sick leave; patients making false claims for payment under the Healthcare Travel Costs scheme; overseas visitors claiming for free treatment when they are not entitled to it.”

To ensure staff are not influenced by outside interests or expectations of private gain – such as hospitality gifts or giving employment to family - we also have a procedure were staff need to declare any ‘conflicts of interest’.

Virginia said: “As part of the Standards of Personal and Business Conduct policy, key decision-making staff will now make an annual declaration, even if they have no interests to declare.

Plus all members of staff who have a ‘conflict of interest’ must declare it within 28 days. These measures form part of what is known as the ‘Sunshine Rule’, an initiative aimed at increasing transparency across the NHS. “Potential consequences for staff who fail to disclose any relevant interests include: disciplinary action; professional regulatory sanctions; civil sanctions; criminal sanctions for fraud, bribery and corruption. Contact Mark Grimshaw if you have any questions.”

Anyone can report suspicions of NHS fraud in confidence, 24/7, online at cfa. nhs.uk/reportfraud or call 0800 028 40 60 (powered by Crimestoppers).

Exceptional patient experience 17

Patient thanks Incredible from @R oyallpoolHosps sta ff on Ward 5b yet people I would be again, without the dead, 3 different inv se estigations Since 12 antibiotics to rule ou pm yesterday & t any naughty bugs . Sat here in awe of time management their work rate, & care, World Famo us Pancreas care pital ay #BroadgreenHos m the other side tod fro 30 mins. in HS on #N ati the ult en ns Se out, x-Ray and Co d an In . ng example of nic ini Cli sh dic A #Orthopae ndly and helpful. frie lly rea re we o Wonderful staff wh osps S is! @RoyallpoolH how great our NH

Over twenty years of attending the dental hospital and the service is still fantastic. Mr Butterworth and his team have looked after me so well and even more so these past few years with more work needed. Saying thank you will never be enough for how caring, thoughtful, professional and amazing they all.

In the car and en route Ho me. Can’t thank the staff at @RoyallpoolHosps enough for their work in the past fortnight. #NHS #thankyou er my osps who looked aft rse at @RoyalLpoolH ms nu su us e tur ulo na fab g rin the Thank you to kindness and ca n dad! ke his wrist!! Your ow bro ur he yo s er aft wa ay he e dad tod d him lik is about!! You treate up what the #NHS Awards #nhs HS #N hs en eth ov 70 #il #NHSHeroes #NHS

Saddest few days. My stepfather passed peacefully and with dignity on Thursday evening with family and utterly wonderful ward 5a staff at @RoyallpoolHosps #hugthoseyoulove

, Paramedics and all ctors, Nurses, HCA’s Do the all to my boyfriend u yo Massive thank ps for looking after at @RoyalLpoolHos e NHS. a& the in to ff dit sta er cre the oth and an absolute al on pti ce ex all last night. You are HSMillion #ProudOfOurNhs @N Every possible care has been taken to ensure that the information given in this publication is accurate. Whilst the publisher would be grateful to learn of any errors, it cannot accept any liability over and above the cost of the advertisement for loss there by caused.

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