February 2014
The Royal Liverpool and Broadgreen University Hospitals
insight www.rlbuht.nhs.uk
@RoyalLpoolHosps Facebook.com/royalliverpoolhospitals RoyalLPoolHosps
New Royal: Construction underway!
NHS Trust
CQC report prais es compassionate staff
Staff survey
results revealed
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Exceptional patient experience
Operation Fresh Start
How are we performing?
‘Operation Fresh Start’ was piloted across the Trust in February. This was a concerted effort by all staff to take a fresh look at the way we work to:
This allows us to monitor the delivery of
• Improve patient experience, safety and flow across our hospitals • Improve the working lives of our staff • To prepare for new ways of working within the new Royal Other NHS hospitals have done this very successfully. It involved a number of Trust-wide interventions to improve patient flow in inpatient areas such as: • Enhanced senior clinical and management presence seven days a week • Every patient reviewed by a consultant by 12pm every day • Board and ward rounds to identify the ‘sick and quick’ so that on ward rounds patients should be seen in clinical priority not simply reflecting the layout of the ward • ‘Jobs’ (such as TTOs) should not be ‘batched’ and should be done in real time. The main point of the exercise was that teams were asked to put forward their ‘five a day’, five things they will do differently every day throughout Operation Fresh Start. These were supported by the senior medical and nursing team and the service improvement and excellence team. Following Operation Fresh Start a number of learning outcomes were developed - more on these in the May edition of Insight.
We, along with all other NHS Trusts, continuously monitor our progress against a series of targets that are set both nationally and locally.
our key corporate objectives of patient experience and quality of care, patient safety, productivity, people and financial health. Below is an overview summary of some of our key performance indicators.
Overview to November 2013 (except where stated) Patient Experience and Quality All Cancers: 31-day wait Diagnosis to first treatment A Cancers: 31-day Surgery wait for second or Anti cancer drug treatments subsequent treatment All Cancers: 62-day wait Urgent GP referral to treatment for first treatment Screening service referral Referral to treatment Admitted waiting times Non-admitted Incomplete Cancer: two week waits Urgent suspected cancer referrals Breast symptomatic (not suspected cancer) Accident & Emergency % patients waited over 4 hours Patient Surveys To increase by 5% the number of patients who rate their experience as good or excellent Patient Safety MRSA and Clostridium Clostridium Difficile Difficile MRSA Venous Thromboembolism (VTE) Venous Thromboembolism (VTE) Assessments Mortality Hospital Standardised Mortality Ratio (HSMR) Risk adjusted mortality - all diagnoses Falls 30% reduction in falls by year end Pressure ulcers Grade 2 or above pressure ulcers rate Grade 3 or above pressure ulcers rate Productivity Productivity indicators Daycase Rate Average Length of Spell (Elective Average Length of Spell (Non Elective) New to Follow Up Ratio Did Not Attend Rates People Sickness absence (July) Sickness absence rate (in month) Finance Financial Performance Financial Risk Rating
latest winners presented Employee of the Month The with their certificate are:
Our monthly award scheme recognises dedicated members of staff who have gone the extra mile to help patients during their stay or visit to our hospitals.
If you would like to nominate someone for this award, please contact the Quality Department on extension 2293.
October: Pricilla Hetherington, ward sister, haematology
November: Joanne Taylor, healthcare assistant, ward 4B
December: Pam Campbell, hostess, Broadgreen ward 5
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Exceptional patient experience
CQC Report praises ‘caring and compassionate staff’ The Chief Inspector of Hospitals’ Inspection team visited our hospitals in November 2013. The inspection team were extremely thorough and in the course of their visit met many staff and spoke to a number of patients across the Trust. The report from their visit, outlines a number of areas of good practice and high quality care being provided to our patients. It also highlights areas where we can do better.
‘Innovative practice’ - robotic surgery at Broadgreen Hospita l
Aidan Kehoe, chief executive said: “We welcome the findings of the report and have found the inspections to be an extremely valuable and positive experience, that we can learn from.’ “I am exceptionally proud that the care, compassion and positive attitude of our staff is praised throughout this report by patients and inspectors. ‘At the Trust and across Liverpool, we are deeply proud of our amazing staff and greatly appreciate their hard work and dedication, often working under immense pressure. Having their commitment and passion for patient care praised in this report gives our staff the recognition they deserve.” “The report does highlight some areas where we can and will improve. We take on board these findings, many of which mirror the findings of our own internal reviews prior to inspection. We have an action plan in place to address areas of concern and this will be provided to the CQC by 5 March.”
Caring and compassionate staff Some of the things the CQC report said we do well were: • S taff were caring and compassionate and patients were positive about their care and treatment at both hospitals. They observed staff treating people with dignity and respect and people were encouraged to share their thoughts and experiences of care. •O ur end of life care service is of a high standard and provides seven day care. We have a dedicated bereavement team which provides care and support to relatives following the death of their loved ones. This is supported by a large and well organised multi-faith spiritual support network. • T he stroke service, had the third highest overall performance scores in the country and the highest scores outside London in the most recently published Sentinel Stroke National Audit Programme (SSNAP) report. •A t Broadgreen Hospital, we held evening educational meetings for patients due to be admitted for surgery to remove their prostate gland.
Staff treating people with dignity and respect
• T here were examples of innovative practice, such as the robotic surgery provided by the urology department and the ‘barn’ theatre at Broadgreen Hospital.
Some of the things the CQC report said we can improve and what we will do are: • Care of ‘outlier’ patients (those being cared for on wards that aren’t usually used for the patient’s specific condition) – We have improved how we record the transfers of these patients already and are working on a new electronic patient tracking system. • Improve medical staffing in vascular and colorectal surgery – We are reviewing staffing levels to ensure that the level of medical cover has the ability to manage the care of these patients effectively. • Prospectively audit the management of patients whose conditions deteriorate while they are an inpatient on the Broadgreen site, including those who are transferred to the Royal – We will review all such patient transfers. We will complete an incident form for each transfer and analysis what action was taken and whether any lessons can be learnt. This will be reported to senior management. • Improve the responsiveness of pharmacy to provide medicines on admission and discharge, and ensure that the emergency department has access to required medication at all times – We are piloting a new scheme where each ward will request patient medication as they conduct the ward round. We will be engaging with staff in the emergency department to understand what the key issues are. • Infection control in the Emergency Department – enhanced monitoring of infection control practices and weekly performance provided to the team.
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Exceptional patient experience
Festive fun for dementia patients People with dementia got into the festive spirit as the Royal’s regular Memory Café took on a Christmas theme. The ‘Remember When’ sessions lay on coffee and cakes for people with dementia from Sedgemoor Dementia Centre in Norris Green and the Royal’s own Memory Clinic while they look over pictures, books and memorabilia to remind them of their younger days. The latest event in December had a festive theme and attendees pulled crackers and passed around photos of the traditional toys and games they would have found under the Christmas tree as youngsters, such as Dinky toys, Action Man, Barbie and Snakes & Ladders. A choir from nearby Archbishop Blanch school took time out of their school day to sing Christmas Carols accompanied by keyboard and trumpet. The sessions are organised in partnership with the Workers Educational Association (WEA), Merseytravel and the Liverpool FC Foundation and are supported by the Trust, Costa Coffee and the Compass Group. Shaun Lever, dementia practitioner at the Royal said: “This event is a great way of giving people with dementia somewhere they can meet each other and chat about objects from their past which might trigger happy memories. “It was a great success - the people who attended were smiling the whole time, wearing hats from their crackers and having a good time. We look forward to hosting another ‘Remember When’ session in the near future.”
Evie McNamara reminds smokers they are not helping our patients recover
We say ‘NO’ to smoking
You will have noticed at the Royal huge posters springing up at the main entrance and throughout the hospital calling on smokers not to light up outside the entrances. The posters depicting patients, visitors and staff, and their powerful messages to smokers, form part of a drive to make our hospitals and their grounds smoke free. Patient Tom Niblock, 21, from Netherton, who spent several weeks in the Royal after receiving a bone marrow transplant, was one of those who volunteered. He had to stay isolated on the ward as his immune system was weak and was dismayed by the smoke that greeted him when he was finally able to go outside. Tom said: “I wasn’t allowed out of hospital for weeks and when I did, instead of fresh air, I was greeted by a cloud of smoke.’ His message to smokers is ‘Don’t make me breathe your smoke.” Tom’s girlfriend Evie McNamara, 20 from Kirkby, has this message for smokers: “You’re not helping patients get any better. Stop smoking outside the hospital.”
Dr Stephen Hawkins, haematology consultant says: “Like many others, I’m allergic to smoke. It’s not just your own health you’re affecting.” Staff nurse Daniel Storey says: “I work here to make a difference. I don’t want to breathe your smoke.” Feedback from members of the public demanded the hospital be a no smoking site and a survey on the Trust’s website revealed 80% of people agreed. It is hoped that the posters will make smokers think of others before lighting up, but we still need staff to ask anyone smoking near the entrance to stop. We are in talks with Liverpool City Council and other Trusts in the area with a view to finding ways of enforcing no smoking on all hospital sites. Aidan Kehoe, chief executive, is also taking part in the poster campaign. He says: “Everywhere else is smoke free, so why not a hospital? We’re here to promote health.”
Do you want to quit smoking? For staff there are sessions every Tuesday morning from 9.30am to 11.30am at the tutorial room, Liverpool Centre for Sexual Health, Royal 1st floor. To book please contact Ginny Biggs on ext 9165/9163
Please call the WEA on 0151 243 5350, to book your place on the next ‘Remember When’ session. Carers, family and friends are welcome to attend.
Organisers of the ‘Remember When’ session at Costa in the Royal
Members of staff have also come forward to support the poster campaign.
Patient Tom Niblock urges smokers outside the Royal’s main entrance to smoke elsewhere
For patients and visitors, speak to your nurse who can refer you to support and advice services or contact local based group Fag Ends on 0800 195 2131. Lines are open Monday to Friday 10.00am – 7.00pm.
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Exceptional patient experience
Emergency Medicine App out now! Our very first app is now ready for clinical staff – especially junior doctors – to download for free. The Emergency Department Handbook, which has been available only on the intranet, is now a handy app, ‘The Royal Liverpool Emergency Medicine Handbook’. The app covers: • T he latest guidelines and protocols for the management of common acute conditions that present to the Emergency Department or that can develop in our in-patients acutely. • Links to relevant Trust policies • Contact details • L inks to useful local, regional and national guidance, protocols and websites Professor Arpan Guha, associate medical director and director of medical education said: “The app is easily searchable by symptom or condition and will make it easier for staff to get the latest guidance to support the care and treatment of our patients. Staff can ‘bookmark’ their most searched for terms to find them even more quickly.”
Dr Ray Raj, consultant in emergency medicine, said: “It can be used at a patients’ bedside, with the right connection and is very user friendly, preventing staff from needing to leave their patients to check the handbook on the intranet. It allows staff to have more confidence in their management plan and provide optimal care in line with the Trust policies also available through the App.” The app will notify users when a policy changes or there are updates and the app can be easily ‘updated’ using the App Store. There is also a feedback mechanism within the app to make your own suggestions to the editorial team. This comes after a great deal of work by the Emergency Department and the Medical Education directorate, along with input from other specialties. To get using the app just go to the App Store and search for ‘Royal Liverpool’ It’s currently only available for iOS users, but may become available for android in the future.
Royal leading the way on patient safety The Royal is piloting a new education package to ensure the views of staff are listened to and improvements are made to provide safer care. ‘Improving Quality in Healthcare: Learning from the Francis Report’ has been developed by Dr Tom Kennedy, consultant physician at the Royal and co-director of education for the Liverpool Health Partnership (LHP). Dr Kennedy said: “This initiative being piloted at the Royal is a huge step towards achieving a more patientfocused health service and addressing the issues and themes highlighted by the Francis report. It aims to give all NHS staff an opportunity to openly and honestly discuss the delivery of patient care, in a structured and constructive way.” The initiative is believed to be the first education programme designed to address the issues highlighted by the Francis Report, by focusing on and involving front line staff - often the place where there is greater understanding of the causes of any issues. The initiative starts with staff taking part in facilitator led group discussions using case studies developed by staff. These are based on real patient experiences relevant to their departments, in order to examine the delivery of care on their ward or unit. Staff then complete an anonymous online survey reflecting on the care they provide. LHP will collect the responses and produce a report to the Trust, to help them identify where improvements can be made. Jan Lacey, matron in the Acute Medical Assessment Unit said: “It’s a very useful exercise. It provides a good way to encourage staff to discuss very difficult issues. We are extremely passionate about helping patients and providing them with the best care possible and this is another way to do that.”
The app features a user-friendly menu screen enabling clinical staff to find the latest guidance for various symptoms and conditions
Liverpool Health Partners will make the package available to as many trusts as possible, beginning with the hospital trusts within the partnership and then rolling out to other NHS organisations in the North West and nationally.
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Developing a sustainable health system
New Royal – Construction Construction began on Monday 3 February, after the deal was sealed before Christmas, with all partners reaching financial close on the new Royal. Aidan Kehoe, chief executive said: “This is a huge moment for all those who have worked so hard, for so many years and we are all delighted to start work on the new Royal. This is fantastic news for our patients, our staff and the city of Liverpool. We will have a world class hospital facility designed to provide a whole new approach to healthcare and help us to tackle some of our region’s biggest health issues. The new Royal will improve the health and wealth of the city creating hundreds of construction jobs and training opportunities and paving the way for thousands of hi tech jobs on the BioCampus.” The new Royal is being built behind the current hospital, on the corner of West Derby Street and Low Hill and will transform one of the key gateways to the city from Edge Lane.The hospital will take around three years to build and fit out, ready for opening in 2017. The site has been taken over by Carillion, the developers of the new Royal and the area is now closed off to the public. The initial stages of development will see Carillion preparing the ground to enable building work, the first big cranes are expected by the end of March. During construction pedestrian access to the rear of the hospital will only be available from the pathway at the side of the Dental Hospital. There will be temporary bus diversions and traffic management schemes in place around West Derby Street – check your emails and the intranet or listen out to local radio bulletins for the latest updates. David Kennedy, Carillion operations director said: “Services will continue at the current hospital throughout construction of the new Royal. We are working closely with the Trust and are committed to ensuring that there is no disruption to patient services due to construction. Every effort will be made to minimise disruption on site and to the local community. We will be regularly updating local residents about developments on site.” Helen Jackson, director of strategy and redevelopment, who has led the project team behind the new Royal for over seven years said: “We have been eagerly anticipating the start of construction and are delighted to now be able to focus on building world class facilities and our plans for transforming the delivery of care we provide to patients.”
Chief executive Aidan Kehoe and chairman Judith Greensmith signed the deal to achieve financial close in December, with John Graham, finance director, Helen Jackson, director of strategy and redevelopment and members of the Project Team
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Developing a sustainable health system
n Underway
Key facts about the new Royal • T he new Royal will be the largest hospital in the country to provide all single en-suite rooms for inpatients, improving privacy and dignity, helping to reduce infection risks and maintain single sex accommodation • There will be 18 operating theatres and 23 wards • There will be a larger Clinical Research Facility • There will be a 40-bedded Critical Care Unit • T he Emergency Department will be one of the biggest in the north-west with a CT scanner and special lifts for major trauma patients, which go straight to theatres •K ey services will be located closer together and there will be shorter walks and an easier layout • P atients and staff have been involved in the design process and we will continue to work with them as plans for wards and other areas are further developed • T he hospital will be more welcoming, with lots of natural light, colour and outside views •W hen the project is finished, there will be an underground car park for patients and visitors. Buses will come onto the site, enabling better and easier access to the hospital • T here will be a dedicated cycle centre and ten electric car charging points • T he hospital will be one of the ‘greenest’ in the country, with renewable energy systems, low carbon technology, use of water meters and leak detection systems.
Regenerating our city – key facts The design master plan for the new Royal site
• The new hospital will create the equivalent of 750 full-time jobs throughout the four year construction. 60 percent of these jobs will go to local people • There is a commitment to use at least 60 per cent of local materials • 15 percent of the workforce will come from priority council wards in the city • There will also be 75 to 100 apprenticeships available • The construction will contribute about £240 million to the local economy • The Liverpool BioCampus has the potential to create up to 5,000 jobs – most of well-paid and high value jobs • The new Royal and the Liverpool BioCampus will deliver a development twice the size of Liverpool One • The BioCampus will be fed by England’s first University Technical College for Life Sciences, ensuring opportunities for local young people
The area of the construction site for the new Royal (in yellow)
• These projects will put Liverpool and the UK on the world’s scientific stage in a key global industry. We will be competing with established international centres like Boston and Singapore to attract the world’s best clinicians, researchers and entrepreneurs
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Improving the quality of life for our patients
Infection control message to staff We have all worked extremely hard over many years to improve how we prevent infection. This hard work and dedication to keeping our patients safe has seen sustained reductions in healthcare associated infections and we have consistently met ever more stringent targets. However we are currently over our targets for this year. As we all know the targets are there to measure improved care and keep our patients safe and all staff would agree that one case is too many. Below is a real example of a patient (name removed to protect privacy). Mrs A is a complex patient who has been admitted to our Trust for over 4 months. She has complex medical conditions and has had multiple procedures whilst in hospital, including hip surgery, a PEG tube insertion and multiple intravenous access lines including a PICC line. Unfortunately she had to be transferred between at least four different wards within four months. Although she was not MRSA colonised when she was admitted to our hospital, she had developed MRSA bacteraemia from a PICC line infection. This caused her health to deteriorate and she underwent a lengthy period of recovery in hospital.
The Flu season has arrived From January we have been caring for patients admitted with Flu. Here are some simple ways in which you can protect yourselves, your patients and your loved ones.
Have you been vaccinated? Flu jabs are free if you: •a re 65 years of age or over • are pregnant •h ave certain medical conditions including chronic (long-term) respiratory disease, chronic heart, liver or kidney disease, diabetes, weakened immune system as a result of treatment eg chemotherapy. •a re a healthcare worker with direct patient contact or a social care worker
We are asking you to do everything possible to ensure that this does not happen to another patient. Please remember to follow these five points: 1. Use alcohol gel before and after seeing ALL patients. 2. Ensure that ALL admissions to hospital, all transfers between wards and all patients who have been admitted for over a month are screened for MRSA. 3. Decolonise ALL patients with a positive MRSA screen. 4. ALL IV lines must only be inserted and used by staff who have been trained and peer reviewed. 5. ALL IV lines must be reviewed on a daily basis and removed if there is any suggestion of infection or if it is no longer required
Using alcohol gel is one of the key ways to avoid the spread of infection
Also
•p eople living in a long-stay residential care homes or other long-stay care facility or those receiving a carer’s allowance, or who are the main carers for an elderly or disabled person.
Think of others We all know “coughs and sneezes spread diseases” please postpone your visit to hospital if you are developing flu like symptoms. If you do have flu or a cold:
Catch it – cover your mouth / nose with a tissue if coughing or sneezing.
Bin it -
dispose of used tissues into a bin
Kill it – Cleanse your hands.
Beat the bugs – help yourself and protect others Healthcare workers are all taught to use a method to wash / gel their hands which ensures no parts are accidentally missed. We would like to encourage patients, relatives and visitors to learn and use this method and join us in our efforts to prevent cross infection. Look out for posters, signs above handwash basins and leaflets. Members of the ward teams and infection prevention and control team are happy to be approached if you have any queries or require assistance.
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Improving the quality of life for our patients
TTP specialist nurse Clare Kay-Jones, patient Jeannie Belfield and Dr Tina Dutt at the Royal’s Haematosis and Thrombosis Centre
Royal gives life-saving care on rare blood disorder In March 2000, 35-year-old Jeannie Belfield counted 35 bruises on her body and went to her GP, completely oblivious to the life-threatening disorder that was rapidly clotting her blood and threatening to shut down her internal organs. “I was confused, had pains in my stomach and headaches,” remembered Jeannie, now 49. “By 5pm, I had a transient ischaemic attack (TIA), a mini stroke. The GP came out and said he’d been trying to contact me because there was something wrong with my blood and I needed to go to the Royal urgently. “The doctor told my mum and husband to expect the worst,” added Jeannie. “My platelets were extremely low at the time. I was going in and out of TIAs.” Jeannie, a former mental health nurse who was otherwise healthy, received neurological observations every half hour and the following day moved to Ward 7Y. She was diagnosed with thrombotic thrombocytopenic purpura (TTP), a rare disorder of the blood-coagulation system causing microscopic clots to form in blood vessels throughout the body. Left untreated, 90% of patients with TTP die as the clots damage vital organs such as the brain, heart and kidneys. Only six people in a million are diagnosed with TTP in the UK each year. Under the care of consultant haematologist Vanessa Martlew, Jeannie was put on a plasmapheresis machine daily, with 25 large bags of plasma replaced in her body
through a central line in her chest. She spent a further six weeks being nursed back to health in the Royal. The Royal recently became the regional centre for TTP and is now home to only the second dedicated TTP specialist nurse in the country, who advises patients on their condition and medical professionals on the symptoms. It is a specialist diagnostic centre and one of only a handful of places in the country that can carry out the ADAMTS13 test to determine if a patient has TTP, receiving blood samples from around the UK. Containing one of only five therapeutic apheresis centres in the UK, the hospital is also ideally placed to provide plasma exchange on-site, while doctors can also draw on the support of the renal team, interventional radiology and intensive therapy unit all under one roof. Jeannie says the Royal’s TTP specialist Clare Kay-Jones has removed the uncertainty around TTP and helped her and others through what can be a traumatic time. She added: “I can email or speak to Clare if I don’t feel too good. She will check my platelets and I can come to the Roald Dahl Centre at the Royal anytime. It’s great that I don’t have to go to A&E. “The first few years I found it hard to not let it be the focus of my life. It’s part of me now and I’ve got to deal with it when it happens.” Consultant haematologist Dr Tina Dutt, who has set up the regional service with her
colleagues, said TTP is unpredictable and can affect people of any age. She said: “Everyone knows if you have a stroke, you’ve got to get to hospital. But the symptoms of TTP are less well known. The fear is that patients can deteriorate rapidly within minutes. Patients need prompt diagnosis and management to have the maximum chances of survival.”
TTP – What to look out for Thrombotic thrombocytopenic purpura (TTP) is a rare disorder of the blood-coagulation system, causing microscopic clots to form in small blood vessels which can damage many organs including the kidneys, heart and brain. Most cases of TTP arise from inhibition of the enzyme ADAMTS13. The symptoms of TTP may start with fever, headache, and sometimes diarrhea. As the condition progresses, clots form within blood vessels which can cause bruising, and rarely bleeding, usually from the nose or gums. Neurological symptoms are present in up to 65% of patients, and may include headaches, difficulty speaking, hallucinations, stroke, paralysis, numbness, fits, or even coma. Blood tests of TTP patients can reveal thrombocytopenia (low platelet count) and a blood film featuring evidence of mechanical fragmentation of red blood cells.
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Developing a world-class workforce
Lord Mayor Gary Millar, Trust chairman Judith Greensmith and breast surgeon Chris Holcombe with the freedom of the City scroll
The audience at Liverpool Town Hall gather to honour the Linda McCartney Centre
In late November, the Linda Mc Cartney Centre was granted the Freedom of the Cityof Liverpool in recognition of the services it provides for advanced and innovative treatments for breast cancer.
Thousands of people each year are cared for at the Linda McCartney Centre and its services have made a huge difference to the lives of a great many people.
Lord Mayor Gary Millar, with patients and staff from the Linda McCartney Centre and model Danielle O’Hara/Lloyd
Linda McCartney Centre gets the Freedom of the City Liverpool’s Lord Mayor, Councillor Gary Millar, said: “The Freedom of the City is the highest honour we can bestow, and the Linda McCartney Centre are a most deserving recipient. Each member of the team is completely devoted to helping those receiving treatment, ensuring they are as comfortable as possible. The dedication and support to those suffering from cancer and the after effects is to be commended.’ “I am delighted to be supporting them as one of my charities and honoured to be granting them the Freedom of the City.” Thanks to the services provided by the Linda McCartney Centre people from all over the North West can travel to the Centre to receive some of the most advanced and innovative treatments available in the UK today.
Margie Shields, from Huyton was first diagnosed with breast cancer in 2002, but later developed bone cancer and has been coming to the Linda McCartney Centre every three weeks for the last eight years to receive treatment. Margie said: “I am still going strong thanks to the fantastic treatment and support from the Linda McCartney Centre. Even though my cancer is terminal, I am able to carry on as normal. More and more people are surviving cancer for longer thanks to the advanced treatments being pioneered at the Linda McCartney Centre.” Dennis Murphy from Birkdale first found out he had cancer in 2005 when he was diagnosed with Non Hodgkin’s Lymphoma (NHL). This eventually became Cell B Chronic Lymphatic Leukemia (CLL). Denis said: “Every four weeks at the Linda McCartney Centre,
I receive, as far as I am concerned, the best treatment you can have and everyone who looks after me, not only displays professionalism but care, compassion and humour. Everyone who looks after me goes the extra mile on each of my visits.” Chris Holcombe, cancer lead for the Linda McCartney Centre said: “On behalf of the staff, patients and supporters of the Linda McCartney Centre, I sincerely thank the City for granting us the highest honour with the Freedom of the City. This honour is amazing recognition for the work we all do to improve the lives of local people with cancer.” During the event, guests watched a moving video testimonial in which cancer patients, Pauline Daniels, Maureen Walsh, Sheena Privett, Mark Emmerton, Margie Shields, Dennis Helsby and Dennis Murphy spoke of their experience of living with cancer and the support provided at the Centre.
Trust recognised in Advancing Quality Awards Our hospitals have been recognised in the annual Advancing Quality Awards, hosted by the Advancing Quality Alliance (AQuA). The awards recognise the achievements of trusts across the North West who contribute to improving quality and enhancing patient safety in the NHS.
As a member of AQuA, we have been improving our care year on year in a number of services. We were recognised in two categories, finishing second in the ‘Best Performing Trust (Y4-Y5 Acute)’ category and third in the category for ‘Most Improved Trust (Y1-Y5)’. Medical director Peter Williams said: “This
is a great achievement for us and a clear sign of our intentions to help improve healthcare in the region. “Being nominated for two of the awards is something we can be very proud of and to finish in the top three in both shows just how determined we are to improve quality of care in both of our hospitals.”
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Developing a world-class workforce
National award for pancreatic team The team behind the Pancreatic Enhanced Recovery Unit (PERU) at the Royal have won the prestigious Health Service Journal (HSJ) Award for Innovation. The team received this national award for their innovative service, which is the first of its kind, speeding up recovery times for patients who have had major pancreatic surgery for pancreatic cancer, pancreatitis or other diseases of the pancreas.
in recognition of the great ideas and hard work of the whole team.” The PERU service runs alongside the Royal’s world-renowned pancreatic service, the Liverpool Pancreatic Biomedical Research Unit (PBRU), which is the only research unit of its kind in the UK funded by the National Institute of Health Research (NIHR) and aims to improve the diagnosis and treatment of patients with pancreatitis and pancreatic cancer.
In its first year of operation, the dedicated eight-bedded unit cared for 114 patients following pancreatic surgery. Patients no longer need to stay in a high dependence unit and their average recovery time in hospital has decreased from 18 days to 14 days. Patient satisfaction rates have soared and patient safety has been maintained. This means pancreatic patients spent less time in hospital and this reduced length of stay is saving the Trust over £300,000 a year.
Well done to all staff involved in the PERU service for achieving this award.
Surgeon Michael Raraty, clinical director for general surgery and lead clinician for PERU said: “We are delighted to have won this prestigious HSJ Award for Innovation,
The team behind the Pancreatic Enhanced Recovery Unit (PERU) at the Royal collect their HSJ award from newsreader Jon Snow
Awards for orthodontic staff Two of the Dental Hospital’s orthodontic staff have won national prizes at the British Orthodontic Conference in 2013.
Simon Watkinson and Billie-Jean Rainet take top spots in awards
Simon Watkinson won the gold medal from the Royal College of Surgeons, for achieving the highest marks in the membership in orthodontics examinations in 2013, as well as first prize from the British Orthodontic Society for his treated clinical cases. Billie-Jean Rainey won first prize from the British Orthodontic Society for her research presentation ‘Reliability of Cervical Vertebrae Maturation (CVM) Staging Method’, at the university teachers group presentations. Both were presented with their awards by Mr John Muir, president of the British Orthodontic Society.
Royal wins award for instant patient image sharing The Royal’s new Picture Archiving and Communications System (PACS) and Radiology Information System (RIS), which is allowing clinicians to instantaneously share patients’ images across multiple trusts, has won a national award.
But radiologists can now view images instantly and seamlessly through the same search and application used to view locally held images.
The Royal won Data Centre of the Year at the Techworld Awards after it replaced its five year old PACS and RIS, in a partnership with ten other trusts across Cheshire and Merseyside – the first large consortium to move away from national programme systems.
“In the past making sure that patients and images were in the same place was a huge undertaking, and some patients had studies repeated because their images were elsewhere,” said Peter Rowlands, consultant radiologist and regional clinical PACS lead. “Now if a patient has imaging it is available on all the sites within seconds.”
Before the systems were implemented, it would have taken an average of 30 minutes of a consultant’s time to identify and secure the transfer of patient images from another Cheshire and Merseyside trust. They would make requests for images by phone, with images sent manually by IT staff.
The new system is expected to free up the equivalent of half a full time consultant radiologist over the course of a year. And sharing of an overnight radiology reporting service between the Royal and Whiston hospitals is likely to mean fewer overnight shifts for registrars.
Sharron Dyce, PACS manager in Radiology, with the Data Centre of the Year award
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Developing a world-class workforce
NHS Staff Survey 2013 Thank you to everyone who returned the staff survey by the deadline in December. Our response rate was 58%, and whilst it was 2% less than last year, the national average was for all Trusts was 49%. We had hoped to reach 70%, but we will try again next year! Congratulations to all the teams and individual staff who have won prizes this year, we have had lovely comments from you about this so it will continue next year, thank you.
What you say really does matter – so what are the headlines? Our most improved scores are that: • 63% of staff would recommend the Trust as a good place to work (up 6%) • 56% said direct line managers give clear feedback on work (up 5%) • 73% of you have had appraisal - we want this to be even higher next year. • 62% of you said your teams often meet to discuss effectiveness (up 4%) • 48% said you are satisfied with the recognition you get for good work (up 4%) Of particular note is that where we have focussed attention on getting things right
through staff engagement, results have improved - for example, clear planned goals - 75% (up 3%), staff able to make suggestions to improve their area of work - 74% (up 4%), staff able to make improvements happen in their place of work - 55% (up 3%) and staff satisfied with amount of responsibility - 74% (up 2%). Some of the areas which have declined over the last year are: • Health and Safety Training (down 6% to 65%) • Equality & Diversity Training (down 6% to 62%) • Staff saying that they have not worked additional paid hours (down 2% to 69%) • Staff saying that there are enough staff to do the job properly (down 2% to 31%) In 2014/2015 we plan to focus our attention on • Going Local - staff engagement plans • Mandatory training improvement plan • Appraisal • Hand washing facilities and availability • Governance, and reporting culture for errors, near misses or incidents • Campaign on behaviour in the workplace
Stella Clayton, deputy director of human resources said: “When added to the top 5 most improved scores above, the results provide great evidence to demonstrate that staff engagement is having a significant impact. Thank you. “But we are not complacent, there are areas of the Trust where the above good things don’t apply, and we want to make sure they do. There are areas in the survey where you weren’t so happy, we want to change that. We will continue to work with you to listen to your ideas to improve services for patients and their families and to improve things for yourselves as valued and dedicated members of our staff.”
Winning teams The teams with the highest percentage of responses to the NHS Staff Survey won cakes and cash prizes. Those teams were: • The Redevelopment team • The Pharmacy directorate • The Surgery Operational team • The Therapies team
NHS Unsung Heroes Our campaign to put the lesser known roles in our hospitals in the spotlight continued in December.
patients were identified. By December, Maria had already had 61 referrals, seeing most of her patients on Haemodialysis ward 6B.
While patients and visitors are well aware of the vital role our doctors and nurses play every day, there are members of staff who are critical to their care they may be less aware of.
Maria helps to ease the concerns of both peritoneal dialysis patients and haemodialysis dialysis patients, who are often worried about the changes they need to make to fit the treatment into their lives. Often patients also need to change their diet and are forced to become less active while some have needle phobias, which Maria can also help them deal with.
The Communications and Marketing team has visited several members of staff, shadowing them while they work and updating our Twitter account about the brilliant work they do using the hashtag #NHSUnsungHeroes. On 13 December, we met Maria Fraser, a renal consultant clinical psychologist in the Nephrology Directorate, based on the ninth floor at the Royal. Maria works with our dialysis patients in a post created in January and funded by the British Kidney Patient Association. There are already clinical psychologists working with cancer patients at the Royal and the benefits of a similar service for dialysis
Maria can speak to patients and their families in her office, with sessions typically lasting around an hour, but can also visit patients while they are receiving dialysis on wards including the high dependency unit. Maria said: “It can be difficult to accept a diagnosis and adjust to the lifestyle changes that may be required. It can also be difficult to adjust to the treatment regime and to undergo medical procedures which may make you feel anxious or upset.
“Sometimes other problems, not directly related to your kidney disease, may affect how you deal with it, such as stress, long term anxiety or mood problems. “People can become depressed, Clinical psychologist anxious or angry Maria Fraser about what is happening to them and feelings of distress can lead people to feel overwhelmed at times. It can be useful to work through theses issues with someone experienced in dealing with psychological and emotional difficulties.” If you are interested in taking part in our Unsung Heroes campaign, or know a member of staff who should, please contact the Communications and Marketing team at communications@rlbuht.nhs.uk
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Developing a world-class workforce
Individual winners
Individual prize winners selected at random from completed surveys are detailed in the table below. The prize draw was organised by Quality
Health, the external organisation conducting the surveys. Although the names of who responded were provided to the Trust by Quality
Health (so that the prizes could be given) nobody at the Trust would ever see what any individual said in their survey, as it is anonymous.
£100
Jonathan
Durnian
consultant
Ophthalmology Directorate
£100
Marie
Shaw
health and safety advisor
Nursing Services Summary
£100
Maria
Kelly
senior post anaesthetic care unit practitioner
Anaesthetics and Theatres
£100
Carla
Bowers
clerical worker
Health Records
£100
Hilary
Hewitt
divisional general manager
Policy Board Summary
£100
Helen
Dwerryhouse
senior occupational therapist musculoskeletal team
Therapy Services
£100
Carol
Larkin
deputy office manager
Breast Services
£100
Linsay
McKiernan
systems support and development lead
Information Directorate
iPad
Joselito
Marinas
clinical skills training manager
Human Resources Directorate
iPad
Rachel
Burke
occupational therapist
Directorate of Clinical Gerontology
Medicine: 5 days extra leave
Catriona
Eccles
staff nurse
Gastroenterology
Surgery: 5 days extra leave
Joanne
McDonough
multi-disciplinary team co-ordinator
Orthopaedics Directorate
Surgery: 5 days extra leave
John
Hynes
staff nurse
General Surgery
CCSS: 5 days extra leave
Marie
Bolger
facilitator
Pallative Care
Corporate: 5 days extra leave Linda
Karoui
clerical officer
Information Directorate
Medicine: 5 days extra leave
Lazarus
Fernandes
staff nurse
Infectious Diseases
Surgery: 5 days extra leave
Pamela
Ashcroft
medical secretary
Ophthalmology Directorate
CEO Question Time • Would you like to know what thought goes on behind key decisions at the Trust? • Would you like to know what our longer term plans are? • Have you got a question that you would like to ask the chief executive? Monthly CEO Question Time sessions with chief executive Aidan Kehoe have given staff the opportunity to ask any question they might have on issues that affect them in the Trust.
press but subject to change) are:
• 9 December 12.30-13.30pm*
• 18 March 2.30-3.30pm • 30 April 10-11am* • 19 May 9-10am • 17 June 2-3pm • 31 July 9.30-10.30am • 28 August 10-11am* • 26 September 2pm-3pm • 29 October 10-11am • 11 November 3-4pm
All sessions are held at the Royal, except those marked * which will be held at Broadgreen.
Staff from all departments and grades are invited to meet with Aidan over a cuppa for an hourly question and answer session. These are informal sessions and questions on any subject are welcome. Notes from the sessions are published on the intranet, with the names of those attending removed, so staff can feel free to ask whatever is on their mind. The dates for the remaining CEO Question Time sessions this year (correct at going to
Aidan answering questions from staff
We are looking for around 15 to 20 members of staff per session, on a firstcome, first-served basis. Staff must book attendance in advance by emailing communications@rlbuht.nhs.uk.
14 Developing a world-class workforce
Staff raise awareness for World Aids Day Jo Marinas, far left with colleagues packing materials donated by hospital staff to the Philippine relief effort
Hospital staff rally in support of victims of typhoon Haiyan Staff from across the Trust rallied around to support the Red Cross collection for victims of the typhoon in the Philippines. Tinned food, clothing, baby clothes, blankets and other materials were donated for the relief effort following the typhoon that hit the Philippines in November, leaving thousands dead and many more homeless.
World AIDS Day was marked on 29 November by HIV Services at the Royal, providing an opportunity to show support for people living with HIV and raise awareness of the importance of testing. Of the 34 million people worldwide living with HIV, nearly 1,000 live in the Liverpool area with many more thought to be carrying HIV without knowing it. Approximately half of those diagnosed now are heterosexual. Last year, there were 94 new cases confirmed in Merseyside. But thanks to advances in treatment being administered by HIV services at the Royal, there were no deaths attributed to AIDS and no cases of the virus being transmitted from a mother to her baby. Key to the ability of people with HIV to live normal lives is early diagnosis, allowing for specialists such as those at the Royal to give the most effective treatment. Denise Davenport, specialist nurse at the Royal’s Liverpool Centre for Sexual Health, said: “Over the past 30 years, medical advances have saved the lives of many people with HIV. But we cannot be complacent - HIV still kills 500 people in the UK each year and affects people
of all ages and backgrounds, from teens to pensioners. “The figures show that if HIV is detected early, treatment is far more successful and you give yourself a great chance of having a normal life expectancy. The best way to protect you and your partner from contracting the virus is to use a condom.”
HIV still kills 500 people in the UK each year and affects people of all ages and backgrounds
The Royal’s World AIDS Day event was held in the main reception by the Trust’s HIV Services team on 29 November, with teams from different organisations providing information and guidance about sexual health to patients, staff and the public. The Royal Liverpool and Broadgreen Hospital choir also performed. Find out more information about HIV and Aids online at: http://www.aidsmap.com/
The collection was coordinated by Jo Marinas, clinical skills and training manager at the Trust. Jo, who is from the northern part of the Philippines, came to Liverpool in the late 1990s. Jo said: “Although my family were spared the devastation as they live in a part of the country relatively unaffected by the typhoon, my heart really goes out to my countryman who have had their lives shattered. I felt I had to do something to support them and have had such an amazing response from everybody. “We sent over 50 boxes of materials to the Red Cross containing such things as tinned food, clothing for all ages including babies, shoes, towels and blankets. These will be a great help to many thousands of people in the Philippines who have lost everything. I can’t thank people enough for their support.”
Denise Davenport, Hayley Downey (specialist practitioner), Carl Jackson (healthcare assistant), Mark Lawton (consultant medicine), Kathy Jones (lead nurse) and Joanne Griffin (healthcare assistant) prepare for World AIDS Day events at the Royal
15
Developing a world-class workforce
The Royal’s team of experts
Doctors, nurses and technicians from Gaza are visiting the Royal to learn how to perform kidney transplants
Gaza surgeons arrive in Liverpool A team of doctors, nurses and technicians from Gaza have arrived at the Royal to learn how to undertake lifesaving surgery in the hope that it could transform the future of kidney transplants in Gaza. The group were invited to take part in training at the Royal by consultant transplant surgeon, Mr Abdul Hammad, who visited Gaza’s Shifa Hospital with a team from the Royal to perform the first ever kidney transplants in Gaza.
The hope is that the team from Gaza will take back vital skills and techniques necessary to carry out more kidney transplants in Gaza that could potentially bring hope to Gaza’s 500 dialysis patients. The team arrived at the Royal and were greeted by a welcoming party that included Mr Hammad and some of the Trust Board members before getting started on their training. The group will spend a number of months learning from some of the best transplant surgeons in the UK, here at the
Royal and Broadgreen hospitals. Mr Hammad said: “This is a great opportunity for the Trust and the team from Gaza to really make a difference to their country. Kidney transplant is the best way to treat kidney failure and therefore it is important that we help Gaza and Shifa Hospital make this a reality for the hundreds of patients on dialysis in the country. “We hope that the team learn from our practices and take this back to make a huge impact to the lives of the people of Gaza.”
Clinical Audit Symposiums 2013 During November and December 2013 the Divisional Clinical Audit Symposia were held culminating in the Trust Wide Audit Symposium on the 20 December. The divisional symposiums were well attended and 23 audits were presented with three commended audits selected from each division to present at the Trust Wide Symposium. The Trust Wide Symposium was held in the lecture theatre and was open to all members of the Trust to attend and see what excellent audit work is going on across our hospitals. The audits were judged by Colin Hont, deputy director of nursing, Frank Kerkham, non-executive director and Debbie Rimmer, head of the healthcare quality team (HQT) at Mersey Internal Audit Agency.
Commended audits from each Division: Division of Medicine • Emergency Department – ‘Pain management in the ED’ – Dr V
Rehnberg (presenter) • Dermatology – ‘Use of alitretinoin for treatment of hand eczema’ – Dr N Meah (presenter) • Liverpool Centre for Sexual Health – ‘Management of contacts of patients diagnosed with Chlamydia at the Liverpool Centre for Sexual Health’ – Ms K Wainwright (presenter)
Division of Surgery • Theatres and Anaesthetics – Theatre Suite Thermo – regulation Dr Meyhew (presenter) • Trauma and Orthopaedics and Clinical Gerontology - Shared care and best practice for national hip fracture – national report 2013 – Dr Tsang (presenter) • Ear Nose and Throat – Excision Margins in skin cancers - Mr B Attlmayr (presenter)
Division of Core Clinical and Support Service • Dental - Patient Management and Outcomes on the Paediatric Prevention Clinic Dr R Parry (presenter) • Palliative Care - Prescription and use of
Syringe Drivers for Palliative Care patients Dr R Heath (presenter) • Infection and Human Immunity - An audit and re-audit of Gentamicin prescribing – Dr J Fold (presenter)
Winner and Commended Audits at the Trust Wide Audit Symposium Winner Palliative Care - Prescription and use of Syringe Drivers for Palliative Care patients - Dr R Heath (auditor) presented by Dr L Chapman
Commended Dental - Patient Management and Outcomes on the Paediatric Prevention Clinic, Dr R Parry (presenter) Infection and Human Immunity - An audit and re-audit of Gentamicin prescribing – Dr J Fold (presenter) Thank you to everyone who presented, attended and contributed in some way.
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Developing a world-class workforce
Self care at work Staff are provided with a two day Self-Care at Work course which has been designed to motivate, empower and promote individual self-care. All participants leave with a personal plan to improve lifestyle. We have had a number of positive outcomes from participants in the last year. Some staff have taken decisions to improve levels of physical activity, eat more healthily, reduce alcohol intake and stop smoking. If you want to appraise your self-care we have a number of courses running throughout the year as follows: Fridays 4 and 11 April Mondays 16 and 23 June Tuesdays 12 and 19 August Wednesdays 22 and 29 October Wednesdays 10 and 17 December For more information please contact Mark Caffrey on ext 2811 or email mark.caffrey@rlbuht.nhs.uk
Focus group for living with blood disorders A new focus group has been set up in the Royal to support those living with bleeding disorders.
Members of the blood disorders focus group The group meets every three months to discuss issues such as improving care of patients with bleeding disorders. They also hope to raise awareness of different bleeding disorders to the public, as well as health workers.
Co-ordinated by haematology sister Clare Kay-Jones; who provides nursing support at meetings, the group aims to change the delivery of healthcare given to patients with bleeding disorders, as well as providing support to other sufferers who want to talk to someone in the same situation as themselves. Chair and spokesperson for the group, Hayley Heron, said: “Being part of the Roald Dahl focus group is our way of improving the treatment and care that we receive as patients. We would like to be a voice for ourselves and other patients, telling people what it is like from our perspective.” If you are interested in joining the bleeding disorders focus group, please email RDfocusonus@rlbuht.nhs.uk for more information.
Staff swimming gala success Twenty members of staff from the Trust successfully retained the Clifford Wallace Inter-hospital Cup against staff from Wirral University Teaching Hospital NHS Foundation Trust in this year’s swimming gala.
40 years and still going strong! In the last year, two of our staff have reached the impressive milestone of 40 years’ service in the NHS. Mary Kelly started working at Broadgreen Hospital in 1973 for the sterile services department, before moving over to the Royal when our two hospitals merged into one Trust. Chrissie Hyland has also worked for 40 years in the Trust, starting working life as a pharmacy technician in the old Royal hospital at the young age of 16 and is still working in the Royal pharmacy team to this day. On behalf of all our staff, we would like to congratulate Mary and Chrissie for all their hard work over the past 40 years.
races, making sure the trophy came back to Liverpool with them.
The gala, which took place in November, saw staff from all over the Trust battle it out against staff based at Arrowe Park Hospital in a number of different races. Led by captain Marie Dewhurst and helped by Andrea Fazakerley, the team managed to win the majority of their
Staff from the Trust retained the Clifford Wallace Inter-hospital Cup
Into the swing Sue Gaskell, medical secretary, in Urology responded to the Health and Wellbeing team offer of subsidised golf lessons last year and it has unleashed a new passion for golf.
Sue with her golfing buddies
Sue said “I had thought of taking up golf before but I was unsure whether to commit to the cost. This initiative has been a really good opportunity. I have loved every minute and the group are really supportive. The majority of us are now on our next group of lessons and we have tackled the local par 3 course. I can’t wait to play regularly in spring”. If you are interested in taking up golf contact Steve O’Loughlin at steve@ mshpartnership.org or Mark Caffery on ext 2811.
17
Developing a world-class workforce
Black History Month cultural food feast
The R Charity’s Angela McShane, governor Sheila Fowler and the Trust’s equality and diversity manager Andrea Smith
The Trust officially sponsored the Cultural Food feast family fun day for the second year running at the Palm House in Sefton Park in October.
patients. The diabetes research team were also on hand, recruiting volunteers for their studies as we know there is a higher prevalence of diabetes for BME people.
This fantastic event was part of Merseyside Black History Month 2013 celebrations. Representatives from the Trust manned a stall at the event among them were Andrea Smith, equality and diversity manager. This was a useful opportunity to encourage diverse applicants for employment and Foundation Trust membership and engaging with the local Black and Minority Ethnic (BME) community on how we can improve services and also trying to find out why we have higher did not attend rates for BME
This annual event promotes cultural diversity and social inclusion through sharing free cultural cuisine. The event also showcases local musical talent performing on stage. This year’s event also included a special performance of “We Live the Dream” – a specially commissioned UK tour celebrating 50 years since Martin Luther King’s immortal speech. Check www.merseysideblackhistory.co.uk for more information about Black History Month.
Say something about bullying We held our second annual ‘Say Something about Bullying’ event in November to raise awareness of unacceptable behaviours in the workplace and empower staff to take assertive action to stamp out bullying and harassment.
experience of transphobia and homophobia. A representative from Merseyside Police defined hate crime and how to report it and played a video raising awareness of recent victims of hate crime including the local murders of Johnny Delaney and Anthony Walker.
Ros Edwards, human resources director opened the day, outlining our commitment to tackling bullying and harassment and asked all staff to pledge support to the “Say something about bullying” and “Expect Respect” campaigns (you can view these on the equality and diversity pages of the intranet).
Anthony’s mum, Gee Walker gave a moving speech about the impact of the racially motivated killing of her 18 year old son in Huyton in 2005. Gee played a video created by the Anthony Walker Foundation to highlight the ignorance of racism. The video can be viewed on: www.liverpoolfc.com/ video/features/1290-colour-blind
Kieran O’Flaherty, human resources manager and Denise Dougherty, staffside representative gave an overview of the Trust’s policy to tackle bullying and harassment and examples of behaviours that have been tackled here. An anonymous member of staff bravely shared their real life account of bullying and harassment in the workplace and the impact that this had on them. Tara Hewitt, diversity consultant gave an inspiring talk including her personal
Some of the things staff said that they will do differently: “Have a lot more awareness of what may be happening around me.” “Never stand back and let it happen.” “Be more aware of the smaller things, office banter etc.” “Be more assertive and not allow anybody to bully or harass me.”
Mo Taher from Inclusion Matters also gave his personal experience of racist bullying in the workplace and actions that can be taken to prevent this. Andrea Smith, equality and diversity manager said, “We want all staff to take the key messages back to their teams to develop a culture where all staff feel confident and assertive to stand up and say something about bullying.”
Staff said that they learnt about: “What people who are bullied go through and how prevalent bullying and hate crime is.” “Harassment and bullying can come in a variety of forms and one does not have to use the words to experience the feelings. The forgiveness of some people, such as Gee Walker is far bigger than any other emotion in the human
race and is something I would hope to aspire every-day.” “How to help put a stop to it. Racism hasn’t gone away too far and it’s the responsibility of everyone to challenge bullying and harassment. Culture needs to evolve in organisations of ‘bringing your whole self to work’ and not hiding who you are.”
Gee Walker talking in the video created by the Anthony Walker Foundation to highlight the ignorance of racism
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Developing a world-class workforce
Health and Wellbeing Strategy Our first health and Wellbeing Strategy (2011-13) provided a framework to instigate a great deal of work in health and wellbeing. We have now completed our new strategy which will enable the Trust to progress work in a number of specific areas.
Sickness absence improvement We have made some great improvements on our sickness absence rates over the last few years. The table below shows how the rates have decreased compared to the same four months the previous year: Month
2012/2013 % sickness
2013/2014 % sickness
September
5.12%
4.47%
October
5.53%
4.88%
November
5.92%
5.19%
December
5.85%
5.14%
These include:
The top five reasons for sickness absence are:
• I mproving understanding of the impact of sickness absence and long term medical conditions
1. Anxiety/stress/depression
• Increasing levels of staff engagement •D eveloping the health and wellbeing programmes required by our staff. • P romoting individual personal responsibility • S upporting staff wellbeing through training and appraisal •D eveloping the occupational health services available to staff
2. Musculoskeletal disorders 3. Gastrointestinal problems 4. Back problems 5. Cold and Flu We have experienced a gradual decline in sickness caused by anxiety/stress/depression and other psychological disorders. We have established a range of initiatives that have helped improve these areas - the Sickness Improvement Plan, Managing Your Own Personal Stress Course, Occupational
Therapy and the continuing use of staff counselling services. Seasonal sickness has been taken into consideration resulting in the Keep Well in Winter campaign that was launched in November 2013 and will continue until the end of the winter period. As part of this 75.3% of our staff have opted to have a flu jab within the Trust. Sickness absence has a cost to the NHS and the table below shows how this has been reduced last year compared to the same months the year before.
• I mproving the communication of health and wellbeing messages
Month
2012
2013
Difference
September
£604,777
£689,333
+ £85,556
October
£652,558
£615,302
- £37,256
We already have a reporting system that ensures that health and wellbeing activity is reported through various trust committees. Our aim for the next 3 years is to further embed our activity. The Health and Wellbeing Strategy 2013-16 has a number of aims including:
November
£716,578
£642,120
- £74,458
December
£722,369
£690,333
- £32,036
•A n open culture where staff feel valued •M anagers who are trained to provide staff with the skills to enable them to improve personal wellbeing • E arly interventions to reduce levels of sickness absence and prevent sickness absence where appropriate. • E mpowering staff to better understand the risks to their own health. •A ctive communication about health, safety and wellbeing and the services available. If you want to make a contribution to our new strategy or want a copy of our new strategy call Mark Caffery, human resources manager on ext: 2811.
The Managing Sickness Absence policy has been reviewed with 160 managers having attended a sickness workshop updating them on the major changes. Self-Care at Work training has been successfully rolled out across the Trust with 50 staff having completed the sessions. During the past year Business HR has participated in major national initiatives managed by NHS Employers and the
Royal College of Physicians Health at Work Development Unit. This work has informed a good deal of the efforts undertaken as part of the Sickness Absence Improvement plan. The Royal College of Physicians have carried out an audit and we have achieved 100% for the implementation of the NICE Guidelines which is a really positive reflection on the Trust’s commitment to support staff health and wellbeing.
19
Achieving international recognition for research and innovation
New appointments at Clinical Research Network
A screenshot from the filming of a bronchoscopy procedure
Sister Angela Wright is filmed tending to a patient
Research in the spotlight The Respiratory Infection Research Group conducts pioneering scientific research at the Trust and the Liverpool School of Tropical Medicine (LSTM). The research focuses on healthy volunteer and respiratory patients that are recruited from the hospital. The Respiratory Infection Research Group recently published in the Journal of Visual Experiments, a peer reviewed, academic video publication. Our first video publication captured the Experimental Human Pneumococcal Carriage model demonstrating both the laboratory techniques and the patient experience. We are presently testing the current pneumococcal vaccine in a double-blind randomised controlled trial to determine the effect of vaccination upon pneumococcal carriage in the healthy adult population. The patient procedures were demonstrated by Sister Angie Wright and Sister David Shaw, the laboratory procedures were demonstrated by Jenna Gritzfeld (PhD student, LSTM). The previous video publication focused on
the research bronchoscopy procedure using a healthy volunteer and followed the samples through to the laboratory in the LSTM. Dr Andrea Collins performed the research bronchoscopy in the bronchoscopy suite with assistance from Sister Carole Hancock, Janet Ashcroft and Amy Lunt, laboratory analyses were performed by Elena Mitzi (research assistant, LSTM). This method of publication is novel and portrays accurately the methods used within the research group. The video publication is open access which increases the audience significantly. The research team plan to use the video publications at public engagement events and to help recruit volunteers. Angie Wright said: “We would like to thank all of the staff that helped to facilitate the filming including the theatre staff, the Clinical Research Unit and especially our healthy volunteers for agreeing to take part.” Watch the video go to: http://www.jove.com/video/50115/ experimental-human-pneumococcal-carriage
Professor Kenneth Wilson has been appointed as the new clinical director and Jacqui Pirmohamed has been appointed as chief operating officer at the National Institute of Health Research (NIHR) Clinical Research Network for the North West Coast. The network helps conduct research in the region, encouraging people to take part in research studies that contribute towards improving treatment in the future. As clinical director, Professor Wilson will be responsible for boosting the level of clinical engagement in research across the patch, ensuring that studies are carried out efficiently, and maximising the opportunities for patients to participate in a study that could benefit them. Professor Wilson has considerable experience of working in trial delivery, both as an active researcher and a director of an NIHR Research Network designed to promote research within the NHS. Professor Wilson said: “The NIHR Comprehensive Research Network will provide NHS patients with new opportunities to learn about and potentially be engaged in research within the NHS. We can now drive forward the delivery of new research across all fields of medicine and surgery as a unified network; providing better services and treatments for our patients. This is going to be exciting and challenging!”
Royal research set to shine A team of professors and doctors from the Royal and the University of Liverpool have teamed up with scientists from the Science and Technology Facilities Council (STFC) to explore the use of intense light to improve diagnosis, prognosis and treatment of prostate, cervical and oesophageal cancers. The project uses technology, nicknamed ALICE, used at Sci-Tech Laboratory in Daresbury and was developed by the European Organisation for Nuclear Research
(CERN) at their Large Hadron Collider site: home of some of the most ground-breaking scientific research in the world. ALICE creates intense infrared light, which will then be used to help identify changes in cells, which could indicate a tumour. This means cancers could potentially be detected at an earlier stage with more accuracy, helping researchers understand more about these cancers. This will directly benefit patients in the detection of treatment of cancers in these areas, creating better equipment that could save thousands of lives.
Doctors from the Royal will use technology, nicknamed ALICE, used at Sci-Tech Laboratory in Daresbury
20
Achieving international recognition for research and innovation
James Norman, director of Information Management and Technology
Transforming healthcare with big data Clinicians could soon massively improve success rates in treating patients and actually personalise care through powerful new insights that could transform healthcare in Liverpool and beyond. Big data has huge potential for Liverpool and now, for the first time, the Royal has a real and affordable opportunity to take the lead in changing how healthcare is delivered. A whole programme is gearing up that will see the Royal collaborate with researchers, academics, GPs, social care providers and a range of other bodies to make it possible to analyse huge amounts of confidential and anonymised data on millions of people. This will benefit areas throughout the Royal, leading to new insights for clinicians and better outcomes for patients. The Liverpool Big Data Collaboration is now being formalised and, as its work accelerates, clinicians at the Royal will be given the power to make decisions based on highly accurate insights that have previously remained hidden. Medical professionals should see their success rates in treating patients significantly improve. And the Trust can expect to manage patients with serious and long term conditions far more effectively. “Big data will change healthcare as we know it,” says James Norman,
the Royal’s director of Information Management and Technology. “Clinicians will be able to tailor healthcare pathways and treatments for individual patients based on highly accurate insights. Drawing data together will give clinicians real-time feedback on the effectiveness of a treatment on an individual patient. And crucially it will give clinicians foresight, moving healthcare to a wellness model.” Big data has the ability to allow clinicians to accurately predict a patient’s likelihood of contracting particular conditions, allowing early intervention. It will also help to show treatments and pathways that will work best for a specific patient, based on information about the patient’s condition, their circumstances, and even their genetic make-up.
Big data will change healthcare as we know it
For example a physically fit patient with a healthy lifestyle and diet could be offered a different rehabilitation pathway to a less fit
individual whose home circumstances require more support from staff in carrying out physical exercises and following their diet. The huge potential that big data offers can now be realised thanks to emerging analytics technologies that are affordable. “Even a few years ago the computer systems required to analyse big data would have cost millions, but now we are looking at a fraction of the price,” says James. “It is now within the realms of reality at a local level.” The Royal has already been fast to seize the opportunity. Body monitors, ordinarily used to monitor athletes’ fitness and sleeping patterns, will now start to monitor some patients’ activity, with the aim of feeding clinicians intelligence about a patient’s readiness for surgery and information on post-operative care needs. A pilot for this technology is already underway in Cardiology and other potential early big data use-cases have been identified in specialities including gastroenterology, diabetes and endocrinology, breast and liver. Big data is also being applied to operational areas. An initiative to use predictive analytics to significantly reduce healthcare associated infections is in its early stages, aiming to tackle an issue that affects some 300,000 patients a year in England. And 30 day emergency readmissions could also soon be cut at the Royal through a big data project that aims to improve both patient’s experience and quality of care.
What is Big Data? Big data will change healthcare as we know it and is far from being just a buzzword, or something that only interests the IT crowd. Big data’s potential is unlocked when we can analyse information held by the NHS alongside a wide range of other data sources, giving clinicians the ability to understand far more about the patient and ultimately uncover critical insights into how to keep that patient well. It will fuel the shift to a wellness model of healthcare.
21
Other Trust news and updates
Security and car parking Anti-social behaviour Antisocial behaviour has decreased recently. With more staff feeling confident to report this to Security or deal with it themselves, we hope to see this fall further. Staff should contact the Local Security Management Specialist (LSMS) for advice on how and when to challenge those causing a nuisance on our premises.
Security and fraud event The Local Security Management Specialist (LSMS) will be co-hosting a security and fraud awareness event in the restaurant at the Royal on 13 March. Both the LSMS and Counter Fraud Specialists will be available.
Help us to help you It’s crucial that all security incidents are reported using the Incident Reporting System, DATIX. With accurate reporting we can raise awareness of security incidents and prevent them from re-occurring. Without you telling us what’s going on, we are unable to do anything about it, so help us to help you. A good example where this has worked is ward 8HDU whose staff recently experienced some difficult behaviour by several seriously ill patients. With the help of the LSMS and the Health and Safety trainer a bespoke training package has been developed to give staff the tools to better manage difficult situations.
Access Control Our sites are fitted with access control systems, such as magnetic locking doors which are accessed via your ID card. These systems are there to protect staff and patients so please, if you see any damaged doors, report them to our
estates department by phoning ext: 2156. For access to be added to your card please take a look at the Security department intranet page. The Trust Local Security Management Specialists (LSMS) can be contacted on ext: 3999 or by emailing ian.wright@rlbuht. nhs.uk or keith.hands@rlbuht.nhs.uk.
New car parking applications New car parking applications for the Royal are being reviewed and permits will be issued by April. Up until April, to access on-site parking in the multi-storey car park and besides the Duncan Building, you will need to be an existing car parking permit holder and will need to use your hospital ID badge, that has been enabled for car parking access. If you have any queries please contact the car parking office on ext: 2149.
Off-site car parking Existing off-site permit arrangements at Kempston St will continue until the end of March. Liverpool Council have agreed that permits that were due to expire in mid-February, will now be valid until the end of March. From 31 March additional spaces will be made available on Low Hill for existing car parking permit holders only. This site is a five minute walk from the hospital and will be manned. This car park will be available to use from 6.30am to 7.30pm every weekday throughout construction. If you are an existing permit holder and wish to park on Low Hill you will need to contact the car parking office on ext: 2149 in advance. The above is correct at time of going to print.
Counter Fraud Update: HM Revenue & Customs (HMRC) email scams A number of NHS staff across the UK have received ‘phishing emails’ from people pretending to be from HMRC requesting personal and on occasion, NHS financial details to use fraudulently.
Please do not follow any links you are unsure of, disclose any personal or Trust information, or respond to it
HMRC will never send notifications of a tax rebate, or ask you to disclose personal or financial information by email. If you have any doubt that an email you receive from HMRC is genuine, please do not follow any links, disclose any personal or Trust information, or respond to it. Please forward the email to phishing@hmrc.gsi.gov.uk and then delete the email. Please also inform your Local Counter Fraud Specialist (LCFS) about it. Examples of fake emails by fraudsters can be found at www.hmrc.gov.uk/ security/index.html along with some advice and guidance on internet security.
The multi-storey car park is now open
For more information on fraud, bribery and corruption contact our local counter fraud specialist, Clare Smallman at the Mersey Internal Audit Agency on 01244 364 479 or email clare.smallman@miaa.nhs.uk.
22 Fundraising
Christmas fundraising The fundraising team were busy over Christmas as money flooded in for R Charity. The R Magical Christmas Concert at St George’s Hall generated more than £6,500 with the audience enjoying a seasonal mix of songs, stories, mince pies and mulled wine. Our own hospital choir were joined by choirs from local schools; Carleton House Preparatory School and Booker Avenue Junior School as well as the Liverpool Gospel Choir and Merseyside Singer of the Year Sarah Chidlow.
As well as songs, there were readings from chairman Judith Greensmith, Julie Hills, a healthcare assistant on the Isolation Ward at the Royal and patient Dennis Murphy who is being treated at the Royal for Cell B Chronic Lymphatic Leukaemia. The host for the evening was BBC Radio Merseyside presenter Maureen Walsh, also a patient at the Royal’s Linda McCartney Centre. Throughout the festive period, our own 12 Days of Christmas saw the main reception at the Royal filled with Christmas cheer, as a total of 20 choirs took turns to delight patients, visitors and staff with festive songs. A host of school choirs, the Royal Hospital Staff Choir and the acclaimed Liverpool Welsh Choral all performed, prompting cheers and applause from people who stopped to watch give money to R Charity. A total of £2,500 was raised. Grateful patients and their families also left more than 100 heart-warming messages of goodwill to staff and patients on a Christmas tree in the Royal’s reception throughout the Christmas period, each donating money to the R Charity.
The Christmas tree in the Royal’s main reception was adorned with messages left by patients and their families
One message read: “Thank you for the exemplary care and support my husband and I received from all staff during his time.” Another message was left by a child to his
The carol concert at St George’s Hall was a sell-out late mother after he saved his pocket money to donate to the hospital’s appeal. Rebecca Grime, acting head of fundraising said: “Thank you to everyone who kindly donated and gave their time during these events. The generosity we saw over Christmas has helped our new Royal appeal greatly. The funds raised will be invested into specialist equipment, patient comfort and improved environments in the new Royal.” To donate or find out about our fundraising events go to http://www.justgiving.com/ RCharity or call in to the Fundraising Office based in the main reception of the Royal.
Doctor for a Day Pupils across Merseyside pretended to be doctors in a bid to win a real doctor from the Royal for a day at their school, raising more than £1,500 in the process. R Charity offered primary schools across Merseyside the chance to win a doctor to inspire their pupils to take up science related activities while raising money to pay for lifesaving equipment and state of the art facilities at the new Royal. The life sciences sponsored challenge enabled the youngsters to dress up as medics for the day, with each school receiving free teaching, fundraising and promotional materials. As the school with the highest percentage of pupils taking part, Carleton House Preparatory School in Calderstones won a day long visit from Dr Nick Beeching and matron Suzanne Marshall from the Tropical and
Infectious Diseases Unit and stars from the Discovery Channel’s ‘Bugs, Bites and Parasites. Dr Beeching said: “This is a great opportunity for youngsters to get involved with health and sciences in a fun way. We taught them how germs spread if you don’t wash your hands or cover your mouth when coughing and we saw what they would look like if they had measles to help them understand why we carry out vaccinations.” Loren Slade, community and events fundraiser at the Royal said: “Not only did the Doctor for a Day challenge help raise much needed funds for the hospital but in return we provided learning activities and resources, competitive challenges and fundraising materials to support the school every step of the way.” Another Doctor for a Day event is planned for later in the year.
Dr Nick Beeching’s heart rate is taken by a pupil at Carleton House Preparatory School
Some pupils at Carleton House Preparatory School were given ‘measles’ to illustrate the dangers of infection
23
Exceptional patient experience
Thank you to our staff Many of our patients and their relatives provide feedback on our services, either by writing to us, commenting on Facebook or Twitter or reviewing our services on NHS Choices. Almost all of the feedback we get is positive and here’s a selection of some of these comments from the last few months.
The Royal From a letter to Aidan Kehoe, chief executive: My mother was recently a patient on the Acute Stroke Unit (2Y) at the Royal and then on the stroke rehabilitation ward (8) at Broadgreen Hospital. She sadly died last week. I am writing to say how impressed I was with all the care she received on both wards. As a consultant physician in the NHS I know the pressures that
services and staff are under. She could not have received better care. The whole team including the consultants, junior doctors, nurses, physiotherapists, occupational and speech therapists, cleaners and the lady who took around the drinks trolley were caring, considerate and always helpful. The ward environments were clean and my mother always looked clean and comfortable with her hair combed even though she was semi-conscious. It made a huge difference to me and my mother’s visitors to see her cared for in this way.
Dental Hospital From NHS Choices Great service, great staff! I had a tooth extracted today, well done to the undergraduate who treated me. I was treated as a patient and not just a number, first class, I cannot praise them highly enough. He is going to make a good dentist. This hospital is a credit to the City of Liverpool but more importantly, Dentistry in general. Well done. Les Norton
Broadgreen Letter to staff: I would like to thank you for the exceptional care and compassion shown to my mother over the last few months after she suffered a shoulder fracture. Her surgeon Mr Inigo GuisasolaGorrochatequi explained the procedure for a right total shoulder replacement to her and arranged for surgery to be performed promptly. She had a lot of confidence in him as a surgeon and it was not misplaced. She subsequently attended both fracture and spinal clinic and Dr De Mattas and Dr Dhotare have been a great tower of support to her. She has been attending clinics for several months now and will continue to be an outpatient while she is being helped to manage the osteoporosis which was identified by professionals in your hospital.
The greatest thanks I would like to give however is to a physiotherapist, Helen Vernon who has worked with my mother for several months now giving her advice and encouragement in the exercises she has needed to do in order to regain movement in her right arm.
My mother is able to do almost all of the things she was able to do before her fall and it is due to the dedication and persistent encouragement of Helen that she been able to achieve the mobility she has today. My mother is 90 years old, lives alone and as a former nurse of the World War II era, might be expected to be critical of modern treatments. However she has nothing but praise for the consultants and staff at your hospital and is very grateful for the wonderful care she has received.
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The Royal Liverpool and Broadgreen University Hospitals NHS Trust
Here are our vision, values and strategic themes for 2013 to 2018 Vision Delivering the highest quality healthcare driven by world class research for the health and wellbeing of the population
Values Patient Professional Open and Collaborative Creative Centred Engaged Patients first
Skilled and experienced
Listening
Working in partnership and teams
Open to change
Care
Integrity
Involving
Compassion
Evidence based practice
Recognising
New ideas
Commitment
Education
Communicating
Innovative
Resourceful
Strategic themes To deliver an exceptional patient experience, making the Trust one of the most sought after places to be treated anywhere in the world:
• Achieve a Net Promotor score of 90 in the Friends anf Family test. • Achieve a ranking in the top 10% of Trusts in the national patient survey.
To improve the quality of life for our patients by
providing excellent, safe, and accessible healthcare which puts patients wellbing at the heart of all we do: • Achieve top quartile performance for teaching hospital peers for mortality by 2018 • Achieve top quartile performance by 2018 avoiding patient harm
To develop a world-class workforce,
recognised for its skills and level of engagement, and founded on a culture of achievement, education, training and development:
To achieve international recognition for our research and innovation, bringing
new therapies from the bench to the bedside: • Development of the first buildings of the BioCampus
• Doubling the number of • To be ranked in the top 10% patients on clinical trials by of Trusts in the national staff 2018 and papers published survey by 2018 by our researchers. • Achieve a sickness absence rate of less than 3% by 2018
To play a lead role in the development of a sustainable health system for the
communities we serve: • Open the new Royal Hospital by 2017
• Deliver reconfigurations and redesigned pathways across all our services where appropriate for better patient care
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