Insight Royal Liverpool Autumn 2018

Autumn 2018

www.rlbuht.nhs.uk

BBC2’s Hospital Staff and patients to star in documentary R Charity – Royal’s 40th anniversary celebrated at Ruby Ball Awards round-up Meet the Trust staff recognised this summer

Exclusive:

Football legend John Barnes supports organ donation week

2 Creating a great place to work for the benefit of staff and patients

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

Thanks to our staff This summer we had a fantastic time celebrating the 70th birthday of the NHS and the 40th anniversary of the Royal.

Our foyer came alive with staff showcasing the amazing work they do in their departments; choirs from local schools brightened up people’s day, staff at Broadgreen enjoyed a barbecue and there was complimentary afternoon tea at the Royal thanks to ISS for our hardworking staff.

It truly was a day celebrating the great and good of the NHS and what the Royal has achieved over the past four decades. The celebrations were the perfect way to thank everyone who is involved in the Trust and the important part they play in the healthcare of this city.

The past few months have been challenging in regards to the future of the new Royal, and we would like to thank you all for your ongoing support, understanding and patience throughout this. Now that we have agreed a way forward and have the support of the Government, we can look forward to the future and the completion of the new hospital.

Aidan Kehoe, chief executive

April 2018 – Sarah Jones, nuclear medicine

May 2018 – Julie McBretney, radiographer

Volunteer of the month

Team of the month

March 2018 – HPB buddies team

April 2018 – Gerontology, 2B

April 2018 – Sarah Farmer

May 2018 – Roy Bowden

May 2018 – Ward 8 at Broadgreen

June 2018 – Royal Liverpool Dental Hospital

Creating a great place to work for the benefit of staff and patients

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Royal’s time to shine on BBC2 Throughout October and November, the Trust has been taking part in filming for the next series of BBC Two’s ‘Hospital’ programme.

Imperial in London and Nottingham, will also see other trusts across the city take part as the series focuses on the healthcare system in Liverpool.

The fourth series of the programme, which has previously been filmed at

It’s been exciting to see production company, Label-1, document the amazing

work that our staff do here and come January 2019, we will get to see some of the patient stories of those who have received healthcare here at the Trust. There will also be an element of ‘behind the scenes’, focusing on senior management and operational issues.

Helping the poor in India Two sisters who work at the Royal have spent four weeks volunteering their knowledge and time in India caring for the poor. Joanne Taylor, 34, and Nikita Foster, 31, are both healthcare assistants (HCAs) working on wards 4A and 4B at the Trust, but wanted to take four weeks of their annual leave to help those less fortunate in Faridabad near Delhi.

“Having just applied for medical school, I wanted to experience how health care works in more under privileged regions,” said Nikita. “We decided to travel to India for four weeks to try and help those less fortunate than ourselves.”

For the sisters, their first day at clinic was a shock, as medications and supplies were at a bare minimum: “Our clinic was facing a rubbish dump and was an outside area with a corrugated tin roof. It was extremely unsanitary and we often had some rodent visitors.”

Both Jo and Nikita would see approximately 250 patients a day, which ranged from adults and babies to children and the elderly. Many patients suffered with pneumonia, wounds, rashes, slipped discs, fevers and arthritis.

“Those patients had no access to hospital and were happy to be fully examined by ourselves and have a little help from strangers,” said Jo. “We were able to use our skills learnt here at the Royal such as wound care, manual bp and basic observations.”

Their older sister, Mandy Taylor, also works at the Trust. Mandy had been keeping up to date with both of her sisters during their travels while looking after Nikita’s two children.

“Everything they have learnt here at the Royal they have taken out there with them to help others. They both loved it; they didn’t want to come back! We have already decided that we are going to go back and I will go with them along with the kids – it’s a once in a lifetime experience for them.”

“We went to India with an open mind and open heart knowing we were not going to change the world. We return home different people and will most definitely appreciate what we have and appreciate our NHS,” said Nikita. The sisters also raised funds to provide clinic supplies, protein and vitamin supplements for the 250 slum children they saw at their camp.

“We would like to thank 4A, 4B and 8A staff for their donations. You are all amazing. Just seeing those people smile from the little help we gave us something that will stay with us forever. It was the most life changing experience and we cannot wait to go back 2019.”

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Deliver excellent digital services to improve patient care

Striving in digital excellence The Global Digital Exemplar (GDE) programme aims to develop world class digital systems to improve the health of local people. It is delivered under the Digital Liverpool Strategy, which has been recognised nationally and regionally for its achievements.

Over the past few months, the Digital Liverpool programme has made some exciting developments. During this time there has been a delivery of a number of key things, including work on EPMA in ED, digital displays, testing of telemedicine, e-handover and eDNAR.

IT Service Improvement Plan

Digital projects

The Trust is currently implementing a range of IT improvements, designed to improve experiences for staff accessing IT systems.

Many elements of the service improvement plan were instigated following results of the 2017 Staff Survey – in which staff asked for improved IT services including Wi-Fi access.

The Trust has been trialling virtual reality which is helping to provide a sensory experience for patients and their families.

It is currently being trialled on palliative care and critical care to improve the quality of experience we provide. Patients can view beaches, forests, rollercoaster or football scenes to provide pain distraction and reminiscence therapy.

Virtual reality is also being considered to be used in dental patients and those with learning disabilities.

From October to December the IT team will be improving services by bringing technology to initially be used in the new Royal, into the current Royal, to improve experiences for staff such as: - Improving wireless connectivity - Deploying a number of additional laptops, replacing legacy mobile carts for EPMA access and ward rounds

Virtual reality

Smart home We have built a laboratory in the Accelerator which is connected to the 5G. In here there is a smart home and smart room which will have cutting edge sensor technology to try both in a hospital and home environment. It is anticipated that this space will help us to test new innovations, working with

many partners across the city, nationally and internationally.

Other projects These projects have already demonstrated huge benefits to patient care: •W e are developing sensors for vital signs and fall detection • E -observations, including E-Sepsis which has already saved lives in identifying people with sepsis for early treatment.

E-Sepsis was highly commended at the HSJ Patient Safety Awards 2018 • T elehealth, which is being used to care for cardiology and respiratory patients remotely and enabling them to be monitored at home •C linical decision support: Using our electronic noting, we will inform clinicians of potential interventions to improve outcomes

- Improving the service provided by the IT Department – including ensuring they react to key issues and maintain hardware stock to meet user demand.

5G revolution As a Trust we are the only 5G Health Test area in the UK to test and develop new technologies. The Liverpool 5G Testbed was awarded £3.5 million of funding, money which will be used to set up trials of 5G broadband in parts of the city.

It was one of only six partnerships across the UK to secure the funds from the Department for Digital, Culture, Media and Sports.

The 5G trials include facilitating cutting edge technologies such as low-cost unlicensed mmWave 5G broadband, open source networking, artificial intelligence and virtual reality to improve patient monitoring and support, and communication between hospitals and the community.

Smart home in the Accelerator

Creating a great place to work for the benefit of staff and patients

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Award-winning staff Histopathologist wins prestigious award

Trust department is centre of excellence The department of Clinical Biochemistry and Metabolic Medicine has been recognised with an award for their clinical work. Together with research undertaken by the Bone Group at the Institute of Ageing and Chronic Disease (IACD) at the University of Liverpool, the department was presented with the Liverpool Paget’s Association’s Centre of Excellence Award.

The Royal’s consultant histopathologist Sarah Coupland has been awarded the ICO Ophthalmic Pathology Award at the World Ophthalmological Congress in Barcelona.

Awardees are chosen by an international committee, consisting of ophthalmologists and scientists, before the award is given during the opening ceremony. Only given every four years, Sarah was the 4th person to receive it and the 1st from the UK. Alongside receiving a medal, Sarah also presented Naumann lecture at the WOC, given in honour of Prof. G.O.H. Naumann who instigated the award.

“It is a great honour to receive this prestigious award. We are humbled and proud to have been recognised by the Paget’s Association as a Centre of Excellence. I would like to acknowledge the immense contribution of my clinical colleagues, especially Dr Eileen Marks, medical and clinical director, for her support, and Dr Vinita Mishra, Dr Fadil Hannan, Dr Milad Khedr and Professor Ranganath for their dedication in providing expert management to our patients and conducting clinical research. Special thanks also go to the scientific team lead by Prof Rob van’t Hof.”

Outstanding support for students

Anticoagulation team recognised The Royal Liverpool & Broadgreen University Hospital’s community anticoagulation service have won an award at the prestigious Anticoagulation Achievement Awards, held in the Houses of Commons, London. The team picked up the award for Best On-Going Management of Thrombosis by a Community Based or Primary Care Service.

The Liverpool Anticoagulation Service operates 37 clinics across 23 sites in the community, with patients being seen within 1 mile of their GP surgery or in their own homes. The service has in excess of 83,000 patient contacts per year and operates an advice line for patients and healthcare professionals. The team is jointly led clinically by a specialist nurse and pharmacist, assisted by an operations manager and comprises of nurse specialists, pharmacists, pharmacy technicians and admin.

“We are thrilled to have won this award for the team,” said Lyndsey Stanley and Janet Davies, joint clinical leads of the Liverpool Anticoagulation Service. “Our team provides a high quality, safe and convenient service for highly complex patients in the community.

We have demonstrated improved clinical and patient outcomes through face to face engagement with patients.”

The University of Liverpool have recognised Trust physiotherapist Rebecca Varnouse for her contribution to student support and training with an award.

Rebecca received the ‘Physiotherapy Practice Placement Educator Excellence Award’ for providing an outstanding level of guidance and support for students on practice placement in the academic year 2017/2018. She was nominated by a student who supervised in A&E. “It was a lovely surprise! I was nominated by a 2nd year student that I had on placement in A&E. It really meant a lot to receive lovely feedback from the students, and also their parents. It made me realise that being a clinical educator and how you treat your students can really have a lasting impression.”

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Change the way we work to ensure we are ready for a successful move into the new Royal

New Royal – way forward The collapse of Carillion in January created an unprecedented situation with numerous complex legal and commercial issues that we, alongside the various parties involved, have been working hard to try to find a solution to.

All parties have been committed to getting an agreement that enables construction to restart as soon as possible. At the end of September the Board of Directors agreed that this could not be achieved within the existing PFI agreement. Within the contract was a clause that would allow the Trust to terminate the agreement if the new Royal hadn’t been completed and handed over by 30 September. The Board therefore agreed to terminate the contract after this date.

At this time the Trust had reached an agreement in principle with The Hospital Company (Liverpool) on the way forward for the new Royal. This would require financial support from the government, which they agreed to provide, bringing the new Royal into public ownership.

Under the agreement reached we would have a managed termination process after 30 September. This will see The Hospital Company (Liverpool) hand over its contracts for construction, supply chain and facilities management, to the Trust, over the course of the next few months.

Subject to legal agreements being reached, this could see construction work restart as early as November. If this is the case, we would expect the new Royal to be completed in 2020.

Aidan Kehoe, chief executive said, “This is really positive news for our staff, patients and the people of Liverpool.

We now have a solution and can work on moving forward. We would like to thank our colleagues at the Department of Health and Social Care, the Treasury, The Hospital Company and funders EIB and Legal and General. We would also like to thank our local politicians, in particular our local MP Louise Ellman,

our staff, patients and local people, who have supported us throughout this challenging period.

Maintaining the current Royal Now that we have a working timescale for construction we can plan what work needs to be done to maintain it for that period.

• An enhanced planned preventative maintenance programme

Our estates team have assessed the building to identify what needs to be done to maintain a safe environment for patients and staff and have introduced the following:

• Providing a robust reactive maintenance programme and raising staff awareness of the current estate.

• Ordering spare parts for critical equipment

• Continued investment, for example £125,000 in lift maintenance.

Eamon Fairclough, estates manager said, “We have set aside funds for ongoing maintenance of the Royal, whilst we remain here. Our Facilities Management team work hard to ensure the building is safe for patients and staff and we continue to carry out both emergency and planned maintenance.”

Complete proposed merger with Aintree Hospital and continue to work with partners to improve care

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Proposed merger: an update Just a few miles apart, Aintree University Hospital NHS Foundation Trust and the Royal Liverpool and Broadgreen University Hospitals NHS Trust have a history of successful partnership working.

By coming together through merger and redesigning services, our doctors, nurses and health professionals, believe they can: • Deliver safer care through improved, joined up and patient-centred health care.

• Improve care – single, city-wide teams treating more patients will ensure that clinical staff have the best skills, and patients get the best results from their care.

• Safeguard specialist services which could otherwise be moved elsewhere in the North West.

• Provide patients with access to cuttingedge technologies and experimental treatments, such as new drugs, by accessing more research opportunities.

• Reduce our combined reliance on agency staff.

• Support inpatient centres of excellence with outpatients in multiple hospitals, where patients spend most time – centralised where necessary, local where possible.

• A sustainable health care service, making best use of taxpayer’s money.

Merging the two Trusts is key to delivering these benefits, as neither Trust can deliver the full range of benefits alone. By exploring ways to work together, and differently, we think we can improve the quality of care we offer and have a much better chance of addressing and overcoming the challenges both hospitals face.

All our teams – clinical and non-clinical – are developing their own proposals for how they would like to bring teams and services together. Even at this stage, some immediate benefits are clear, for example:

Research benefits Mr Jones is a patient at the Royal and has been diagnosed with a rare rheumatology disease. He researches the disease to discover that there is a new clinical trial taking place, looking at new treatment options. He contacts the trial but finds out that they are not supported at Royal and the nearest centre is Aintree. He contacts the research team at Aintree but in order to be considered for the trial, Mr Jones has to be re-referred for treatment at Aintree. Mr Jones must make an

appointment with his GP and explain that he wants to be re-referred.

In the proposed new model, Mr Jones will have access to clinical trials taking place across the new organisation with no requirement for re-referrals and new treatment pathways to be established.

This is an opportunity to make care safer and make our hospitals the best place for health professionals to work, attracting hard-to-recruit staff, but we need your help to get this right.

In the coming weeks there will be opportunities for staff, patients and the public to share thoughts on the merger and how we should best shape the future of our services to create single, city-wide teams which offer the best possible care.

Timeline for merger The merger proposal is currently in development, with a full business case being produced. This will be used by regulators – NHS Improvement and the Competition and Markets Authority - to decide whether to approve the merger.

Much of the timeline for this process is outside our control but we are working towards merging the Trusts by 2019.

If approval is received, we would begin a five year programme of bringing our clinical and corporate services together.

To find out more about the merger visit the intranet or you can contact the Programme Management Office on 0151 529 6642.

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Deliver high quality care to all patients by improving the way we admit and discharge

Improvement in patient discharges One of the areas that the North Mersey A&E Delivery Board is focused on is making improvements to the safe and timely discharge of patients aged 75 and over.

The Royal, together with Aintree University Hospital NHS Foundation Trust, Mersey Care NHS Foundation Trust and Southport and Ormskirk Hospital NHS Trust, undertook a research project to help identify some of the barriers which prevent these patients being discharged from hospital.

•3 7% of patients that didn’t meet a member of staff to talk about discharge are more likely to be dissatisfied with the discharge process

The research was conducted by an independent market research company with the intention to improve the experience for our patients across all hospitals.

•1 in 5 patients were discharged before 12pm

As part of this research, staff focus groups were held across the four trusts and talks were held with over 200 patients and their relatives who had experience of care from the four Trusts involved.

The research highlighted key patient findings such as: •1 2% of patients had spoken to a member of staff about their discharge on the same day that they were admitted.

•8 6% of patients agreed ‘the shorter the stay the better’ •4 6% of patients thought hospital was the best place to recover

The research highlighted that staff felt:

Understanding SAFER SAFER is a combined set of simple steps for adult inpatient wards to improve patient flow and prevent unnecessary waiting for patients. As a Trust, if we routinely undertake all the elements of SAFER, we will improve the journey our patients’ experience.

• Family and public education was important

S - Senior review of patients by 12pm

•A change in perception of hospitalisation was needed

A-A ll patients to be aware of their discharge plans

• Positive about using SAFER

F - F low of patients must start before 10am

As a result of this research, over the upcoming months the North Mersey A&E Delivery Board aim to implement a number of changes to help reduce the levels of delayed discharge. This will ultimately help to improve the levels of service that we each provide to our patients.

E - E arly discharge of medically optimised patients before 12pm R-R eview of patients expected to stay more than 7 days weekly

Reaching out in the community A recent HIV, ageing and comorbidities (HAC) event was held in collaboration between the Trust’s HIV community nursing team and Sahir House, Merseyside’s HIV voluntary support agency.

The two-day conference at the Quaker Meeting House in the city centre was aimed at educating and empowering people with HIV (PWH) to understand risk factors, and prevent and self-manage comorbidities in the context of HIV. A variety of presentations and workshops were delivered by HIV doctors, HIV nurses, GPs and other related professionals to help inform PWH about health implications of growing older with HIV and empower them to manage other long term health conditions.

report revealed that new diagnoses of HIV in the over 50s continues to increase, with the proportion of new diagnoses in this group almost doubling over the last decade.”

“According to the Terence Higgins Trust, the fastest growing group of PWH in the UK are older people,” said Pauline Jelliman, operational and lead nurse in HIV and TB community nursing. “A 2018

“The recent HAC event was therefore initiated, planned and delivered in response to this demographic, with a broad aim of raising awareness of risk associated with developing co morbidities,” said Pauline.

Public Health England (PHE) also commented that as people with HIV continue to age, it is critical that HIV and other services continue to evolve to meet the needs of people living with HIV including the management of comorbidities and other complex health conditions.

They anticipated that free innovative patient-centred event would empower PWH to access generalist healthcare services, or self-monitor in a timely manner to prevent ill health and make healthier lifestyle choices.

“The event was evaluated by both the 47 delegates and presenters with overwhelming positive feedback. The delegates demonstrated a positive learning experience, which results in being better placed to self-manage and monitor their own conditions in partnership with their health or social care teams.”

“It is hoped the HAC event can be replicated across the country by consulting the HAC Merseyside 2018 model.”

Deliver high quality care to all patients by improving the way we admit and discharge

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Staff get their #jabdone Flu vaccination season is now well underway at the Trust and we thank all staff members who have already received the jab. The target this year, in order to provide optimum protection for staff and patients within the Trust, is to have 100% of front line staff vaccinated by midNovember 2018.

Foyer vaccination sessions at the Royal will continue to run until Friday 9th November (Monday to Friday) from 10am to 2pm. At Broadgreen, sessions take place Monday to Friday in the Day Case Unit, 2pm to 3pm and 5pm to 6pm.

Ward based clinical staff are encouraged to have their vaccination from one of the trained vaccinators based on wards and departments across the Trust.

Last year, a fantastic 87% of frontline staff were vaccinated which was reported as the 6th best compliance rate in England.

Workforce analysis of sickness data from last year also showed that Trust employees who received the flu jab were 22 times less likely to go off sick with flu after the vaccination. We hope to have the same support from staff this year and achieve an ever better target.

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Fundraising

Ruby celebrations at Anfield We’d like to thank everyone who supported R Charity’s Ruby Anniversary Ball, held at Liverpool Football Club. Not only did we get the chance to celebrate 40 years of our wonderful hospital at the charity’s third annual fundraiser, but thanks to our guests’ incredible generosity, we also raised £55,000.

This money will now fully fund a Fiberoptic Endoscopic Evaluation Swallowing machine – also known as a FEES machine. A FEES machine assesses how well a patient is

swallowing and is a key piece of equipment for our speech and language therapists at the Royal and Broadgreen Hospital, as well as staff in the Stroke Unit.

The machine will help to reduce lengths of stays for stroke patients, improve the quality of care, reduce cost, reduce the risk of infection and most importantly, improve patient safety.

On the evening, guests at the ball enjoyed a glittering drinks reception before sitting

down for a three course meal with wine, followed by live music and even a little bit of magic.

Fundraising 11

Thanks to R Supporters After sadly losing two family members, Ian Wakefield contacted R Charity and offered to raise funds for the Intensive Care Unit (ICU) at the Royal by climbing Ben Nevis. In total, Ian raised an amazing £1,993.11.

“Bringing in the New Year was not quite the start of 2018 that I had hoped for, with the sad loss of my beloved nan (Nannie Bet) and my beautiful sister-inlaw, Jo. How is it fair that two lives can be taken so suddenly from us?” said Ian on his JustGiving page.

“In their honour and memory, I wanted to climb Ben Nevis in an effort to raise

as much money as possible for the incredible work the ICU do on a daily basis. Although I never thought we would require their services, they gave the most outstanding, compassionate and innovative care to our Jo. The care she received was second to none and they did us all proud until we had to say our goodbyes. What would we do without them, our NHS.”

Dr John Williams organised a golf tournament at Woolton Golf Club, raising £750 for Neck of Femur Unit Enhanced Recovery Project

Dr Simon and Nicky Bowers organised the Cheer Up Ball and raised £4,093 for R Charity

5k Santa Dash Join R Team and take part in Liverpool’s fun-filled 5k Santa Dash, taking place on 2nd December 2018.

Here at R Charity, this year we are looking for 70 Royal Santa’s to help celebrate 70 years of the NHS while raising much-needed funds.

Local businesses donated prizes to the NHS 70 raffle, along with Pauline Drane who donated her villa in France. Total raised £590.29

Mike Quayle took part in the Manx Telecom Parish Walk and raised £1,385.25 for the Transplant Unit

If you want to join in and become one of R Charity’s Royal Santa’s, text SANTA to 07917598692 to find out more.

Jim Peterson from the RAF Typhoon Display Team raised £2,284.80 for St Pauls Eye Unit

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Creating a great place to work for the benefit of staff and patients

Transforming lives: Peter Watt, design engineer Within our Trust there are hundreds of varied roles, with each of them playing a vital part in the delivery of care to our patients. The amazing work some of our staff do is well recognised, but there are some roles that fly under the radar while making immense contributions to peoples’ welfare.

One of those people is Peter Watt, a design engineer here at the Royal. He has had a varied technical career, including working at Clatterbridge Hospital as a medical physics technician in radiotherapy, before joining the clinical engineering department in the Duncan Building of the Royal. For approximately 35 years he has been contributing to the design of a number of award winning innovations aimed at patient welfare.

“I would be in my lab with little to do were it not for individuals with good ideas and drive,” said Peter. “These individuals are the expert healthcare providers who confront problems routinely, have ideas and willingly share these and collaborate with others to design and refine workable and viable solutions to problems. It is team work with multiple disciplines involved.”

Most recently Peter was involved in the creation of the Babysaver and its deployment to Uganda. The Babysaver was a collaborative project with Professor Andrew Weeks at Liverpool Women’s Hospital, and is designed to be used to resuscitate babies without the need to cut the umbilical cord, which has important benefits for both mother and child. These Babysavers are crucial as they are a cheap yet effective alternative to medical equipment in a country where healthcare facilities have limited funds and access to electricity.

The idea for the Babysaver was brought about after the completion of another project with Professor Weeks, the LifeStart Trolley. A retired consultant gynaecologist in the North East had initially identified the problem that when born, some babies do not spontaneously breathe and need resuscitation on a machine which was often quite far from the bed.

“The removal of the baby is not only distressing for mother, but the umbilical cord prematurely cut means that the new born is deprived of oxygen and blood volume which is actually very serious,” said Peter, who then designed a prototype that was designed to fit beside the bed. The trolley contains all of the facilities of the resuscitation machines, ensuring that mothers were close to their new babies, but also erasing the need for the umbilical cord to be cut.

Aside from collaborations, Peter has developed various other devices. Recently he has re-designed and now manufactures the Silver Thread ERG Electrode. This product is used in electro-retinography to detect abnormality of vision and is produced exclusively here at the Royal and sold internationally. The production project provides technical skilled work for a team of Liverpool University students from a variety of academic disciplines.

“There are numbers of projects that have been developed in the Royal over the years, really too many to mention,” said Peter. “Anyone in the hospital is welcome to come and see what we do and view the project photo museum.

Innovation requires time, effort, some funding and risk. Generally only a very few projects will survive to make it out into the real world, take off and fly – but when that happens it’s great.”

Prestigious appointment for clinical director The Royal College of Physicians (RCP) has elected Trust clinical director of haematology, Professor Cheng-Hock Toh, as its new academic vice president.

Alongside working at the Royal, Professor Toh is also the president of the British Society of Haematology and leads the Sepsis Research Group at the University of Liverpool’s Institute of Infection and Global Health.

On being elected, Professor Toh said: “I am humbled and honored to be bestowed this trust by our fellows. I look forward to working with and for the RCP as it looks beyond its 500 years.”

The position is one of three vice presidents roles who are senior officers of the RCP, and within this role Professor Toh wants to help modernise and personalise how the RCP expands its research–active medical workforce.

“I am passionate about integrating research into clinical care. We know that patient outcomes are better when they are involved in research. But doctors’ outcomes are also better with greater job satisfaction by being at the cutting edge of their subject area.”

Aidan Kehoe, chief executive of the Trust, said: “The appointment of Professor

Cheng-Hock Toh to this prestigious role at the Royal College of Physicians is fantastic news and very well-deserved.”

“At the Trust we are all very proud of Professor Toh’s appointment and he will no doubt be a great leader within the RCP; drawing on his wealth of experience as a respected academic clinician. While he should be very proud at a personal level, this is also great for the Trust and the city of Liverpool, so well done.”

Deliver high quality care to all patients by improving the way we admit and discharge 13

LFC legend supports donation A true Liverpool FC legend dropped by the Royal to support this year’s Organ Donation Week. Ex-England footballer, John Barnes, visited the hospital to meet some of our transplant patients and the nursing staff who look after them.

“My wife ordered me to sign up to the organ donation register, it’s something I’ve been meaning to do for a long time,” said John, whose two children work in the NHS. “Any opportunity I get to show support I

take advantage of, so it’s good to be here.

No matter what people have been through, football is always on the agenda!”

After visiting patients on wards 9A and 6B, John was more than happy to sign autographs and get photographs with staff and the public in the foyer before signing the register at our organ donation stand.

“Being an ethnic minority, black, I know there are issues of not enough people

from those communities on the register to donate. Donation within ethnic minorities is a big problem, and being from the Caribbean I know how important it is to highlight that.”

“It’s not a difficult conversation for me to have or to have with my friends and family, because if you can do good after you have gone and help people I don’t see much of an issue. However the more we talk and have conversations about donation, the better.”

Epic drive for organ donation awareness The father of a patient who received a kidney transplant at the Royal has helped to raise the profile of organ donation, particularly within the Black, Asian and Minority Ethnic (BAME) communities, by driving from Mumbai to Chester.

Priya Shah received a kidney transplant from her husband Jaideep after suffering from kidney failure. Originally her father, Bhal Shekhar Chilana, was going to donate his kidney but was rejected due to low kidney function.

“When I couldn’t give Priya my kidney, I knew I still had to do something. So I decided to drive from India to the UK to raise awareness of how important organ donation is,” said Mr Chilana. The trip took 79 days for him and his wife, Namita, who travelled across 17 different countries. “I just wanted to thank the NHS and the team here at the Royal in any way that I could. It was amazing to

from these communities. This low percentage for BAME patients arises partly from the need to match kidney donors and recipients according to blood and tissue types.

Priya thanked Dr Sanjay Mehra, consultant transplant surgeon, and living transplant co-ordinator, Ann Strong, for all their support in the process.

Namita and Bhal Shekhar Chilana, Dr Sanjay Mehra and Priya Shah finally meet the team that helped save her life.”

According to NHS Blood and Transplants (NHSBT), around three people die each day waiting for a transplant. Patients from BAME communities often wait considerably longer as there are a lower percentage of organ donations. At the end of 2017/18, NHSBT reported that 35% of patients on the waiting list for a kidney transplant were from BAME backgrounds, but only 7% of donors were

“Ann was there the whole time - it felt like she was solely dedicated working for us.

Meeting Dr Mehra really assured us that receiving a kidney from a living donor would be fine. Jaideep and I have a six year old son and we didn’t want to put one of us at risk and make life worse, but the team here at the Royal played a very good role in bringing us both to a stage where we knew we could say yes. They were brilliant.”

In 2017 to 2018, the Royal carried out 123 kidney transplants, 42 of which were from living donors like Priya’s husband, Jaideep. It was the Trust’s best number on record.

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Deliver high quality care to all patients by improving the way we admit and discharge

Successful trial benefits patients Earlier this summer, the Trust launched a successful week long pilot of ambulatory care on 2A. Ambulatory care is a way of treating patients with some emergency conditions on the same day without admission to a hospital bed overnight.

This can provide a better patient experience, better managed patient flow and reduced hospital admissions.

“Research shows that this model is beneficial for patients and reduces pressure on hospitals,” said Dr Vicky Price, ambulatory care lead and consultant for acute medicine. “According to national audits, up to 30% of all medical admissions can be ambulated. In the future, we aim to deliver a permanent ambulatory unit from 8am-9pm. We hope this will help to prevent admissions, facilitate early discharges and involve all specialty services.”

•W aiting for scans or diagnostic tests is the same duration as an inpatient •R egular reviews either in person or telephone by a dedicated team •C an be in your own home with your loved ones/pets/familiar surroundings During that week, 144 patients were seen and as a result of the pilot, more than 98% of patients were kept in their homes while

being treated and not admitted onto our wards. Approximately half of those patients were streamed from triage in A&E, and half were returning patients or GP referrals via the phone line.

The feedback that we got from patients was really positive; with some highlighting that the service was much safer, efficient and convenient: ‘better for the body and mind.’

Some of the benefits of ambulatory care include: • T reatment given at home or in hospital as a day case appointment • T he patient is not exposed to any of the risks of hospital acquired infections

Celebrating the re-launch of the RECU The respiratory department have re-launched their Respiratory Enhanced Care Unit. The team on 6x/6y are now trialling the new Philips Respironics V60 ventilator prior to buying, which is a non-invasive ventilator used for patients who are in acute hypercapnic respiratory failure.

It’s a way of correcting respiratory acidosis, where the lungs can’t remove enough of the carbon dioxide produced by the body.

Alongside the machine meeting the national guidelines and quality standards for delivery

of non-invasive ventilation, it enables better patient quality and care being delivered.

“RECU and 6X/6Y are places where patients with tracheostomies, laryngectomies and respiratory issues can be nursed in a safe and secure environment. Many people think we are just non-invasive ventilation (NIV) but we do all sorts of respiratory enhanced care,” said Tracy Perry, COPD and Respiratory specialist nurse. “Currently we have four beds but will be expanding to six and then hopefully eight in the future.”

On RECU there will also be new charts launched for patient observation, and eventually all the older machines will be replaced so there is not a two-tier care system. The respiratory team are also looking to develop oxygen target saturation silicone wristbands to be used in respiratory, with a view to then go Trust wide, so that patients oxygen saturations can be targeted correctly and prescribed and administered the correct prescription.

“In Liverpool in particular there are so many respiratory issues so the more awareness the better. The nursing staff here are so highly skilled as we manage complex patients.

You could be looking after an 18-year-old asthmatic and then an elderly patient with COPD who needs to go on to palliative care, plus all the different elements that come with respiratory illnesses.”

Deliver high quality care to all patients by improving the way we admit and discharge 15

Successful listening events Through this year, the Trust has held a series of Listening Events to gain valuable feedback from patients and the public about key issues.

It’s also an opportunity to promote development initiatives to improve service delivery.

Dialysis patients in control The dialysis team on 6B have recently launched their ‘shared care’ programme, which is part of a national initiative called Shared HD. The programme enables patients to engage in their own dialysis care, from learning about their condition and how haemodialysis works to participating in tasks such as taking their own blood pressure, programming their own machine and setting up their own trolley for the treatment.

“It empowers patients who are on dialysis to become an active part in their treatment and decision making. It’s extremely important for patients to be engaged in their own care and for them to make their own decisions and choices,” said Andrea Williams, 6B’s dialysis unit manager. “That includes the long term

outcomes for patients on dialysis. How patients are empowered in their care is much improved.”

One of those patients is Tara Bashford, the first self-care patient on the Shared HD programme here at the Royal. She spoke about how it has given her a lot more independence: “I started on it 6 months ago and it has revolutionised my dialysis. I can dialyse better; I have more independence and can dialyse when I want.”

Another advocate is Andy Heywood, who said that despite having the confidence that the consultant is there to help you and the health care professionals, the person that knows your body best is you.

“I really wanted me to own the machine, not the machine to own me – so I own the illness,” said Andy. “With Shared HD I can maintain confidence in doing things and control my own life, and be happy with what I am doing.”

The events took the form of drop in sessions and displays in the main entrance to the hospital and visits to the wards to meet and talk to patients and their carers. On average feedback was obtained from 20-30 service users on each day.

There has been an emphasis on nutrition for patients, with ISS providing a meal tasting event and the dietetic team providing weight management advice, and the volunteer service also took part, showcasing five roles for volunteers: dementia buddies, discharge buddies, mealtime assistance, welcome and navigators, and befrienders and companions. Health Watch have also supported the Trust in carrying out two listening events during the summer across all wards on the Royal site and the Emergency Floor.

There next Listening Event will be held in November.

16

Deliver our financial plan and ensure we are as efficient as possible GOT AN INTERVIEW LATER, GOING TO NEED A FAKE BIRTH CERTIFICATE

HR DEPARTMENT SPOT AN ISSUE WITH THE BIRTH CERTIFICATE!

ONE FINAL QUESTION...

DO YOU HAVE A UK BIRTH CERTIFICATE?

PHEW...

YES

IS THAT THE LOCAL COUNTER FRAUD SPECIALIST?

I THINK WE HAVE A FAKE ID!

GOT AWAY WITH IT!

IF YOU COMMIT FRAUD, YOU COULD END UP IN PRISON

Helping to report and stop fraud Fraud has been identified as the crime that people are most likely to experience in the UK, and no individual or organisation is immune from the risk.

The NHS Counter Fraud Authority (NHSCFA) is the centre of excellence for combatting fraud, bribery and corruption against the NHS - work which protects vital resources intended for patient care. The Trust’s AntiFraud Specialist (AFS), Virginia Martin, works with the Trust to implement the NHSCFA’s mission. This work includes awareness raising, fraud prevention and deterrence, and undertaking criminal investigations.

“The NHSCFA estimate losses to fraud in the NHS to be £1.25 billion per annum

– enough money to pay for over 5,000 frontline ambulances,” said Virginia. “This is taxpayers’ money that is taken away from patient care and falls into the hands of criminals.”

When we say ‘fraud’ we mean a range of economic crimes, including bribery and corruption, committed by individuals to obtain a financial or professional gain.

This could take many forms, including: timesheet claims for work not done, travel expenses for mileage not incurred, suppliers to the NHS submitting false invoices for payment, NHS job applicants misrepresenting their qualifications or experience and, providing fake references or ID.

Cases have also included patients claiming free treatment/prescriptions when they are not entitled and scam emails from organised criminal gangs attempting to trick NHS organisations into paying money to them. Penalties for fraud and bribery offences are up to 10 years prison and/or unlimited fine.

NHS staff can report any suspicions directly to their AFS or director of finance - please refer to the Trust’s AntiFraud, Bribery and Corruption Policy on the staff intranet for further details.

Alternatively anyone can report fraud 24/7 in confidence, online at www.cfa.nhs.uk/ reportfraud or freephone 0800 0284060 (powered by Crimestoppers).

Getting It Right First Time Getting It Right First Time (GIRFT) is a clinically led programme which is helping to improve the quality of patient care and deliver operational productivity improvements.

This is done via implementing recommendations locally and nationally across 35 clinical specialties.

At the Trust, a number of specialities are already taking part in the programme including spinal, orthopaedics, ENT, ophthalmology, urology, vascular, general surgery and the emergency department.

Over a six month period, there have been reviews within the departments currently practising GIRFT, with the results helping to drive better clinical outcomes along with quality, efficiency and productivity (QEP).

The outcomes may also contribute to financial savings, but the focus is a clinical drive toward better patient care.

“GIRFT gives us a lot of suggestions and outcomes over what we can do better for our patients. The programme is about how we can take those results and go forward,” said Alex Wells, assistant director of Service Improvement. There is now a full 12 month timeline identified for future reviews. “Going forward we will be holding monthly steering groups which will focus on recommendations from GIRFT and to see how we are implementing them at the Trust.”

The programme originated from a successful national orthopaedics pilot, which to date has produced £50m of

savings over two years and improved quality of care, with 50,000 beds freed up annually by reduced length of stay for hip and knee operations.

“For me the most heartening aspect of the GIRFT programme has been the level of engagement from the clinical teams – who have seemed to relish the opportunity and time to discuss their service and get constructive feedback,” said Paul Richardson, regional clinical ambassador for GIRFT and consultant gastroenterologist at the Trust. “We are already seeing solid clinical quality gains in the implementation phase. The uptake and roll out of GIRFT within the Royal has stood as a potential model we are trying to encourage other trusts within the region to adopt.”

Deliver high quality care to all patients by improving the way we admit and discharge 17

NHS 70 in pictures Back on July 5, staff at the Trust celebrated NHS 70 with a special birthday event here at the Royal, Broadgreen and the Liverpool Dental Hospital. The celebratory event also coincided with the Royal’s 40th birthday year. On the day, staff and volunteers showcased a range of display stands in the foyer from different departments; a complimentary barbecue was enjoyed at Broadgreen, staff took part in our very own ‘Bake Off’ and there was entertainment from various choirs along with Atomic Kitten singer, Natasha Hamilton, plus much more.

18

Exceptional patient experience

Patient thanks So last Mon I had a Kidne y issue and w University Hos as rushed to pital. After an Royal Liverpoo emergency O to say a mas l sive thank yo p and rest in u to all the st ward 8Y I’d Your all doin just like aff and everyo g an amazin ne involved la g job!! #respe @RoyalLpool st week. ct Hosps

final trip now to @RoyalLpoolHosps to s trip 2 d! en s, ek What a we s to Dr John, nurse up! Massive thank nks lad tha est ve eld ssi my Ma k pic lley! tea lady with the tro 1 of you!! gle sin ery porters and even the ev ls ge ff on Ward 3A! An aswell to all the sta

Had A MRI at Broadgreen this morning. The staff that attended to me were brilliant. Radiographer talked me through as MRI was happening.

Even let my husband come in with me. Both the nurse and radiographer made me feel at ease. Thankyou you were both brill xx

o A+E Last night going int nkful as I am now. st mo the tly ac ex Never been so tha sn’t miles from home wa ff at sta the d on my own 360+ sai s thi the world. With re comforting thing in mfortable, they we de me feel very co ma ps os olH @RoyalLpo you. all fantastic. Thank

If anyone needs so me fun Friday news , today I had my fin scan and results an al d I am cancer free!!

Here’s to my wond surgeon Mr Loh at erful @AintreeHospital an d consultant Dr Seshadri at @RoyalL poolHosps. We are now off to celebrat HAPPY FRIDAY! e.

hospital extra at Liverpool dental the fabulous team to nnon and Cheryl u yo Ca re nk Cla tha n, ge Hu ell Sarah McKerna Tyr n so Ali tient you also rd, pa Lo us thanks to Mr th such an anxio wi ing az am u yo re Bealey not only we theter and a cannula ence between a ca taught me the differ

@RoyalLpoolHosps just to let you know someone in a shop was telling me with huge gratitude abo ut the care their son had received in Broadgreen.

Over two weeks seriously ill,cared for amazingly we ll,& now safely home.

She was in tears telling me .Important to pass on.@A idanKehoel

@RoyalLpoolHosps best wishes to all at d an s nk se tha st rne My ea ecial mention to tho niversary, with a sp ay. tod ve ali be n’t on this #NHS70 an uld ut whom I wo tho wi , 5B d & an 5A s me on Ward the world to d dedication mean Your hard work an years!

70 xt ne the re’s to countless others. He

@RoyalLpoolHosps two weeks in and Prof Brennan has done it !!! I don’t know how but with such low rates my Grandads survived! I cannot thank your team enough I’m in awe! Happy 70th birthday!!!

g it ff on 2B for makin K YOU to all the sta AN hours. t TH las r big he a in say Would like to th my mum on 6X wi be to le ab erf be d to much, wond ul possible for my da for us, thank you so ne do u yo at wh t Will never forge xxxx l staff, love you all caring professiona

My self and Steve would like to than k all staff and doctors on ward 9A for all the care and attention you gave to Steve over last 2 weeKs after his Kidney transplant, we both cannot than k you enough for all your hard work that you do, many many thanks love Steve and Lynda brown xxxx

ver met a more nose, and I have ne my on ry it rge su g havin on the day case un I was in yesterday ! The student nurse life ff my sta in ff the sta o of Als friendlier group ke the best nurse! ever and she will ma overing and was the nicest girl azing!!! I’m not rec am re we ep sle to t pu g when I was gettin nce .. thank you good as my experie hope the result is as

I have been in the Royal Liverpool Un iversity Hospital ma 2014 the surgeons ny times since are very nice and sp eak to you on your simply cant fault an level, and I ything about them.

Expert nursing and The porters make kind staff. you laugh and help to keep your spirit staff are very helpf s up. The ward ull and kind. Cater ing try to help you as they can. In fac out as much t all staff in all depa rtments help to ma good as possible. ke your day as Thanks to everyon e.

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