December 2014
The Royal Liverpool and Broadgreen University Hospitals
insight
NHS Trust
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Smoke Free Hospitals: Smoking banned from 11 March
www.rlbuht.nhs.uk
New Royal:
counting down to 2017 Page 13
@RoyalLpoolHosps Facebook.com/royalliverpoolhospitals RoyalLPoolHosps
Thumbs up from the CQC
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Exceptional Patient Experience
How are we performing? We, along with all other NHS Trusts, continuously monitor our progress against a series of targets that are set both nationally and locally. This allows us to monitor the delivery of
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 September 2014 (except where stated)
Team Brief 2015 Team Brief takes place once a month at 10.15am in both the Broadgreen and the Royal education centres. The dates for 2015 are:
• January 9 • February 6 • March 6 • April 10 • May 1 • June 5 • July 3 • August 7 • September 4 • October 2 • November 6 • December 4 It’s really important that Team Brief is attended by all teams and that every member of staff receives a brief. If you have any questions contact communications@rlbuht.nhs.uk or call the Communications team on extension 5584/5489.
Patient Experience and Quality All Cancers: 31-day wait Diagnosis to first treatment All 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 Difficile Clostridium 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
Employee of the Month 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.
The latest winners presented with their certificate are: If you would like to nominate someone for this award, please contact the Quality Department on extension 2293.
June: Anna Clarkson, mortuary dispatch officer
July: Matt Cullinane, Senior operating department practitioner, Interventional Theatres
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Exceptional Patient Experience
Smoke free hospitals 11 March 2015 is national No Smoking Day and from this date forward, there will be a complete ban on smoking on all our hospital sites.
patients and visitors. This is being updated in line with national guidance from the National Institute for Health and Care Excellence (NICE) for all hospitals in England and Wales to be smoke free.
This will mean that:
Other neighbouring hospitals are also banning smoking from their sites. From 11 March the Walton Centre will be smoke free and the Liverpool Heart and Chest Hospital and Mersey Care NHS Trust will be banning smoking from their sites. Other hospitals are also making plans to stop people smoking on their sites.
• Patients, visitors and staff (including contractors) will not be allowed to smoke with hospital grounds. This includes electronic cigarettes • All smoking shelters will be removed • Boundary lines around hospital grounds will be clearly marked as no smoking areas and disposal bins provided at entrances to our sites • Patients who smoke will be fully supported with nicotine replacement therapies during their hospital stay • Support will be available to help staff stop smoking but staff smoking in uniform or with name badges close to the hospitals will face disciplinary action There is already a Smoke Free Policy available on the intranet, which outlines expectations of staff,
Aidan Kehoe, chief executive said: “As the main hospital in the city with some of the highest number of people with cancer along with the highest death rates from cancer and respiratory diseases, we have to make a stand against smoking. “We’re offering support and advice to anyone who wants to quit and highlighting the benefits of a life free from smoking. We ask that everyone supports and respects our zero tolerance on smoking and will be considering how we can enforce this.”
10 reasons to quit smoking: 1. Smoking causes around 80,000 deaths in the UK every year 2. About half of smokers will die as a result of diseases caused by smoking and may die around ten years earlier than non-smokers 3. If you are a smoker under the age of 40 you are five times more likely to have a heart attack than a non-smoker 4. Smoking causes more than 90% of lung cancer deaths 5. Passive smoking increases the risk of lung cancer by about a quarter for non-smokers. 6. Children exposed to second hand smoke are three times more likely to develop lung cancer later in life 7. Second hand smoke in children leads to increased risk of: • Sudden Infant Death Syndrome (SIDS) • Middle ear Infection (Glue ear) • Lung Disease, Bronchitis & Pneumonia • Respiratory Tract Infection and Asthma • Dental decay 8. If you smoke you are more likely to have complications following surgery 9. Smoking can delay your recovery and the wounds are slower to heal
We Say No to Smoking - Our message to you: Patients:
Visitors:
“If you are a smoker, we will support you with nicotine replacement therapies and help make your stay as comfortable as possible. But we cannot let you smoke whilst in our care.”
“If your loved one smokes it is important you support them with not smoking whilst they’re in our care. We can also help you stop smoking if you want.”
“Not smoking whilst in hospital will help you recover quicker and may help you quit for good.”
Staff: “We work in the NHS to care for people. We need to encourage people to stop smoking to improve their health or the health of future generations.”
“Hospital visits can be stressful. But you can’t smoke at an airport, a football match or a train station. So please don’t smoke during the short time you are visiting.” “If you smoke we can help you quit.” “Staff smoking in uniform or with name badges close to the hospitals will lead to disciplinary action.”
10. Quitting a 20-a-day habit could save you £183 a month which is £2,190 a year. Within 10 years you will have saved £21,900 which is the equivalent of two years mortgage repayments!
Help to quit: Help is on hand in the form of our on-site stop smoking service for staff and patients. This service is provided by Roy Castle FagEnds and is there to provide you with advice, guidance and information about how to stop smoking. It can help you find out about nicotine replacement therapy, local support groups and other ideas and tips to help make giving up a little easier. You can contact them on extension 2332.
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Exceptional Patient Experience
Respiratory health takes centre stage Visitors to the Royal were able to test the age of their lungs and learn how to use inhalers properly, as staff dedicated a day to improving the city’s respiratory health. Patients, visitors and staff who were keen to test out their respiratory health, were asked to blow into a spirometer. The test measures the volume and speed of the air you can blow from your lungs and gives doctors an indication of how clear the airways are. Dr Justine Hadcroft, clinical director of respiratory medicine said: “Sadly Liverpool has some of the worst respiratory health in the country. Diseases such as chronic obstructive pulmonary disease (COPD), lung cancer, asthma and pneumonia are all too common on Merseyside and can cause long term and sometimes life threatening health issues.” The Department of Health estimates three million people are living with COPD in the UK – but only a third have been diagnosed. Asthma affects five million people in the UK and causes around 1,000 deaths a year. In 2013, there were over 450 emergency attendances to the Royal related to asthma. Pneumonia – an acute lung infection – is the biggest cause of death worldwide. The respiratory research group at the Royal in collaboration with the Liverpool School of Tropical Medicine (LSTM) has developed a unique model to test vaccines for bacteria that causes pneumonia. Lung cancer is the second most common form of cancer in the UK. The cause of lung cancer in eight out of 10 cases is smoking. Dr Hadcroft said: “Our respiratory team at the Royal work extremely hard, providing the very best care and quality of life possible to people with respiratory diseases. The best way to reduce the likelihood of developing any respiratory diseases is to quit smoking.”
‘Caring and compassionate’ staff
CQC report significant improvements
A follow-up inspection by the Care Quality Commission in September found significant improvements in our hospitals. The inspection team had first visited our hospitals in November 2013, and found areas of excellent practice, including end of life care and the way our emergency department and acute medical unit work together. The report praised our ‘caring and compassionate’ staff and their commitment to providing good care to patients. It also identified some areas for improvement. The CQC carried out a followup unannounced inspection in June and July and the follow-up report concluded we are meeting requirements in all but one of the areas they identified for improvement.
Spirometry testing lung health
Inhaler testing for patients, visitors and staff
This area related to our Heart Emergency Centre (HEC), which we now moved to another part of the hospital and spent £700,000 on refurbishments and staffing. We are also continuing to improve our risk management processes, learning from complaints and have encouraged staff to report incidents and nearmisses. The weekly Patient Safety Bulletin to all staff highlights learning from incidents and complaints as well as highlighting best practice. We have also set up a dedicated incident hotline for staff to report incidents to us, which is extension 3215.
Aidan Kehoe, chief executive said: “I am really proud of the positive way our staff have responded to the CQC report and of their hard work and dedication. Once again, this report commends our caring and compassionate staff. Care and compassion is at the very heart of all that we do in our hospitals and I am very proud of the commitment of our staff to provide high-quality care for our patients.”
Additional improvements made •W e have recruited additional staff in the emergency department with the specific responsibility for cleaning and preparing cubicles between each patient. •W e are implementing an electronic whiteboard system that allows us to track patients across the hospital to help ensure patients are being treated as quickly as possible by the right team. •W e are reviewing our outpatient clinics so that waiting times are reduced and ensuring that patients are informed about what’s happening throughout their visit.
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Exceptional Patient Experience
Listening Week 1 – 5 September The Trust gathered useful feedback from patients, relatives, carers and visitors during a Listening Week in September. Volunteer student nurses from the University of Liverpool donned ‘Here to Help’ sashes and encouraged people in main reception to write down their experiences of the Trust on postcards. While 80 people said they would be extremely likely to recommend our hospitals to friends, three said they would be extremely unlikely to. Comments recorded on the postcards included that staff were really helpful at main reception, one person said they had waited too long in clinic to be seen with no feedback about the waiting time from staff, while another complained that patients smoking at the front of the hospital in nightwear was unacceptable. It is one of our quality objectives to deliver a seven day service so we gathered feedback on outpatient clinic appointments, investigations, procedures and operations being offered on a Saturday and Sunday. Results from the 125 postcards completed by
Volunteer student nurses from the University of Liverpool encouraged people in main reception to share their experiences of the Trust
patients, relatives and visitors about having a seven day service included 124 people who would attend an outpatient appointment at the weekend, and 110 people would attend for investigations, treatment and surgery.
The Patient Advisory Liaison Service (PALS) hosted a stand outside their new interview room near the main entrance to inform patients, relatives, carers and visitors about their service. They used a video pod to gather feedback from anyone willing to be filmed, with 10 people taking part. The final day was hosted by the shadow lead governor Doreen Schlechte and another shadow governor, Paul Smith, who managed to attract more public members for the Trust. A “you said we did” poster will be published to share with patients, relatives, visitors and staff. Further listening weeks are planned for March 2015.
Visitors were able to sample dishes from the Trust’s varied menus The catering department held food tasting in the main entrance to showcase the choices available for patients while the Patient Safety nursing teams promoted their work and the Falls Prevention Team exhibited a new alarm system introduced to help prevent falls. Promotion of Infection Prevention and Control initiatives was held at both hospital sites and, with winter approaching, the importance of the flu vaccination was highlighted. The Vasculitis Patient group and our vasculitis specialist nurse were also available to give advice and support. Chief executive Aidan Kehoe attended a mealtime experience event on ward 5 at Broadgreen where patients who need to be in hospital for a prolonged length of time recover and receive rehabilitation treatment. A new menu has been specially developed for this group of patients by the catering department.
Visitors were able to find out more about vasculitis
60th wedding anniversary Mr and Mrs Braithwaite celebrated their 60th wedding anniversary with staff from wards 5Y and 5X in August. The couple are well known on the ward as Mr Braithwaite receives regular treatment on 5Y day unit. Staff surprised them with flowers and cards on their memorable day. Jo Buchanan said: “On behalf of all staff on wards 5Y and 5X we would like to send our congratulations to Mr and Mrs Braithwaite.”
Mr and Mrs Braithwaite celebrating their 60th wedding anniversary with Michelle, a nurse on ward 5Y at the Royal
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Improving the quality of life for our patients
New service for frail elderly patients A new Liverpool Frailty Service was started on 3 November. This is a collaboration with Liverpool CCG, Liverpool City Council, Liverpool Community Health and Mersey Care to provide integrated support to certain frail elderly patients from the hospital to the community. It aims to have patients medically fit and ready to leave hospital within 72 hours and provide them with support in the community. As part of this, ward 2A is now a specialist frailty unit with supported physiotherapy and supported discharge also being provided. Patients will be
admitted via the Emergency Department or Acute Medical Assessment Unit and frailty specialist nurses will be available to assess patients in line with the criteria for the ward. Dr Matt Tedford, consultant geriatrician and clinical lead for the service said: “This service means patients see the right team at the right time to provide person centred care. This integrated service between the hospital and the community is the first of its kind on Merseyside. In other areas of the country these services have been proven to reduce mortality, hospital readmissions, lengths of stay and long-term dependency.”
Better support for frail patients
Who is the Frailty Unit for? The Frailty Unit is for patients who meet the ‘Bournemouth’ criteria, which is as follows:
3. Incontinence (urinary and/or faecal)
4. Reduced mobility
5. D ementia with abbreviated mental test (AMT) score of less than 3
6. Carer arrangement breakdown
7. Multiple pathologies
1. Over 90 years old 2. Over 65 years old if in residential/ nursing home or from intermediate care 3. Over 75 years old with 2 or more of the following conditions:
N.B. The following exclusion criteria applies:
1. Acute confusion
1. S ingle organ pathology requiring admission to a speciality bed base
2. Falls
2. Chest pain/suspected acute
coronary syndrome 3. H ead injury with Glasgow Coma Score of less than 9 4. Hip fracture 5. Stroke 6. H aemodynamic instability requiring resuscitation 7. Unexplained acute abdominal pain For referrals please speak to one of the frailty specialist nurses on 07771 389 582.
Changes to anti-coagulation services Anticoagulation services in Liverpool are changing. Patients will now access clinics in their own community. Following feedback from patients, we are making some changes to the way the anticoagulation service is delivered. In the future you will be able to access the service from 22 different clinic locations based across Liverpool. This means that your current clinic may be changing. However, there is no current change to referral processes. This map and table shows where and when you can attend a clinic closer to you. For more information on all of the new clinics locations and opening times, please visit: www.liverpoolcommunityhealth.nhs.uk/ anticoagulation-service.htm Or call: 0151 247 6066 or email: liverpool.anticoagulation@nhs.net
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Improving the quality of life for our patients
Pledge for zero tolerance on infections We are asking all staff to sign a pledge for zero tolerance on infections in our hospitals to keep our patients safe from harm. MRSA, if it gets into the blood stream, has a mortality rate of up to 50%. This is why our target for MRSA infections this year is zero. However, we have already had some MRSA infections and are performing below what we all want for our patients. Lisa Grant, chief nurse said: “We must not put our patients at risk of infection, when this can be avoided by complying with basic infection prevention and control measures. Whether you are a senior consultant, a healthcare assistant, or a cleaner, a bed manager, a senior manager or member of admin staff who occasionally comes into contact with patients – it is all our responsibility to protect our patients from infection.” Peter Williams, medical director said: “Evidence shows that even following the very basic rules of infection control can prevent infection. It’s essential to keep patients safe and I expect all medics to sign up to the pledge.”
“Many of our executive staff and clinical directors have already committed to reducing patient infections by signing the pledge. We’re really keen for all our staff to join them and sign the pledge to show they support zero tolerance on infections.” For more information on the latest infection prevention control techniques and training contact the clinical skills team on extension 3156 or the infection prevention and control team on extension 4416.
Modified early warning score charts (MEWS) will soon be replaced by the national early warning score charts (NEWS). This change started in surgery in November, shortly followed by medicine, then emergency services and critical care. This change will have benefits such as: • Easier, more user friendly charts • More robust action plans • Early detection and treatment of sepsis. The charts have been trialled in medicine and surgery and been well received with positive feedback. Monday 3 November begins ‘NEWS week’ with numerous drop-in sessions to offer training and familiarisation with the new charts and policy.
Clostridium Difficile
All staff who take and record observations must attend one of the NEWS drop-in training sessions. Separate sessions will be arranged for Broadgreen before rollout. For further information, contact the resuscitation training department on extension 2045.
Safe IV medication administration
Extra training sessions have been established where members of staff can get up to speed with the very latest infection prevention measures and sign up to the pledge. Aidan Kehoe, chief executive said: “I’m really proud of the hard work and effort our staff have put in to reduce infections in our hospitals.
Goodbye MEWS, hello NEWS!
Intra venous medication administration should follow the five ‘rights’ to avoid errors: Methicillin-resistant Staphylococcus aureus
1. the right patient 2. the right drug 3. the right dose 4. at the right time 5. via the right route. Our policy states that a second practitioner should witness the preparation and administration of IV medicines. The following points should be followed: verify the patient’s identity, check the prescription, witness the reconstitution, check the diluent used, check the rate of administration, check the expiry dates and all calculations. Witness the safe administration or commencement of infusion and sign the relevant documentation.
ZT Clnical directors: Caption: Clinical directors taking the lead on zero tolerance
Follow these guidelines to ensure our patient’s safety.
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Improving the quality of life for our patients
Keep well this winter Cold weather can trigger or worsen some illnesses, meaning that health services are more in demand. There are a range of treatment options available to you and your family: • Your GP is your first point of contact for non-emergency illnesses which you can’t treat yourself, and practices can offer same day appointments if necessary • When the surgery is closed, you can still see a local GP with the GP out-of-hours service; just contact your usual practice number and your call will be re-directed • NHS 111 is available 24 hours a day, 365 days a year. Calls are free from landlines and mobiles • Walk-in services provide treatment 365 days of the year for illnesses you can’t treat yourself. There’s no need for an appointment • Your local pharmacy can offer free, confidential advice on a range of health issues and you don’t need an appointment • Remember, emergency departments and ambulance services are for lifethreatening conditions like strokes and heart attacks only. There are lots of things you can do which could help you stay well: • Be prepared for common illnesses like coughs and colds by keeping a wellstocked medicine cupboard at home to see you through winter months. Your local pharmacy can provide you with advice on what to include • Make sure you’re up to date with repeat prescriptions, leaving plenty of time ahead of public holidays (such as Christmas) • Visit www.nhs.uk for information about health issues, and details of GPs, pharmacies and dentists in your area • If you’re eligible for the free seasonal flu vaccination make sure you get in touch with your GP to arrange it. Eligible groups include two to three year old children, people aged 65 and over, adults and children with long term health conditions, and pregnant women • If you don’t have a GP – perhaps because you’re new to the area or you’re a student – you can register with your local surgery.
Improving emergency access Our emergency department has been contstantly busy throughout the year. We’ve had a 4% increase in attendances and we are seeing more very sick patients with complex needs. In the months leading up to winter, we have seen 14% more emergency admissions this year than last year. The demand on our services is expected to increase over winter and providing safe and effective care within four hours for patients presenting as emergencies is a constant challenge. Our Emergency Department is often crowded, which leads to a poor experience for patients and their families. Staff across the emergency floor have established an emergency access taskforce to review and change how we manage attendances and the care and treatment patients receive. The team are implementing a range of measures including: • F or every shift, there will be a medical and a nurse controller, who will work together to ensure quality standards are maintained and provide an overview of the department as a whole. This is similar to the role of the trauma team leader being a ‘hands off’ clinician so that situational awareness is maintained • I ntroducing a new method of ‘Pit-Stop’ triage providing a proactive input at the first point of patient contact. This allows early investigations and streaming of patients and has been shown to
reduce time to decision making and enhance the patient experience •M aintaining beds in observation areas consistently •W orking closely with specialties to ensure faster transfer of patients onto wards. In addition to this, consultants will continue to be available 24/7 to help speed up clinical decisions. Dr Kate Clark, clinical director for emergency care said: “We want to be the best Emergency Department in the North West, providing safe, quality, excellent clinical services. We want our patients to be treated as we would wish to be treated ourselves. We’re implementing these new measures across the emergency floor to help us achieve this but we need the full support of our colleagues throughout the hospital. We need specialties to maintain ownership of the specialty bed base. Our focus is on getting the right patient, to the right bed base as soon as possible, keeping the appropriate patients on the emergency floor and moving the more complex speciality patients at the earliest opportunity. Delays in patients arriving at the right bed base increase mortality, morbidity and length of stay. “The emergency department works well when speciality patients accepted for admission are moved to a bed in a timely fashion. If specialities can identify two empty beds by 11am and which patients from the emergency floor they would take responsibility for, we can make a huge difference!”
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Improving the quality of life for our patients
Supporting domestic abuse victims A new service providing support to women who are victims of domestic abuse has been launched at the Royal. This Ruby project, a collaboration between the PSS (Person Shaped Support) Women’s Turnaround Project and the safeguarding team at the Trust, is the first service of its kind in Merseyside providing support to victims while they are recovering at the Royal.
or those with chaotic lifestyles, this is often more difficult and sadly we often see them coming back to our emergency department again and again. The Ruby project brings that support to the victim while they are in our care in hospital and it is empowering them to break the cycle of abuse.”
Kirkdale, who meet the patient in hospital. Heather Bromilow, senior practitioner at the PSS Women’s Turnaround Project, said: “We know from experience that well-timed and wellcoordinated intervention reduces the likelihood of these women coming to further harm. “We will conduct a risk assessment and create a safety plan for them before they leave the hospital, establishing whether they have any belongings with them, whether they have children and where those children are, whether they have safe accommodation to return to or finding them a secure place to stay. We will discuss initial advice around criminal procedures, disclosures to police, advice on how to deal with unwanted aggressive behaviour from the perpetrator and working alongside staff at the hospital, ensuring relevant information is recorded.
The project secured £123,000 from Comic Relief after a successful pilot supported 77 women between January and March and led to seven convictions of abusers. The money will keep it going for the next three years. In addition, the Ruby team delivered domestic abuse awareness training, working toward the aim of training around 7,000 frontline clinical staff. Dave Roberts, safeguarding lead for adult protection at the Royal, said: “We see around 20-35 female victims of domestic abuse each month at the Royal. Sadly these figures double in December with the festive period.
“The second stage of support will be to encourage women to attend our women-only centre and assess their needs, looking L-R: Chair Judith Greensmith, PSS practitioners Heather at the whole picture including Bromilow, Kimberley Worthington, Louise Ellman, MP Jane substance dependency, mental Kennedy, Merseyside Police and Crime Commissioner and Dave health, finances, child support, “When these women are in Roberts, safeguarding lead for adult protection at the Royal our care we provide them with education and employment and information on who they can speak accommodation. From this we will to about their abuse. But for women with develop an individually tailored support plan and Support is provided by specially trained staff at complex issues, such as substance dependency, together we will prioritise their needs.” the PSS Women’s Turnaround Project based in
AAA screening at Goodison Park The Royal’s abdominal aortic aneurysm (AAA) screening team returned to Goodison Park a year after diagnosing an Everton legend with a potentially fatal aneurysm. Last September, the AAA screening team detected a small aneurysm when they gave Everton’s 1966 FA Cup-scoring hero Derek Temple the ultrasound scan they use to check men over 65. AAAs involve the wall of the body’s main blood vessel weakening and expanding in the abdomen. Left unchecked this can cause massive internal bleeding and is fatal in 98% of cases. The condition is most common in men aged 65+ and current figures show the condition claims about 6,000 lives a year. In September, the team from the Royal screened attendees at ‘Pass on the Memories’, a weekly programme run by Everton in the Community and Mersey Care NHS Trust supporting people with dementia. They were joined by Everton legend Ian Snodin to discuss the team’s past while also finding out if they have an aneurysm.
Derek Temple said: “Raising awareness is of paramount importance in saving lives and I am only too happy to help with something like this. I think a lot of men over 65 have the mindset of just leaving things and not bothering to get them checked out. I only hope the programmes being run by the NHS, can help change that perception.”
Robert Fisher, consultant vascular surgeon at the Royal and director of the Cheshire and Merseyside AAA screening programme, said: “This screening programme is so important because people may have an abdominal aortic aneurysm without knowing about it until it bursts and sadly, by then, it’s usually too late.
Former Everton player Ian Snodin, screening technician Deana Clarke and AAA screening programme administrator Tim Dwyer
The most common symptom of a ruptured aortic aneurysm is sudden and severe pain in the abdomen. If you suspect that you or someone else has had a ruptured aneurysm, call 999 immediately and ask for an ambulance.
The Royal is the only hospital in Cheshire and Merseyside accredited to carry out screening, monitoring and preventative surgery for AAAs as part of a national programme of screening and research.
Men who are 65+ can book a screening appointment by calling 0151 706 4767 or emailing aaascreeningprogramme@rlbuht.nhs.uk.
“Men are six times more likely to have an AAA than women and the risk increases with age, so this screening programme is directed at men in their 65th year, but older men can refer themselves to the programme. I am convinced that this screening program will save lives across Merseyside and Cheshire and hopefully reassure men against the threat of an aneurysm.”
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Improving the quality of life for our patients
Liverpool hosts first keyhole surgery kidney transplant in Europe A patient at the Royal Liverpool University Hospital became the first in Europe to receive a kidney using keyhole surgery.
The Catheter Passport
Catheter Passport A new document providing all healthcare providers with vital information on patients discharged with catheters has been launched. The Urinary Catheter Passport, for patients with indwelling urinary catheters, provides patient information and relevant information for other healthcare professionals in hospitals or community based care, who would be involved with the patient’s care. The aim of the urinary catheter passport is to improve communication between healthcare professionals caring for patients and helping their decision making for catheter management and early removal of a catheter. Early removal of inappropriate indwelling catheters will ensure reduction in infections, use of antibiotics, length of stay in hospital and increase patient safety. It could also assist in the prevention of unnecessary emergency admissions as patients are directed to the most appropriate healthcare provider.
Brian Blanchfield, 51, a print company director from New Brighton, received his sister’s kidney in a procedure carried out by surgeon Professor Pranjal Modi from Ahmedabad, India during a workshop of unique surgical techniques. It is common for kidneys to be removed from a donor using laparoscopic - or keyhole - surgery, but Professor Modi is the only surgeon in the world using the technique to give the kidney to its recipient. This process is normally done by open surgery. In future, the technique could benefit people with a body mass index of more than 35, who it is currently considered unsafe to provide with a kidney transplant using open surgery. We are also looking into robotassisted kidney transplants as an alternative future option. Transplant surgeon Sanjay Mehra at the Royal arranged for Professor Modi to spend a week at the hospital, where he carried out the operation three times. The procedure – which involves an opening of around 6cm compared to the 20cm cut of open surgery – was viewed live on a big screen at the Royal’s lecture theatre by 25 medics from across Europe. The visitors were able to assess the techniques and ask the professor questions as he operated.
The catheter passport complies with national guidance to reduce harm to patients. Sue Lancaster, continence specialist nurse said: “By reducing the number of unnecessary urinary catheters we can reduce the harm to patients. From May 2014 all patients coming into or out of hospital with a catheter must have a catheter passport!” For more information please contact the continence specialist nurse on extension 3760 or bleep 5043 or call the Infection Prevention and Control team on extension 4416.
The surgeons in action
Brian Blanchfield recovering after surgery Mr Mehra said: “I met professor Modi in 2010. He told me about laparoscopic transplant which was unbelievable at that time because I’d never heard of it. He later invited me to his unit so I learned more about it from him. We are very fortunate to have had him in Liverpool and to share his techniques with the surgical community.” Prof Modi, who has performed the procedure around 175 times in India, carried out the operation on Brian on Friday 26 September before repeating the procedure on two more recipients the following Monday and Tuesday, when events were watched on the audio visual link. Brian Blanchfield was diagnosed with nephritis in 1985, and up to recently had controlled his illness using medication. After Brian’s sister Pam Morfett was established as a match and a process of tests and interviews were complete, a date was set for the siblings to come to the Royal. Pam was discharged days later and a week after the procedure, Brian was free to go home to New Brighton. He said: “The renal team have been superb. Every step of the way they’ve talked us through it. They’ve explained how the op would go and how I would feel afterward and everything has been exactly as they said it would.”
Improving the quality of life for our patients
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Melissa Lawson with her two-year-old son Michael
Transforming lives: New mum thought leukaemia was post-pregnancy aches When Melissa Lawson spotted bruises on her legs she put it down to her newborn son gently pinching her skin.
had chronic myeloid leukaemia, a cancer that starts in bone marrow stem cells - the cells that produce all blood cells.
But the bruises, and the constant backaches she thought were the result of her recent pregnancy, were actually signs of something far more sinister – leukaemia.
She was referred to the Royal Liverpool University Hospital and spent two nights here as doctors ran tests to establish the most suitable course of medication.
Sixteen months on and with her son, Michael, approaching his third birthday, Melissa wants other people to know what to look out for.
“It was hard on my partner, Mike,” remembered Melissa. “He is a car valet and had to take unpaid time off work to look after our baby. That was quite a hard time. When Mike had to go back into work my mum and dad were able to step in and help out. My family have all been brilliant.”
She explained her initial confusion about the symptoms that eventually prompted her to see a doctor, and warns others to be more aware of the signs. Melissa, 19, from Moreton, Wirral said: “In April last year I was getting stomach pains and coming out in bruises but couldn’t explain what was bringing them on. I had back ache quite early on and mum said she had back ache for about a year after having my brother so that’s what I put it down to. But one day I felt so sick, had a headache and my stomach was really swollen. I had big, lumpy bruises too. Mum said ‘something is not right’.” Melissa saw a doctor and was immediately referred to Arrowe Park Hospital, Wirral. A day later, aged just 18, Melissa was told she
Melissa takes the tablet imatinib, which aims to suppress rather than cure her condition. Since 1998 it has greatly improved the survival chances for patients newly diagnosed with chronic myeloid leukaemia, which was once between three to five years, by inhibiting the leukaemia and encouraging the regrowth of normal bone marrow stem cells. One recent study showed that of those that responded well to the drug, 95.2% survived after eight years. Melissa has monthly checks of her blood cells to ensure the leukaemia is being managed effectively. She still experiences too much pain and nausea to return to work so looks after her son full time.
She added: “I didn’t know anything about leukaemia so I wasn’t looking for the signs because I didn’t know what they were. Even when I was getting bruises I had put it down to the baby. I think a lot of people won’t be sure what it is so I want to raise awareness so other people know what to look out for.” When she is ready, Melissa says she hopes to have another child. “Professor Clark at the Royal said it’s not impossible for me to have children again. This may be feasible once the leukaemia has been successfully treated for another year or two. I’m grateful I’ve got Michael and he’s healthy but it would be nice to have a brother or sister for him.” Prof Clark, a consultant haematologist at the Royal, added: “Symptoms of leukaemias are often vague ‘everyday’ complaints such as tiredness, aches and pains or maybe recurrent infections, that don’t go away with simple measures. There may even be no symptoms, as they are sometimes diagnosed on a blood test in an unrelated routine check-up. It is always worth seeking medical advice if you have easy bruising, as with Melissa. A simple blood test via the GP is all that is needed to rule out a leukaemia or similar blood disorder.”
12 Developing a sustainable health system
New Royal – countdown to opening In October, we marked 1,000 days to the opening of the new Royal in 2017 with a day of events for staff and supporters of the project. Stakeholders and local dignitaries gathered at the Royal’s Education Centre where the planned glass art work for the main entrances was unveiled. Visitors also had the opportunity to see some of the materials that will be used to create the new hospital close-up, and viewed new images of how the interiors of the hospital will look. The colour schemes that will help distinguish each ward to improve way finding were also revealed. As part of the celebrations, the Trust used external sponsorship to commission renowned light artist Andy McKeown to produce a light show. Helen Jackson, director of strategy and transformation said: “It is amazing to think that we are only 1,000 days away from opening the new Royal. We wanted to mark this moment by illustrating more of how the hospital will look and feel. Key to this is the wonderful artwork of Alexander Beleschenko. This will have a huge aesthetic impact on the new Royal and there is considerable evidence to show that artwork can have a positive impact on people’s physiological and psychological health. “We’re holding events for our staff and others who have supported the new Royal and we’ll be hosting special events for others every 100 days, until the new Royal opens.”
Alexander Beleschenko’s design for the main entrance at the new Royal
Glass art work unveiled Stunning glass artwork proposed for the main entrances of the new Royal Liverpool University Hospital was revealed to the public for the first time as part of the celebrations counting down 1,000 days until the hospital opens.
The artwork, a modern interpretation of a large stained glass window, has been designed by renowned, award-winning glass artist Alexander Beleschenko. The proposed designs will greet people to the building at entrances facing Prescot Street and West Derby Street, covering a total area of 217 square metres.
“The artistic intention is that these artworks signify arrival and generate a positive feeling to those coming into the hospital. The colours are very contrasting and basically prime and bright.
“The work is about celebrating Liverpool and re-working the tradition of stained glass in a contemporary way. This is my first project in Liverpool and I am very chuffed and honoured to be here. “I love Liverpudlian culture and Liverpudlian accents. Liverpool ruled the music world when I was a boy and that is a big part of my design.”
Alexander Beleschenko has twice received the Art for Architecture Award from the Royal Society of Arts and is Honorary Fellow of the Royal Institute of British Architects. His major commissions include significant works for the Herz Jesu Kirche, in Munich, Southwark Station and Canary Wharf in London. He said: “Music is the inspiration behind the two entrance artworks. This is a direct response to the huge musical tradition associated with Liverpool. But one of the great things about using glass is that people will find their own readings and interpretations as light on the glass constantly changes.
Alexander Beleschenko at the 1,000 Days event with a sample of the glass artwork he has designed for the new Royal
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Developing a sustainable health system
New Royal construction update Construction on the new Royal continues to gather pace with ground floor slabs 95% complete and the fourth lift and stair core finished. The fifth and final tower crane is now on site. Re-alignment of the entrance road from Prescot Street to the Linda McCartney Centre will start in January with some preparation work starting in December. Construction of the state-of-the-art new Royal is progressing rapidly, with three lift shafts completed and five tower cranes dominating the skyline at the end of Edge Lane. The foundations for the main hospital are complete and work has also started on the concrete flooring and superstructure.
A drone captured these stunning images over the new Royal site in November
Local communities get share of £30,500 new Royal funding Nineteen local community organisations shared £30,500 from Carillion to support their work and build a lasting legacy for Liverpool. These organisations are the first winning submissions to the Liverpool Community Fund, set up by Carillion as part of the new Royal Sustainable Communities Programme, which will provide £100,000 over three years. Carillion, the Trust and Liverpool Charity and Voluntary Services (LCVS) have worked closely with local community organisations to identify their needs and select successful bids for this first round of funding. The winning bids were announced in an event at the Royal Liverpool University Hospital attended by some of the successful organisations and MP for Riverside Louise Ellman. Among the successful bids where Liverpool Homeless Football Club, who will receive funds to pay for rented city centre offices,
which are needed to reach homeless people living in the city. Merseyside Play Action Council were also successful with funding for 71 play scheme organisations to provide good nutritious food during the school holidays, to children who receive free school meals during term-time.
Louise Ellman MP for Riverside said: “It’s fantastic that after all the hard work of so many people to get the new Royal off the ground, we are now starting to see the benefits of what the project will bring to the people of Liverpool. The construction is starting to take shape and funding local projects like these will bring benefits to the people of Liverpool for years to come.”
Other successful projects including those providing play equipment and activities for children, group activities for isolated men, support for families in crisis, advice on healthy lifestyles and many more. David Kennedy, operations director of Carillion said: “We’re not only building a world class hospital that will serve the people of Liverpool for generations to come. By supporting community projects like these we’re building a lasting legacy here. Working with the Trust and LCVS, we have taken the first big step towards achieving this, with more funding rounds to follow over the next three years.”
A lasting legacy for the community
14 Developing a sustainable health system
What is Project Shape? Simon Constable, programme director, NHS Leadership Academy and lead for Project Shape outlines how we’re looking at better ways of managing the Trust: Project Shape was launched in August in order to identify ways in which we can organise ourselves better and improve the way that the Trust is managed. It is specifically looking at the clinical operational teams and the way the specialities are organised, led and managed. We hope to have a new structure in place for April 2015. This will probably include new management roles and responsibilities. Alongside this we will have launched our own in house leadership development programme, which we hope will give current managers, as well as future talent, a taste for wanting to do more to enable themselves to “be the best that they can be”.
Doing things differently Most organisations, the NHS included, undergo regular structural reorganisation.
We want to do it very differently in Project Shape. This time it is up to the teams themselves, and the leaders of those teams, to construct something they feel would work better. There’s lots of really good evidence that placing management decision making as close to the patient as possible is really good for patients and staff.
structure. It aims to signal a new way of doing business, including organisational change, with the people most involved having control over their own destiny. Given the changes in environment with the new hospital and potential for change within the local area, change is impossible to avoid. So we might as well get really good at it.
Throughout September a series of meetings and workshops were held with the clinical operational teams to explore what might work and what won’t. From these, the concept of a “care group”, rather than a “clinical business unit”, is emerging. These would be clinically adjacent specialties bundled as logically as possible together around the most common patient pathways. They would also be interconnected with each other. In some cases they would be geographically adjacent in the new hospital as well. Nothing has yet been decided, but there is a lot to do if we are to do what we need to ahead of April next year. Project Shape is more than just a new organisational
Simon Constable speaks at a workshop on Project Shape
Going paper free The Paper Free Health Record (PFHR) programme is picking up pace and has begun its roll out across our Trust. The system will help us to become paperless well before the new Royal opens its doors and way ahead of the national 2018 paperless NHS deadline. Clinical staff can expect to save time and have far better access to critical information held in case notes. And patients can expect to experience a more modern, efficient and safer service as their journey is managed more effectively. The system, a key component of electronic patient record (EPR), will deliver major benefits including reduced costs, environmental impact and saved storage space. Consultant cardiologist Dr Julian Hobbs, the clinical lead, said: “The system will help to speed up clinical decision making, and avoid the risk of wasting time with repeat investigations where case notes have previously been mislaid. The introduction of a new letters system will also streamline communication with GP’s, allowing electronic communication to be properly logged and stored.” One major benefit of the electronic system is increased access to clinical
information, at the point of care via fixed or mobile devices, supporting better patient safety. Clinicians will be able to search for previous entries and have an increased ability to share information between providers, including social care. Access to information will be controlled depending on a member of staff’s role and a full audit trail is in place. The system will make a wide range of processes paperless, removing many of the paper forms that currently exist. All of the information that would
ordinarily be entered onto a case note will now be done digitally, including referrals and paper from external sources. The continuation sheet and consent processes have already been developed. The scanning of existing paper records will be carried out in-house. Patients will be able to sign tablet devices and the Trust’s IT team is also looking at smartcard technology to allow electronic signatures. For more information contact Jane Kelly: 0151 706 5733 jane.kelly@rlbuht.nhs.uk
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Developing a world-class workforce
Unsung heroes: Practice Education Facilitators As part of our on-going campaign to put lesser known roles in the hospital into the spotlight, the Communications and Marketing team paid a visit to the Practice Education Facilitator (PEF) team to speak to Heather Kirby.
visiting them to discuss learning matters or to meet new students. “We organise study days for staff and students including a theatre escort day, management day and interprofessional learning of key topics. We deliver welcome
sessions in local universities and organise special student inductions at the Trust.” The PEF team represent the Trust at education conferences and are hoping to present their innovative approach to incorporating students into Trust-wide quality audit processes in Nottingham next year. If you are interested in taking part in our Unsung Heroes campaign, or wish to nominate someone, please contact the Communications and Marketing team at communications@rlbuht.nhs.uk.
Heather’s role is to ensure the quality of our learning environments within the Trust reflect the high standard of patient care we deliver. Heather says: “We make sure that all learners in the Trust are taught and learn excellent clinical and professional skills, and are all assessed properly. We don’t work clinically with students but instead we support their mentors and educators. We do this for all healthcare professions except student doctors and dentists.” There are no ‘typical days’ as a PEF. Heather says one day they may be in clinical areas talking to educators and the next day they may be in a meeting discussing placement pathway routes for trainee scientists. “We monitor the number of students in the Trust, ensuring they are safe and appropriate. We also work closely with universities, often
PEF team (L-R) Christine Burton, Heather Kirby, Jayne Kemp, Noeleen Ryan, Deborah Roberts
New nursing programme We have been developing a project that will see each and every one of our 1,780 registered nurses go through a training programme to ensure that they have the skills and the support to provide the highest standards of nursing care. Every nurse will undertake a core competency training programme which will be delivered by the University of Liverpool and by specialist practitioners within our Trust. The content of the core competency training will embody our vision, values and strategic objectives. This training programme will be followed by a specialtyspecific training programme to develop and maintain specialist competencies.
Programme. It is a declaration and validation that we have a very competent nursing workforce that puts patients’ wellbeing at the heart of all we do. The programme will also ensure that all our nurses share the vision of the Trust. This is where we all make the difference and the programme is recognition of that.” For more information on the programme email: RLBnurse@rlbuht.nhs.uk
All our staff already have most, if not all, of these competencies. The Royal Liverpool and Broadgreen Nurse Programme will formalise and reaffirm this. Following completion of the extensive training process, our nurses will be nominated for their skills, values and behaviours and will be considered for graduation as a Royal Liverpool & Broadgreen Nurse. Lisa Grant chief nurse said: “I am extremely passionate about the Royal Liverpool and Broadgreen Nurse
The nursing programme will ensure staff have the skills and support needed
This is where we all make a difference, the programme is recognition of that
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Developing a world-class workforce
The admin workforce review The administrative workforce review was undertaken to achieve greater consistency and standardisation in the way that clinical administration teams were organised. This was required to meet the changes ahead in managing the transition to the new Royal as well as making efficiency savings, in response to the economic challenges that all hospitals have had to address in recent years.
Identifying the issues An initial analysis revealed that clinical admin roles were covered by a wide range of job descriptions and inconsistent reporting structures. This situation had grown over a long period of time. The analysis also revealed that admin staff experienced some challenges linked to very old IT equipment along with varied and sometimes unrealistic expectations that can be placed on clinical admin staff. The feedback from this analysis was used to address some of the day-to-day issues experienced by admin staff. As a result the IT department accelerated the roll-out of equipment and expectations around what admin staff should do was communicated to the relevant groups.
Working with staff to find solutions
A series of one-to-one meetings were held with the staff affected by the implementation of the model over a few months. These were supported by staff side colleagues, Human Resources representatives and department managers. Through the excellent co-operation of all involved these meetings have enabled informed decision making as to how each individual will work within the new structure.
Implementing the new model Each department is now in the process of introducing the new model in line with the workforce requirement in each department. The majority of changes in the workforce have been met through a voluntary redundancy scheme that has been part of this process. A primary objective of the review was to make changes without the use of compulsory redundancy and this aim has been met.
The outcomes •R edeployment of staff has also been kept to a minimum and there has been no need to down band staff
• I mplementation of the model will save the Trust approximately £3.5million over the coming five years, which vastly outweighs the cost to administer the project, which was £168,542 • T here is a greater understanding of admin roles and addressing issues that admin staff faced in some departments such as use of old equipment • J ob descriptions have been simplified. There are now five job descriptions that cover roles within the model as oppose to many more that were often inconsistent • T he management structure is far clearer for staff • T here is a clearer route of progression within the admin structure • T here is clear visibility of organisational shape, which makes it easier to decide where staff will be situated within the new hospital building
Four members of staff with a combined total of 110 years’ service to our hospitals all retired on the same day. Medical secretaries Yvonne Todd (Dermatology, 43 years’ service), Ann Brown (Rheumatology, 17 years) and Pam Earley (Rheumatology, 25 years) all retired while Lynn Llewellyn (Dermatology, 25 years) left the Trust after many years of dedicated service.
A series of meetings and workshops were undertaken in 2013 with clinical and admin representatives from across all levels in the Trust, in order to agree on the use of a consistent admin model. This led to unanimous support for one model which has formed the basis for change to the admin workforce. The proposed model was also endorsed by separate medical secretary working party group along with the executive team and staff side colleagues. The managers of each department submitted workforce plans in order to clarify how the agreed model could be set-up within their departments. New job descriptions were also created for the roles that make up the model.
Staff consultation Thereafter a consultation process commenced with the distribution of a consultation document to relevant staff, in December 2013 and follow-up briefing sessions were held. Once the feedback from the consultation was compiled and reviewed the decision was taken by the executive team to implement the model.
L-R: Yvonne Todd, Aidan Kehoe, Ann Brown, Lynn Llewellyn and Pam Earley
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Developing a world-class workforce
Work experience opportunities As part of our wider participation with the local community and schools we are establishing a set programme giving students the opportunity to experience various career pathways within the NHS. Courses will run at certain times during the year and pre-booking is essential. To be considered you must meet the criteria below:
• P laces are limited and while they will be decided by our Trust the participant’s age and aspirations will be taken into account.
Learning about clinical pathology
For further information on work experience and shadowing opportunities please contact: Stephanie Cater, work experience coordinator on 0151 706 5382 or email: stephanie. cater@rlbuht.nhs.uk
Work shadowing 20 students from Lakes College in Cumbria recently spent an afternoon taking a tour of the some of our facilities. They spent time in the clinical chemistry and pathology laboratories, speaking with staff and seeing how blood cultures were processed. They also had an opportunity for a question and answer session with one of our occupational therapists. Later in the afternoon we were able to showcase some of the amazing work being carried out in our hospitals with talks regarding care in the fields of dementia and radiology. There were also talks from an occupational therapist working in mental health and the Trust Practice Education Facilitators.
Are you aware that many of our mobile phones have various apps that help us get information on whether or not we are getting enough exercise? HR Manager Clare Vickers said: “As someone who has been trying to introduce more exercise and healthy eating into my lifestyle I have found the Health app on my Samsung phone really helpful.
•A ll participants must be aged 14 to 16 at time of placement • T he placements will entail one week’s experience working in a non-patient facing area
Getting healthy by using your phone
Mike Gregson, course leader from the college said: “We were all very impressed with the obvious planning and preparation that had gone into the visit. The education department presentations were excellent and the students that visited the pathology labs were more than impressed.”
“The app allows me to log my food intake on a daily basis and calculates how many calories I have had that day and whether I have had more than the recommended amount of carbs etc. “The app also has a pedometer which tracks my steps per day and how many miles I have walked and calories burned. It also allows you to track your exercises each day with a nifty A-Z list of exercises that you can select and log the time spent undergoing each one. At the end of the day you are given a summary of what you have done. “If you don’t have a Samsung there are other apps such as my fitness pal which offer the same functionality.” The free apps can be found on the following sites: http://www.nhs.uk/ Change4Life/Pages/ be-more-active.aspx http://www.nhs.uk/ Pages/HomePage.aspx
Stephanie Cater, work experience coordinator with Lakes College student
Smartphone apps, such as this app for iPhone, can make it easier to eat more healthily and record the amount of exercise you are doing
5 tips for keeping well this winter If you follow these few simple steps you will better placed to manage anything that the winter can throw at you. 1. Get your flu jab The most effective way to stay healthy at this time of year is to get your flu jab. 2. Eat well Eat healthily, with lots of fresh fruit and vegetables and at the right time. Our Health and
Wellbeing team provide a Weight Loss Challenge for staff. 3. Keep Good Mental Health We provide lots of training to help staff reduce stress in their lives as well as the Staff Support Service on 0151 330 8103. 4. Exercise – Get Active Getting more active can often be the key to improving our health and wellbeing. 5. Making Healthy Choices
We have a number of initiatives that make it easier to make healthy choices around alcohol, smoking and getting quick help for long term conditions such as back pain. The Health and Wellbeing team have produced a handy guide for staff with great tips on keeping warm in winter and tips that will help you, your family and friends. You can get a copy by contacting the Health and Wellbeing Team on Ext 4682 or emailing ann. dinnarr@rlbuht.nhs.uk.
Keep Well in Winter
2014 - 2015
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Developing a world-class workforce
The Equality Delivery System (EDS) 2 The aim of EDS2 is to ensure that NHS organisations are treating people in line with equality legislation and that this is clearly recorded. Andrea Smith, equality and diversity manager says: “This year each division will be required to assess their performance and produce evidence against the outcomes for their area of work to demonstrate what they are doing at a local level to meet the diverse needs of patients and staff for our next performance assessment in March 2015. “I will be working with the divisions over the next couple of months to ensure that they understand the requirements.” Gradings under EDS2 simply relate to how many protected groups out of 9 (gender, religion and belief (or lack of), sexual orientation, disability, age, ethnicity or race, gender reassignment, pregnancy and maternity, marital or civil partnership status) we can evidence have the same performance outcomes and experiences in comparison to others for each of the 18 outcomes. Andrea adds “The focus is on improving the way in which people from different protected characteristics are treated as patients, carers and employees.”
Line managers – what would you do? A member of your team does not contribute in meetings, prefers to work alone and has minimum interaction with his colleagues - how do you handle it? Tom is a senior software technician. He has excellent technical skills but likes to work alone and frequently sits at his desk with headphones on to block out the noise of the office. His manager, Tariq, would like to give Tom an excellent mark for his knowledge and technical skills but must mark him down because he has not met the organisation’s behavioural requirements of working together collaboratively. Tariq gives Tom the news at his appraisal. As a line manager what would you do?
For further information on EDS2 visit http://www.england.nhs. uk/ourwork/gov/edc/eds/ more information on previous work on the EDS in the hospital is published here: http://www.rlbuht.nhs.uk/ Equality%20and%20Diversity/ Pages/Equality%20Delivery.aspx
Employees are appraised on much more than just skills, knowledge and ability to perform tasks, but also on their behaviour or ‘contextual performance’. While these behaviours are not directly related to the person’s job, they create the environment within which tasks are performed and are often the same for everyone who works in the organisation. Tariq tells Tom that he recognises his excellent technical skills but, has had to mark him down on his contextual performance. He then explains to Tom that he has noticed he does not contribute at meetings or volunteer to help his colleagues when they are struggling with their work or deadlines, even though he has the skills to do so. Tom is distressed by this assessment of his performance but does accept the ‘needs some improvement’ grading.
The ‘positive about disable people’ symbol means an employer is committed to employing disabled people.
A few weeks later Tom gives Tariq some information about Asperger’s Syndrome. He tells Tariq that it was suggested at university that he might have Asperger’s but as he was doing well in his studies this was never pursued. He would like a workplace assessment now because his partner has
suggested this may explain the way he works. Tariq talks to Human Resources and they agree to refer Tom for the assessment. It identifies possible adjustments to help Tom with working relationships. Tom and Tariq talk about the report together and Tom explains he does not intend to be unhelpful, but does not always notice other people are struggling with work he finds relatively simple. He needs to block out other people to be able to get on with his own work, hence the headphones and he doesn’t speak at meetings because he believes if someone wanted to know his opinion they would ask. Tariq agrees he needs to apply the organisation’s behavioural requirements differently to accommodate the way Tom works. Tariq agrees to make the following reasonable adjustments for Tom, which include, appraising his performance in a way that takes his Asperger’s into consideration. Tariq will fulfil his own team working objectives by telling Tom when someone else on the team needs his help and Tom will then provide the help needed. Tariq also decides that everyone at meetings will be asked for their views and input. That way both Tariq and Tom will be fulfilling the organisation’ requirements of working together in order to succeed together. Remember: If an employee with a disability is marked down in a performance appraisal for failing to meet behavioural requirements if the reason arises from their disability they may be being discriminated against. You must therefore make adjustments to behavioural requirements where it is reasonable to do so. The line manager guide to working with disabled colleagues and line managers guide to reasonable adjustments is available from the Staff Hub on the intranet.
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Developing a world-class workforce
Community centre saved by staff car park A local community centre has been saved by a proposal for our staff car parking at the Royal. Kensington Fields Community Centre’s five-a-side football facility will become a 100-space, daytime car park for staff at the Royal. This will generate £25,000 a year for the centre and help secure the asphalt pitch, so youngsters can play football safely during evenings and weekends. John Risley, a volunteer at the community centre, told Liverpool council’s planning committee: “Money generated from this will enhance the centre, which is currently under threat.” A petition signed by 217 people supported the proposal and Central ward Councillor Nick Small said: “There is very widespread support from the local community for this proposal. What
This is a win-win for the new Royal and for the local community
this will give is a revenue stream to the community centre, allowing it to invest in sports facilities for young people in the area. Without this funding the community centre may well be in jeopardy. This proposal is a winwin for the new Royal and for the local community.”
Security Matters: Violence and aggression against NHS staff
Councillors granted the pitch off Low Hill and Hall Lane a dual purpose for the next two years. It will provide contract parking for staff between 6.30am and 7.30pm, from Monday to Friday. Vehicles will access the car park from Hall Lane behind the centre and pedestrians via a second entrance onto the road.
In memory of Linda Phillips It is with great sadness that we report the sudden passing of Linda Phillips, a secretary in Dermatology for 25 years. She passed away peacefully and suddenly on 29 October 2014. She leaves behind two daughters and five grandchildren. Linda was a much-respected colleague who gave her all to Dermatology and she will never be forgotten.
Linda Phillips, a secretary in Dermatology for 25 years, who died recently
Staff are all too often subject to abuse from patients and visitors. It’s important to know what measures are available to prevent and deter abuse of our staff and when it is appropriate to apply sanctions against offenders. We do not tolerate abuse of our staff. Abuse takes many forms. There are physical assault, verbal abuse, racial abuse and sexual abuse to name a few. Recording incidents of abuse is really important to ensure appropriate measures can be applied to those who have abused staff. Of course, not all abuse of our staff is intentional and it is recognised that patients are sometimes too unwell to realise what they are doing is abusive. These incidents still need recording in the same way to ensure the best outcome possible for patients and staff should they find themselves again in our care. We have procedures to deal with those who intentionally abuse staff which are laid out in the policy ‘dealing with violence and aggression’, Recording available on incidents of the intranet. abuse is really For more important information, take a look at the security department’s intranet pages or contact your local security management specialist (LSMS), Ian Wright on extension: 3999 and Keith Hands on extension: 2280.
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Achieving international recognition for research and innovation
Leading the way with vaccine testing The Clinical Research Unit (CRU) is the world’s first NHS unit to test new vaccines using the Experimental Human Pneumococcal Challenge programme. The vaccine aims to reduce the incidence of ear infections in children caused by pneumococcal disease. Pneumococcal bacteria is carried in the noses of approximately 10% of the population. This study aims to test if the vaccine will prevent the carriage of the bacteria thereby reducing the spread of infection.
ICE referral now available for Consent 4 Consent Consent 4 Consent is a Trust wide initiative that holds contact information about potential research participants. In order to facilitate opportunities for as many patients as possible to take part in clinical studies you can now refer them, via ICE, to the Consent 4 Consent team who will contact the patient directly.
Healthy volunteers receive either: the pneumococcal vaccine or a placebo injection. Following three doses, the volunteers are inoculated with pneumococcal bacteria to find out if the vaccine prevents carriage of the bacteria. Over 20 volunteers have successfully received their first vaccine. The pneumococcal inoculations have now begun which is an incredibly exciting time for the CRU staff. If successful the trial may lead to the roll out of a pneumococcal vaccination which
could reduce the incidence of respiratory and invasive infections which are a leading cause of antibiotic use and mortality in children under five years old worldwide. Staff on the unit are being kept very busy as we continue to recruit and screen volunteers until March/April 2015. If you are interested in the study and would like to see if you are eligible, please contact the research team on cru.contact@rlbuht.nhs. uk or text Vaccine to 07920 210 867. You will be paid for your time.
Congratulations to the ENCEPH UK team! The Trust is the first in the UK to recruit a patient for the ENCEPH UK study.
• Study the clinical predictors of Encephalitis, and of poor outcome
The study is an observational prospective multi-centre cohort study – understanding and improving the outcome of Encephalitis. Encephalitis is a serious condition that causes inflammation of the brain, often caused by a virus or by the body’s defence system.
• Better understand those outcomes in terms of cognitive function, quality of life and cost
Referrals can be made through ICE via SERVICES then click either “Patients”, “Nursing” or “Cons to Con Ref” there is a free text box to add any additional information – for example if the patient is interested in cardiology or renal research studies.
Claire Matata, research nurse said: “The devastating impact that Encephalitis has on patients and their families means this study is important in helping to improve the care and support we provide in the future. It’s been an honour to work with patients and their families who have taken part so far.”
If you have any questions please contact Lorraine at lorriane.burgess@rlbuht.nhs.uk.
Over the coming five years it is hoped the research team will:
• Develop the means of intervening to improve the outcome Recruitment continues at an impressive rate. Professor Tom Soloman, the study’s chief investigator said: “The study which came out of preliminary observations made in Liverpool, is progressing extremely well. The Royal has been one of the highest recruiting centres.” Congratulations to all involved in the study and good luck with your work. Are you involved in a study where the Trust is the first in the country to recruit a patient? If so, Research Development and Innovation would love to hear from you! Contact them on ext 3756.
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Other news
Annual General Meeting This year’s AGM took place on Monday 8 September, with many attending to hear how we performed in the past year and to learn more about our future plans. Our chair, Judith Greensmith, welcomed the public, staff, board of directors and shadow governors to our lecture theatre in the Education Centre at the Royal. She said: “It’s been a really exciting year for us with work commencing on the new hospital.”
The attendees were then shown a timelapse video showing the construction of the new Royal. Mr Kehoe said: “The new Royal is not just about a new building, it’s about bringing world class healthcare to the city.” A question and answer session followed and the event finished with Judith saying: “Thank you very much for coming and let’s hope for a really good year.”
John Graham, director of finance and deputy chief executive, talked through our 2013/14 accounts and said we kept well within capital resource limit.
Macmillan Coffee Morning Cakes, fruit and even popcorn was sold at a Macmillan Coffee Morning in the Linda McCartney Centre. On Friday 26 September, the ‘World’s Biggest Coffee Morning’ in aid of Macmillan Cancer Support was celebrated at locations across the country. Macmillan staff based at the Royal set up a stall selling a wealth of sweet and healthy treats to raise money, raising a total of £200 for the charity. Alexandra Burgess, assistant directorate manager for the outpatient department said: “We’d like to say a special thank you to Sandra Walton and Christine Turner from ISS as they organised the cakes and manned the stall – Sandra even came in on her day off!”
“The retained surplus for the year was over £11m. There was a £17m increase in income. We spend £1.5m a day on running costs and £700,000 on staff salaries.” He added: “When we have Foundation Trust status we will have a greater degree of control over finances.” Aidan Kehoe, chief executive went on to tell attendees about our stroke telemedicine service, emergency handbook smartphone app and clinical trials carried out in the hospital. He then spoke about things we need to improve over the next year which includes improving our emergency department four hour standard and infection control.
Cakes were sold at the Linda McCartney Centre for the World’s Biggest Coffee Morning’ in aid of Macmillan Cancer Support
Aidan Kehoe, chief executive, signs up for Consent for Consent during the AGM
High Sheriff visits Macmillan staff sell cakes during coffee morning in the Linda McCartney Centre
The High Sheriff of Merseyside paid a visit to the Royal on Monday 29 September. The High Sheriff, Abila Pointing MBE, was met by chief executive Aidan Kehoe and chair Judith Greensmith. After watching a fly-through of the new hospital, she visited Interventional Radiology where she was met by Nancy Nicholas, directorate manager and lead radiographer Gavin Flinton. The group then moved on to the Stroke Unit, Ward 2Y where clinical director for Gerontology and Stroke Paul Fitzsimmons showed them round.
The High Sheriff (far right) visits ward 2Y at the Royal
22
Fundraising
Kathryn lifts roof in dad’s memory Kathryn performs at Liverpool Cathedral earlier this year.
Mezzo Soprano Kathryn Rudge had her dad firmly in her thoughts when she sung at the Royal Liverpool University Hospital charity’s ‘Celebrate a Liverpool Life’ carol concert. Her long-planned performance at the event had huge added poignancy – her father George Rudge lost a battle with blood cancer he had valiantly fought for eight years in November, aged just 58. In September 2006, when Kathryn was studying at the Royal Northern College of Music in Manchester, George was diagnosed with blood cancer and feared he may not see that Christmas. “Suddenly my focus shifted from grades and lessons, to what opportunities can I find so my mum and dad can come and see me perform,” Kathryn recalled. Since then, the 28-year-old has sung at the Philharmonic Hall, with English National Opera and even at the Royal Albert Hall – always with her parents George and Sue there to support her. So determined was her dad to see her performance at the Albert Hall, he got special permission from doctors at the Royal to go despite his latest blood transfusion being imminent.
It was his wish over the last few weeks that our journey should still be celebrated, especially at the concert
As Kathryn prepared for her recital at Liverpool’s Anglican Cathedral on 9 December – just three weeks after losing her father – she said she would view the evening as a celebration of his life and the care he received at the hospital. All proceeds from the concert went to the Royal’s R Charity, who have launched an appeal to fund equipment and services for patients in the new hospital. Kathryn said: “It was his wish over the last few weeks that our journey should still be celebrated, especially at the concert. It was a very fitting tribute to him as he held his treatment at the Royal in such high regard, right to the end.” She added: “It means the world to be able to give back when it is particularly close to home. The Royal became a second home to our family. It was so nice to do something which is a celebration of the future and the past, and so special to be able to help the hospital.” The Celebrate a Liverpool Life concert on Tuesday 9 December was hosted by BBC Radio Merseyside’s Roger Phillips. The concert also featured Christmas carols sung by the Royal Liverpool Philharmonic Choir, conducted by Professor Ian Tracey.
Kathryn with mum, Sue, and dad, George
23
Fundraising
Schools bid to win a doctor for a day
Graham Cheung and fellow consultant orthopaedic surgeon Sanjay Kalra
TV doctor Ranj Singh is urging primary schools in Merseyside to sign up for their chance to win a doctor for a day. The Royal is offering primary schools the opportunity to take up fun and informative activities during a ‘Doctor for a Day’ challenge on 13 February 2015. The school with the most pupils getting involved will be rewarded with a real doctor for a day in March and book vouchers will be given to the schools in second and third place.
Surgeon gets back in the saddle for mountain challenge A surgeon at the Royal who is scared of heights tackled Britain’s tallest mountain for the hospital’s R Charity. Graham Cheung, 39, climbed, peddled and paddled to raise around £1,000 for the new Royal appeal for the R Charity’s Ben Nevis Charity Challenge on 13 September. The event in the Scottish Highlands challenged participants to climb Ben Nevis, cycle 13 miles and canoe four kilometres of Loch Lochy, all in a single day. Graham’s father was briefly treated at the Royal before he passed away with oesophageal cancer in 2004. Then, in 2010, his mother, Judy Kim Cheung, had surgery for bowel cancer at the hospital before undergoing radiotherapy and chemotherapy at Clatterbridge Cancer Centre. She returned to the Royal for more surgery in 2012 and is now in remission. Graham, an orthopaedic surgeon who
Loren Slade from R Charity (far left) with the team from Barclays
specialises in hand and wrist surgery, said: “I thought I’d do my bit. It’s not only the place where I work, but it’s my local hospital and has given my family excellent treatment. “I don’t like heights, I can’t swim and I had barely ridden a bike in 20 years before the challenge. But I was fine going up the mountain – I just started to feel it in my knees on the way down. Loren Slade from R Charity said: “The challenge has already raised nearly £20,000, including match-funding from Barclays, which could pay for three new ECG blood pressure monitors in our new Bone Marrow Transplant Unit. “As the regional centre for bone marrow and stem cell transplants - offering transplants to patients from Merseyside, Isle of Man, and parts of Cheshire and North Wales - we are keen to ensure our new hospital has only the best equipment.”
The group of R Charity supporters who took on the Ben Nevis challenge at the foot of the mountain
Each registered school receives free teaching, fundraising and promotional materials. The R Charity School programme also provides the opportunity for primary school children to raise funds for the Royal through a life sciences sponsored challenge and they can even dress up as medics for the day! Dr Ranj Singh, star of CBeebies and ITV’s This Morning, said: “‘Doctor for a Day’ is a unique and brilliant idea. Getting kids and young people involved in raising money for such an important cause is fantastic, and to top it off, they get to learn lots along the way! I would encourage everyone to take part if they can, and to help support this wonderful project.” Loren Slade, community and events fundraiser at the Royal said: “Not only is this a great way to help raise muchneeded funds for the hospital but in return we will provide learning activities and resources, competitive challenges and fundraising materials to support the school every step of the way.” To register your school and receive your Life Sciences Fundraising pack call 0151 706 3150 or email loren.slade@rlbuht.nhs.uk
TV’s Dr Ranj Singh, has backed the Royal’s Doctor for a Day
24
Fundraising
Hollyoaks ‘medics’ abseil down the Royal A Hollyoaks ‘nurse’ and ‘junior doctor’ overcame their fear of heights to abseil 200ft down the Royal. Since joining the long-running soap in October, Daisy Wood-Davis has become used to walking the wards of the fictional Dee Valley Hospital as ‘nurse’ Kim Butterfield. But on 19 October, Daisy was joined by on-screen sister and ‘junior doctor’ Lindsey, played by Sophie Austin, to walk down a slightly less familiar hospital environment – the side of the Royal.
Debbie and the group of charity supporters she trekked with
was more than a little worried, especially when I looked down from the top! “I’m a junior doctor on the show but I could never dream of doing the job for real. They do fantastic work and it’s an honour to help provide them with the best equipment possible in the new hospital.”
Debbie endures extreme heat and rough terrain for hospital charity
The fictional sisters raised £550 for the hospital’s R Charity by completing the feat.
A member of staff at the Royal Liverpool University Hospital trekked through searing desert heat in Jordan in memory of a friend who lost her battle with breast cancer.
Daisy said: “I’d done zipwiring but apart from that I like to stay clear of heights. I’d never done an abseil before so I was very nervous beforehand, but it was great fun!
Debbie Atkinson, 52, has worked at the Royal since 2007 as a research governance facilitator; ensuring clinical trials have ethical approval.
“It was for such a good cause I couldn’t really say no. I’m fairly new to the city but I’ve already heard about the exciting plans for the new hospital and it’s great that I was able to do my bit to help the fundraising appeal.”
But she left her day job behind and flew to Amman in Jordan, braving temperatures of nearly 40 ºC to make her way to Petra, a 2,000-year-old city named in 2007 as one of the New Seven Wonders of the World.
Sophie added: “It was great to have my on-screen sister there for moral support because I
Daisy WoodDavis, who plays Kim Butterfield on Hollyoaks
Sophie Austin, who plays Lindsey Butterfield on Hollyoaks
Tim tackles Great Wall of China for hospital charity A member of staff at the Royal completed the trip of a lifetime by walking 80km along the Great Wall of China. Dad-of-three Tim Dwyer, based in the Vascular Department, was so moved by the experiences of patients in intensive care he wanted to raise money to pay for new equipment. Tim, an administrator on the Cheshire and Merseyside Abdominal Aortic Aneurysm Screening Programme, did the nine-day trek of one of the Wonders of the World for the hospital’s R Charity in September, raising £2,600.
working hard to raise much needed funds for our new 40-bed critical care unit so every penny Tim raises will take us one step closer to having the very best equipment in this unit.” If you would like to follow in his footsteps and take up your own personal challenge in 2015, call the R Charity fundraising team on 0151 706 3150. Sponsor Tim online at: http://www. justgiving.com/Tim-Dwyer or text TIMD82 and the amount you wish to donate in £’s to 70070.
Tim, who started as an audit clerk in ITU at the Royal 10 years ago, trained by avoiding the lift to take the stairs to his eight floor office.
“We trekked for about eight hours a day, up and down mountains and along steep mountain paths with big drops to the side carrying heavy equipment. It was tough! “I lost a friend, Karen, to breast cancer three years ago when she was 52 so this cause is especially close to my heart. That’s why I chose to do the trek during Breast Cancer Awareness Month to support the hospital’s R Charity. I think Karen would have been looking down laughing at me!” The group lived on a diet of herbal tea, dates, almonds, pitta and humous and despite having no electricity or running water after 6pm, Debbie says she would recommend the trip to anyone. “It was superb,” she added. “The whole experience was awesome.” Debbie raised nearly £2,000 toward a new mammography unit at the Royal.
He said: “It was hard work at times, walking for up to eight hours a day, but it was an incredible experience. A lot of it is just a pile of rocks and we wouldn’t see anyone else for hours.
She added: “I work at the Linda McCartney Centre and it’s such a privilege to be a part of the amazing work that goes on here. Charitable donations play a large part in supporting breast cancer services at the Royal and we want to make the new hospital even better for women in the future.”
“We got up at about 4.30am one morning so we could see the sunrise coming over the Wall. That was my highlight of the trip – it was amazing.” Loren Slade, from the R Charity, said: “It’s great to see another fantastic member of staff supporting our new hospital appeal. We are
Debbie said: “It was really hot in the day but in the night it got quite cold – down to -5ºC – and it was wet and windy too. Sand would blow in through the tent door in the evening and it was quite difficult to sleep.
Tim Dwyer sports an R Charity t-shirt on the Great Wall of China
Sponsor Debbie online: https://www. justgiving.com/Debbie-Atkinson7
Exceptional Patient Experience
25
Thank you to our staff Royal Liverpool: “My father recently died on ward 9X at the Royal aged 92. Having flown from France with only hand baggage, arriving at the hospital, I had little in the way of toiletries. I then spent over 24 hours at my father’s bedside. Needless to say the comfort pack was much appreciated from a practical perspective. The contents had obviously been carefully thought out – it’s invaluable when your brain is muddled and you have many things to remember. More importantly was the psychological impact of such a gesture. I felt cared for and loved, made to feel special and thought of at a moment when I was feeling very much alone. The staff on ward 9X couldn’t have been more caring, responding not only to my father’s needs but the needs of the whole family. When the doctors decided to stop curative treatment we were told that going forward they would be there to care for us too. This was much appreciated and a great source of comfort. A reclining chair, pots of tea, a towel to take a shower and even my father’s request for an icelolly – nothing was too much trouble. The staff dealt with us honestly, showing empathy and understanding. We would like to congratulate the Royal as such an approach requires training and human investment. I will continue to share the wonderful experience of end of life care witnessed on ward 9X.”
Dental hospital: “I had a tooth extraction today and the staff were all beyond reproach. They were friendly, helpful and amazingly caring. They put me at ease and really made me feel safe. I’ve had a bad experience with a dentist previously but the Dental Hospital totally eradicated my fear. I would recommend this facility to anyone.”
Broadgreen: “I spent the better part of four days in Broadgreen whilst having a total knee replacement. The pre-op arrangements were good as was the reception when we arrived on the morning of my operation. Whilst very professional, all the staff were warm and friendly in their approach and very reassuring - I was extremely apprehensive about the procedure. The surgery was a success with no complications. The anaesthesia team were great and had me laughing on the way in. The recovery afterwards was excellent with everybody striving to make me as comfortable as possible. My wife and family were impressed by the cleanliness of the ward and by the warm atmosphere that pervaded the hospital. Catering was excellent and aftercare in general. The physiotherapist was brilliant, working really hard to get me going. I had the impression that my success was more important to her than simply getting through twenty minutes of spending time with a patient before moving onto the next one. It seems strange to say it, as I had just been through a painful procedure but when I was discharged on the Thursday, following the op on Monday, I felt sorry to leave such a supportive team.”
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