Issuu

The community magazine from the Royal United Hospitals Bath Get set for winter (page 6&7)

Scanning the future (page 9)

Amy’s Sepsis story (page 8)

insight ❆ ❅

ISSUE 40 WINTER 2018/2019

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Royal United Hospitals Bath

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NHS Foundation Trust

RoyalUnited HospitalBath

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Our latest CQC rating

@RUHBath

inside this issue 4&5

News roundup

RUH is hi-tech leader

Smokefree for 2019

Dementia-friendly RUH

Contributors

Welcome Welcome to this winter edition of insight, our community magazine. We’ve been making big plans to manage the anticipated extra demands that winter can place on our services here at the RUH, and across the healthcare community. We’re confident we’re ready and able to continue to provide high quality and safe care – but we’re also asking everyone to look after yourself, and take our advice on pages six and seven to help you stay well. Take the example of Joan Turner, who’s 91 and has stayed well despite living with type 1 diabetes for 70 years. You can read her remarkable story on page 8. 2019 is going to be an important year for the Trust. We’re consulting our community about the future shape of our maternity services across Bath and North East Somerset, Swindon and Wiltshire, see pages 18 and 19, and will listen closely to all feedback. And in the summer we start the move of our world-renowned services and staff from the Mineral Water Hospital to our brand new RNHRD and Therapies Centre at the RUH site. See page 12 for how you can help with our last big fundraising push. Finally, we’re doing our bit to make 2019 a healthier year for all our staff, visitors and patients – by going smokefree. We’ve signed the pledge - see page 10 for how you can support our new smokefree site. Best wishes

Joan Turner, 70 years with diabetes

Amy Bulbeck, Sepsis survivor

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James Scott Chief Executive We’re always keen to hear your feedback about insight, or any aspect of our work. Please email ruh-tr.communicationteam@nhs.net

We’re looking good – our Care Quality Commission report We are very proud to have been rated Good by the Care Quality Commission (CQC), following an inspection of our services carried out in June 2018. Among the inspectors’ findings, Maternity services are rated as Outstanding and the Trust remains Outstanding for being caring. Critical care services, medical care and children and young people’s services are all rated as Good and the Trust is also rated Good for being safe, effective and well-led and Good for its productive use of resources. The report particularly praised our Maternity service for our focus on child and adult safeguarding and for working closely with other relevant agencies, as well as for the care we offer families. Trust Chief Executive James Scott said: “We are delighted that the CQC has recognised the hard work and dedication of all our staff that has driven these

improvements that rightly deserve our new rating of Good overall. “I am proud of the progress we have made since the last CQC report in 2016. But we are not complacent – and where there are areas in which we need to further improve, we are already working to address them.”

“We are pleased that the CQC found examples of outstanding practice, and recognised that the working culture in the Emergency Department was excellent, with staff committed and enthusiastic whilst working under challenging conditions.”

Whilst the CQC found examples of outstanding practice in urgent and emergency care, and the service was rated as good for being effective and caring, overall this service remains rated as Requires Improvement.

The CQC rating is a feather in our cap as we set out on our ‘Improving Together’ journey, part of the Trust’s strategy to achieve our vision to provide the highest quality of care, delivered by an outstanding team who all live by our values.

Dr Bernie Marden, Trust Medical Director, said: “We acknowledge that the hospital and our Urgent and Emergency Care service are under year-round pressure. We are continuing to take steps to improve and are working closely with our health and social care partners to enable patients to be seen, treated and discharged in a safe, appropriate and timely manner.

Training began in September and eventually every single member of the Trust will be part of this long-term approach to further improve the RUH for our patients, our working colleagues and our community. This is an investment in learning like nothing the Trust has done before – leading to helping shape the way the RUH works every day.

Our outstanding maternity team

www.ruh.nhs.uk

News Roundup Nana’s female fellowship

The Anticoagulation team

RUH Clinical Engineer Nana Odom has been awarded a prestigious 12-month NHS fellowship for female healthcare scientists. Nana Odom is one of four candidates chosen for the 2018 Chief Scientific Officer’s (CSO) WISE Fellowship programme for NHS England. It offers a unique opportunity within the NHS and beyond for mid-career female healthcare scientists to gain invaluable leadership experience. Nana, who has worked at the RUH since 2017 said: “I want to inspire generations, empower other women and promote and support diversity in NHS leadership through telling my story. I am looking to build a brand as a female clinical engineer in the NHS. I also want to use this opportunity to contribute to raising the profile of healthcare scientists who make up five per cent of the NHS workforce. Our involvement has significant impact on all patient pathways through the services we provide.”

National award for RUH thrombosis team

There are around 300 healthcare scientists working at the RUH. They use their knowledge in science and technical skills to advance care either by working directly with patients, or in supporting roles or involvement in research and innovation.

In 2017 the RUH Anticoagulation Team conducted an audit over three months to review the management of CAT. This led to the setting up of a new telephone clinic for patient consultations, a clear treatment route and a new patient information leaflet.

Congratulations to our Anticoagulation team, who’ve won a national award for their work to further improve the care of cancer patients at risk of lifethreatening blood clots. The team were shortlisted for the National Anticoagulation Achievement Awards and, at a ceremony at the House of Commons, were named winner in the ‘Best work in the prevention and treatment of cancer-acquired thrombosis’ (CAT) category. Thrombosis is the formation of a blood clot in a blood vessel or artery. This can have serious medical consequences, including death, but can be prevented and treated in time if it is identified.

Clinical engineer Nana Odom 4

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Consultant Haematologist Mark Robinson said: “We’re absolutely thrilled to have been given this award. It’s national

recognition not just for us but for all our colleagues in many areas throughout the hospital who help in the treatment of this complex condition.”

Nathan Jones, Anticoagulation Specialist Pharmacist, said: “As a result we’ve found that GPs and patients are now more informed, patients can obtain their medication in the community and they have a designated support network in place to help manage their condition. It shows the impact of the service on improving patient safety and ensuring a patient-centered approach.”

Playtime on the Children’s ward

The Restart the Heart team at Bath Rugby

Hands on – pupils learn live-saving skills

Save a life coaching for Bath rugby fans Bath Rugby fans had the chance to learn some life-saving skills during the Toulouse game at the Rec. Before and after the game and at pitchside at half time, our Resuscitation Team from the RUH ran handson demonstrations in basic CPR (cardiopulmonary resuscitation). People of all ages had a go at giving life support using one of ten mannequins, and were taught the techniques that could restart a heart in an emergency. The event was part of the international Restart a Heart campaign that ran in October. During the week the Resuscitation Team coached non-clinical staff at the RNHRD site and at the RUH. They were also out and about in the community at schools in Frome and

Corsham to show pupils that they’re never too young to learn life-saving skills. Dawn Fairclough, RUH Resuscitation and Simulations Services manager said: “It was great to get to meet so many people of all ages and teaching simple CPR skills so that, if needed, they could do something amazing and be a real lifesaver. Every second counts when someone has a cardiac arrest, and if a bystander immediately performs CPR it can double the patient’s chances of survival.”

There’s never a dull moment on our Children’s ward – particularly during national Play in Hospital Week. Young patients enjoyed music, dressing up and games, all proven to help their treatment and time in hospital. RUH Play Specialist Lyn Gardiner said: “Play helps children cope with pain and fear while they are in hospital. National Play in Hospital Week is an opportunity for us to show the positive impact play and distraction has on a child’s hospital experience. “The fun doesn’t stop when National Play in Hospital Week is over. Every week our Play Specialists put on a variety of play activities to welcome children and prepare them to cope with surgery or other procedures.” Playtime superheroes

Across the UK there are over 30,000 cardiac arrests outside of hospital every year, but the survival rate is less than 1 in 10. This year’s Restart a Heart campaign aimed to train more than 200,000 people in life-saving CPR.

Relocating our specialised pain services We’re proposing to move our worldrenowned specialised services for people with chronic pain from the Royal National Hospital for Rheumatic Diseases (RNHRD) to the RUH site in Summer 2019 – and we’re asking for your feedback. Patients will have access to the same high

Architect’s drawing

quality services, provided by the same team. We’ve worked closely with staff and patients over the last few years to ensure the best new home for these specialised services. We’re proposing our Bath Centre for Pain Services (BCPS) will relocate to a specially refurbished building on our Combe Park site. This will be separate from the main RUH building, as our patients tell us a traditional hospital setting is not the best environment for their rehabilitation. It will include specially designed residential accommodation, group treatment areas including therapy and group rooms, office space for the BCPS team and a dedicated therapeutic courtyard area. We’re proposing that our Complex Regional Pain Syndrome and Complex Cancer Late Effects Rehabilitation services will be based in our new RNHRD and Therapies Centre,

with residential accommodation provided elsewhere on the RUH site. Between now and 20 December 2018 we’re seeking views from anyone who has an interest in these services to help in our planning, to ensure that we continue to provide the best services. More information and a brief survey are available online www.ruh.nhs.uk/ painrelocation or share your thoughts via email ruh-tr.haveyoursay@nhs.net All other services currently provided at the RNHRD site, including Rheumatology, Therapies, the Bath Centre for Fatigue Management and diagnostic services, are relocating to the RUH site in summer 2019. www.ruh.nhs.uk

Sometimes there’s no place like home In some cases we can recognise that a hospital is not necessarily the best place for a patient to be. Our Frailty Flying Squad is a specialist team of doctors, nurses and therapists who support frail elderly people to remain at home rather than being admitted to hospital. The team works in the Emergency Department and the Medical Assessment Unit to identify older patients who, with some intensive assessment and therapy, have the opportunity to return to their own home or where they would rather be. This service operates seven days a week. We have other initiatives to allow patients to spend as little time as possible in hospital and get home quickly. For example, our Emergency Surgical Ambulatory Care Service is a clinic that cuts waiting times and admissions. It allows patients with acute, general surgical problems such as appendicitis or hernias to be diagnosed and operated on in a day. Most go home that same day, meaning fewer admissions where patients need a bed – around 120 a month.

WE’RE BRRR-ACED FOR WINTER

Winter is here and we’re working closely with our health partners to encourage everyone – including our staff – to stay well, look after yourself and help to ease winter pressures on local services. We’re backing the national NHS awareness Help Us Help You campaign which provides clear, practical guidance on what we can all do to stay as healthy as possible. Cold weather can be seriously bad for your health. The three key messages of the Help Us Help You campaign are: • Stay well this winter – get your flu jab. It’s free to many. Reduce the risk of spreading flu by using a tissue to trap germs from coughs and sneezes, then bin it. Wash your hands often with warm water and soap. • If you think you need urgent medical attention – call the non-emergency NHS 111 helpline for advice on the best service for your needs. • If you’re not well, don’t wait until you feel worse – ask your pharmacist and ward off coughs and colds before they get more serious.

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We’re also advising not to visit someone in hospital or in a care home if you’re feeling unwell, in case of spreading infection. The winter initiative is for all, but is particularly designed to target groups that are most at risk – the over 65s, pregnant women and parents with children aged 2-5, carers, the elderly and people with long-term health conditions. Dr Ian Orpen, Chair of the B&NES, Swindon and Wiltshire Sustainability and Transformation Partnership (STP) Clinical Board said: “We’re asking the public to prepare for winter by taking actions to avoid getting unwell, particularly if they are at risk, and making the right healthcare choices and accessing the appropriate healthcare service at the right time if they do become unwell.” Health organisations, GP surgeries, hospitals and social services providers are all working together as part of the STP to join up and simplify health and social care provision for people across the region.

Winter on the front line We all remember that winter 2017/18 was a harsh one, with flu and bad weather making it particularly challenging at the RUH. The hospital is busy all year round, but we expect there’ll be more demand for our services as we go into 2019. We started planning for this year at the end of last winter. We know we’re likely to face some challenging conditions, but as always it is our priority to maintain high standards of care and safety for our patients.

At our front door, the Emergency Department, or A&E as it’s known, it’s really important for patients to be seen promptly, and we assess 95 per cent of patients within eight minutes. If you need urgent attention you are a priority. The majority of patients are admitted, transferred or discharged within four hours. However, we acknowledge that sometimes we are unable to meet that target for all patients and are taking steps to further improve our performance. We remain one of the top-performing Trusts in the region in ensuring a swift

Helping the homeless in hospital Staff at the RUH are linking up with local charity DHI – Developing Health & Independence – to help homeless people who come to hospital needing urgent treatment. Matt Hanna and Nadia Mitchell are based at the RUH, aiming to ensure that homeless people are discharged to suitable accommodation rather than back onto the streets. They see patients on a variety of wards and work closely with the Emergency Department and the mental health and alcohol liaison teams. They also liaise with local authority housing teams and with organisations such as Julian House and St Mungo’s. Matt said: “We are a link between the hospital and the community services outside. If a homeless person is discharged onto the streets it means their health and recovery is compromised.” Nadia said: “Our role is to break the cycle of a homeless person repeatedly returning to the hospital. It’s better for them if we can offer them somewhere secure to go and to regain control of their lives and live independently, and it’s better for the health services if we are able to reduce repeat visits to hospital.” The DHI team also helps the Trust to fulfil its obligation under the Homelessness Reduction Act to refer patients who are homeless, or are threatened with homelessness, for help from the local authority, if they give permission to do so. This RUH-DHI initiative is a Government-funded project that will run until March 2019.

patient handover between ambulance and A&E staff, meaning that ambulance crews are freed quickly to get back on the road to answer 999 calls. This is all about what’s known as ‘patient flow’ – the movement of patients through the hospital from admission to discharge. We aim to ensure there is a minimal wait in providing the right treatment, in the right place and at the right time, and that patients are discharged promptly and safely when they no longer need our care.

Have a chair – you’re Fit2Sit One idea that’s brilliant in its simplicity is offering patients – if they’re well enough to sit – a chair rather than a trolley bed while they’re waiting to be seen for treatment. Matron Simon Andrews came up with the plan for the Medical Assessment Unit (MAU) – and won backing from our Innovation Panel to buy 12 special recliner chairs. He said: “Hospital patients benefit by staying as active as possible – and they can start by waiting in a chair in the Emergency Department rather than on a trolley. “We’re backing the NHS’s national #Fit2Sit campaign. The aim is to improve a patient’s experience and their outcome. Using chairs in cubicle areas allows patients to be more comfortable and relaxed and to remain in their own clothes, with the expectation that they’ll be going home soon. “Other hospitals have tried the chair system with great success and patients are happier too.” The Medical Assessment Unit is also carrying out a trial where more patients are admitted directly, rather than via the Emergency Department. A team of consultants triage patients over a dedicated phone line, advising GPs and healthcare professionals whether to send their patients to the Unit.

Matt and Nadia, helping the homeless in hospital

In the first two weeks nearly 100 patients were directly admitted to MAU, where they are seen by Medical Nurse Practitioners within ten minutes of arrival. Necessary investigations and diagnostics can be completed and the patient can then be discharged or admitted to a bed. www.ruh.nhs.uk

She survived Sepsis – Amy’s story 20-year-old Amy Bulbeck is full of praise for paramedics and staff at the Royal United Hospital – and is now using her experience of Sepsis to make others aware of the life-threatening condition. Sepsis is a rare but serious complication of an infection which, without quick treatment, can lead to multiple organ failure and death.

Ward that evening. The staff were absolute angels. “It is fair to say that I am one very lucky lady considering the statistics and the fact I was battling severe Sepsis, which is even more down the line than Sepsis, as my kidneys nearly failed.

Amy, from Westbury in Wiltshire, spent six days in hospital after suddenly becoming seriously ill. She posted her experiences on Facebook and is asking other people to share her story.

“I hope this post helps raise awareness about Sepsis and if you feel unwell, take no chances, get to your GP and be SAFE. Your health is worth it. Even if this only helps one person it’ll be worth it.”

She said: “It was within minutes that symptoms began occurring. I was being sick, aching, shivering and a rash had appeared all over my thighs. I climbed into bed and just couldn’t control the pain. “Sunday morning came and all that was in my head was “this is the worst I’ve ever felt, I feel like I’m dying.” Mum was straight back on the phone to 111 and after a few questions they sent an ambulance. Ten minutes later the ambulance arrived.

Signs of Sepsis “Upon arrival to the A&E I was put in for numerous tests over the stretch of 9 hours as it was hard to diagnose.

S lurred speech or confusion, E xtreme shivering or muscle pain, P assing no urine (in a day), Severe breathlessness, It feels like you’re going to die S kin mottled or discoloured.

“I was admitted to the Charlotte

Many thanks to Joan Turner, from Midsomer Norton, for writing to insight.

Joan’s NHS story “I shall always appreciate the National Health Service as I was diagnosed with type 1 diabetes a few months after the NHS was formed, back in 1948. I have recently celebrated my 90th birthday and I am thankful that I am still enjoying a full and happy life with family and friends. In the early days it was much more difficult to keep control of my blood sugar. The only way was to boil urine over a burner and watch it change colour! Now modern technology has taken over which helps me to control the hypos and hypers. We are all very thankful to the diabetic staff, the doctors and nurses at 8

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Somerton House in Midsomer Norton and in the RUH. They have all been amazing. I have been able to live a completely normal life, including travelling abroad many times. All my injections were done in some most unusual places! We have many supportive friends and family, including 10 great grandchildren! One of them, Ivy, 11, is also type 1 diabetic. Diagnosed at 5 years old, she now monitors her blood sugar levels herself and is using one of the most up to date pods which puts insulin directly into her system. She is also cared for at the RUH by the wonderful Paediatric Diabetic team. In the photograph she is

showing me the pod and I am showing her my 70 years medal! So our family will be for ever thankful now and in the years to come for our great National Health Service.” Joan Turner Note: Joan’s medal was awarded by Diabetes UK in recognition of her courage and perseverance of living with diabetes.

RUH leads in video technology Video technology that makes intubation – the process of keeping a patient’s airway open to enable them to breathe during an operation – much safer, has been introduced for all routine procedures at the RUH. One of the newly refurbished waiting rooms

Inside our new Radiology department We can now boast that we now have one of the most modern and bestequipped departments in the region. After five years work and a £7.5m investment programme by the Trust, we’ve celebrated the official opening of our new and upgraded Radiology department. It has: • Six new or refurbished MRI and CT scanners. • X-ray and ultrasound facilities. • A PET-CT scanner used in the detection and diagnosis of cancer and dementia, Sally Hunter (left) and Di Did you know? installed in 2016. Pressdee (right) with the The RUH Radiology new CT3 scanner • Bigger and Department undertakes improved waiting a full range of diagnostic scanning to be undertaken. areas for patients. imaging, including PET-CT. The new MRI scanner Head of Radiology The department operates on (MRI3) is a high magnetic Craig Forster said: seven separate sites across field strength scanner (3 “We’re really the locality undertaking Tesla) and will enable us to proud of our around 293,615 patient provide high quality imaging new department. examinations per year. for our patients. It means we can meet the Team Lead Radiographer for increasing demand CT and MRI, Di Pressdee said: “This is for Radiology and provide the best services fantastic, both for our patients and staff. and treatment for our patients. This major The facilities enable us to give patients investment confirms the RUH as a centre of the dignity and privacy they deserve in an excellence and care in Radiology.” environment that is more comfortable and Last year, more than 275,000 patients welcoming, helping to make patients feel came for imaging in the Radiology more relaxed.” Department, of which over 58,000 were The larger and improved waiting areas CT and MRI scans. That illustrates what a for patients feature vitrographs – abstract crucial part the department plays in the colour photographs, usually taken smooth running of the hospital, with so through glass – by the world-renowned many patients reliant on a scan for their photographer Sir George Frederick Pollock. next stage of care. These were kindly donated by his family. The latest CT scanner to arrive (CT3) is the While the extended Radiology Department first of its type to be installed in the South is now officially open, further upgrades to West, the most recently developed dualthe existing MRI and CT scanners continue source CT scanner provided by Siemens. It allows faster and more complex and will be completed next summer.

Anaesthetists are now using a videolaryngoscope – a metal tool with an integral camera – whenever they place a breathing tube into a patient’s trachea to enable oxygen and other gases to pass into and out of the lungs. Other hospitals use videolaryngoscopes only in extreme circumstances, but the RUH is now the first in the UK to provide the new equipment for all such procedures, whether routine or emergency in nature. They will be used in all areas of the hospital including operating theatres, the Intensive Care Unit and the Emergency Department. Consultant Anaesthetist Tim Cook said: “The new videolaryngoscopes are another important step in improving patient safety, both during routine anaesthesia and especially in cases where we’re dealing with a difficult airway. The videolaryngoscope improves the view of the airway, making this critical procedure more reliable, easier and safer.” The Trust has invested in 21 new C-MAC videolaryngoscopes and more than 100 blades, manufactured by Karl Storz Endoscopy UK, which has worked in collaboration with RUH clinicians for six years to bring the new technology to the Trust.

John Hughes, Fiona Kelly and Tim Cook with the new equipment www.ruh.nhs.uk

Wishing you a happy – and smokefree – 2019 From 1 January 2019 we’ll be an entirely smokefree site. benefits, but what people might not know is that this can also make a difference to how quickly a patient recovers from illness or surgery. Our aim is to make sure every patient is given the opportunity to access support with that.”

Did you know? • Half of all life-long smokers will die prematurely as a result of their addiction. We’ve signed the NHS Smokefree pledge, (l to r) Trust Chief Executive James Scott, Chairman Brian Stables and Medical Director Dr Bernie Marden

This means that patients, staff and anyone visiting the RUH won’t be able to smoke on our grounds. We’ll be removing the smoking shelters, although vaping will be permitted in outdoor areas only.

we’re clear that as a health organisation it’s the right thing for us to do. Quitting smoking is a personal choice and we’re encouraging everyone to make sure they’re ready for not smoking on Trust grounds.”

We’re clear that as a hospital we have a responsibility to look after everyone’s health. By going smokefree, we’ll be supporting those who are trying to quit smoking, and everyone will be protected from the dangers of secondhand smoke too. Studies show that 80% of secondhand smoke is odourless and invisible, but those who breathe it are exposed to the same risks as smokers like heart disease and cancer. Children face increased risks, including meningitis and asthma.

Earlier this year we introduced a new team to our hospital – our Healthy Choices Advisors are on hand to support inpatients to cut down on drinking alcohol or quit smoking. All inpatients are asked a few simple questions, and if appropriate the Healthy Choices Advisors will come to offer guidance and referrals for further support.

This is a step that Public Health England has asked all hospitals and mental health trusts to take. To mark our commitment, we’ve signed the NHS Smokefree Pledge which is endorsed by Public Health England and other health bodies. Medical Director Dr Bernie Marden said: “Clean air is better for everyone, so

Respiratory Nurse Specialist Claire Jones said: “Quitting smoking and cutting down on alcohol consumption has well known health

Remember – from 2019 we’re a smokefree site. If you have an appointment, or are visiting, be prepared not to smoke. Vaping will be allowed, outside. Inpatients will continue to be able to access nicotine replacement therapies, such as patches, to help to manage cravings while staying in hospital. 10

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• Smoking is the largest cause of cancer in the UK. • Within 24-hours of quitting smoking, toxic carbon monoxide is eliminated from the body. • By quitting, a smoker who has ten cigarettes a day will save, on average, nearly £120 a month. That’s over £1,400 a year.

www.friendsoftheruh.org.uk | 01225 824046 | ruh-tr.volunteers@nhs.net

The Friends of the RUH is a voluntary organisation that provides amenities and comforts for patients and relatives which could not otherwise be provided by the NHS. It also organises volunteers to work across the hospital, fundraise, and run a café and shop that are open seven days a week.

Helping our dementiafriendly hospital Many thanks to all our volunteers, and everyone who gave so generously, to help us raise £24,000 towards caring for patients with dementia. The money is going towards helping the Trust achieve the ambitious target to be the first truly dementia-friendly hospital in England by 2020. The funding meant we could provide activity boxes packed with puzzles and games for patients, and to install two reminiscence pods, or rempods, on Combe ward. One rempod has an area to create the feel of a railway carriage, including an LCD screen that plays hours of scenic countryside footage. All aboard the railway carriage reminiscence pod

Helen Slocombe , Senior Sister, said: “The dementia train is a wonderful resource to have in our dayroom here on Combe ward. The screen footage itself is fantastic to give a really true-to-life feel of being on a train. The accessories are also great, in particular the scents of “seaside” “smoke” and “train interior” which create a sensory starting point for discussions and memories for the patients. “When a patient is agitated, and or confused, the train area can be used to distract them from their distress and helps to achieve a sense of calm. Relatives also find it interesting and the seating area is a wonderful place to have quiet time with a loved one, as if enjoying afternoon tea on a real train!

Astrid Siddorn, Nikki Brown and Jane Davies launch the activity boxes

“The ward feels very privileged to have this in the dayroom to assist us with providing a safe, calm and happy environment for our patients.”

Interested in joining our team and making a difference? See the contact details at the top of the page. www.ruh.nhs.uk

Therapies Matter – can you help our charity raise the final amount? Our hospital charity, The Forever Friends Appeal is appealing to the public to help make one last push towards reaching its fundraising target of £2m for the new RNHRD and Therapies Centre. Tim Hobbs, Head of The Forever Friends Appeal fundraising team said: “We have £250,000 left to raise towards the important new Therapies Centre which will provide therapy services for around

25,000+ patients who are treated each year by the combined services at the Royal National Hospital for Rheumatic Diseases (RNHRD) and the RUH Therapies and Pain Departments.

“I would like to thank everyone who has made a donation towards this major build that’s taking shape at the RUH.” Tim Hobbs, Head of Fundraising

“Many patients are reliant on our therapies services to manage their acute injuries, long-term condition or help them recover from debilitating illness, operations and accidents. For instance, you may be a cardiac patient, recovering with a broken hip, or be recovering from a stroke and are learning to walk again – so all the support we secure will really make a huge difference to what we can do with this new facility.” “The construction of the new centre with its wonderful new hydrotherapy pool facility is well underway. If the public can help us raise this essential £250,000 towards our target, their contributions will be doubled pound for pound by the Brownsword Match Funding Challenge.

Ed Jackson in recovery 12

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At the beginning of this year, we launched our Therapies Matter fundraising campaign which featured real life stories from patients who’ve received specialist therapy treatments at the RUH. Ex-rugby player Ed Jackson, a spinal injury patient, shared his story

alongside other patients about how therapies have helped them recover, achieve personal goals and get back to ‘normal’ life. You can read their inspiring stories on our website.

If you would like to help The Forever Friends Appeal reach their fundraising target, you can: • Make a one-off donation online at www.foreverfriendsappeal.co.uk or set up a regular direct debit. • Take part in one of the Appeal’s fundraising events in 2019 (visit their website for more details). • Fundraise at your place of work. The new RNHRD and Therapies Centre is on course to open in 2019, and under one roof it will combine expertise and house many of the hospital’s Rheumatology, Therapies and Pain Management services. It will have a large hydrotherapy pool, a specialist gym and rehabilitation equipment, garden spaces for patients to exercise, outpatient rooms and a biologics treatment space to support treatment, recovery, wellbeing and the management of long-term conditions.

Compassionate Companions Project We’ve also been awarded nearly £80,000 to fund an innovative three-year pilot project to offer patients a compassionate companion in their final days and hours. The gift to our Forever Friends Appeal is from The Sperring Charity, the legacy of Midsomer Norton builder Ralph Sperring, who left his estate to benefit the local community. The Compassionate Companions Project will be delivered by Dorothy House Hospice Care with support from our Palliative Care Team, to provide companionship support to patients, ensuring that no-one spends their final days alone and in an unfamiliar environment.

Talking about dying An innovative project at the Royal United Hospital promoting the importance of end of life conversations is highlighted in a new report that says doctors need to get better at talking about dying to patients.

take or refuse, or where to spend your final days. Helen Meehan, RUH lead nurse Palliative and End of Life Care, said:

“Caring for people nearing the end of life is one of the most important things we do, not The report, Talking only in hospital about Dying, by but also in our the Royal College communities. of Physicians, The Conversation says it is vital Project at that medical the RUH is staff have the supporting our knowledge and staff to have skills to undertake sensitive and sensitive compassionate conversations conversations when patients with patients are ready. and their Helen Meehan, RUH families when The RUH Trust Lead nurse Palliative treatment is no is named, and and End of Life Care longer curative included as a or recovery good practice is uncertain. case study, as one of four English hospitals leading the way in “The conversations support supporting end of life care and patients to consider what is talking honestly and openly important to them and what about death. wishes they might have for future care, including their end of life The RUH began its initiative, care. We know that if we have called ‘The Conversation Project’, these conversations earlier and five years ago, aiming to support support patients and their families earlier recognition of patients with with thinking about planning end of life needs and improving ahead, they are more likely to communication and planning receive the appropriate support ahead for the end of life – such when it is needed.” as deciding on what treatment to

The funding will enable a new companion support worker role with Dorothy House Hospice Care to support coordination of volunteers at the RUH. These volunteers will provide compassionate companionship to patients during their last days or hours of life on the hospital wards. Helen Meehan, Lead Palliative and End of Life Care Nurse and Project Lead, said: “We are so grateful to The Sperring Charity for choosing to support this much-needed companionship service for our patients. This means that thousands of hours of volunteer time will be given to patients on our wards, seven days a week. “Caring for people nearing the end of life is one of the most important things we do in hospital as well as being able give respite support to patients’ families so that loved ones can have some respite during what is an emotionally and physically exhausting time. “Often the last sense patients lose during end of life care is their hearing. Being able to provide a compassionate companion during their final days or hours to provide comforting words, be with them or hold their hand is very much the support these patients need at this time.”

The Sperring Charity’s generous gift www.ruh.nhs.uk

Membership news

Caring for You As we near the end of 2018 and tip into the New Year, we are also coming to the end of our Caring for You schedule. These are events for our members that cover a range of subjects, giving our members and the public the opportunity to step behind the scenes and understand more about the work of the hospital and how it supports the health and well-being of the local communities. We always have a guest speaker or clinical team who explain their work and what’s being done at the hospital. We’ve had a fantastic range of topics in 2018 and these events are proving to be more and more popular with our members. There are still two events coming up before the next issue of insight, so please add these to your diary. 23rd January 2019 - Cancer & Survivorship 13th March 2019 - The Value of Therapies All events take place at 6pm-7:30pm in the Post Graduate Medical Centre (Dept. B20). You can book a place by contacting the Membership Office on 01225 826288 or by emailing ruhmembership@nhs.net

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What interests you?

Maybe you have ideas about certain topics which you would like to hear about? We would love to hear from you. Please complete the form and return it to our Membership Office by 9 January 2019 using our freepost address: FREEPOST RSLZ-GHKG-UKKL, Foundation Trust Membership Office, Royal United Hospital, Combe Park, Bath, BA1 3NG.

Annual General Meeting Unable to attend our 2018 AGM? Don’t worry, here’s our recap. Our Annual General Meeting was held at the Assembly Rooms in Bath on 26th September, and were delighted to meet so many of you. Over 130 people came to the meeting and we shared our achievements and challenges over the past financial year, including our plans on how we continue to enhance and develop the services we provide to our patients. Those of you who came along heard about the commitment and dedication of our staff and volunteers to deliver safe, high quality, cost effective, patient-centred care. You can read more about this in our Year in Review brochure which can be found on our website. Log on to www.ruh.nhs.net click on About Us and the Annual General Meeting 2018 page.

We hope to share our Caring for You 2019 events calendar in the next issue of insight.

Caring for You Survey 2019/20 Please select up to 7 topics from the list below that you would be interested in seeing on our Caring for You schedule 2019. ■ The Role of Carers in Hospital

■ New Developments at the RUH

■ Maternity Services

■ Focus on Nursing

■ Mental Health

■ Diet, Stroke and Diabetes

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■ Restart a Heart

Other topic ideas:

■ Medicines Optimisation ■ Balancing Confidentiality and Access to Data in our Health and Care System ■ Emergency Department – Working Together

insight Winter 2018/2019

To book your place at an event, sign up as a mem Membership Office on 01225 821262 or ruhmem

Annual Members’ Meeting We were delighted to see so many members at our AMM on 26th September. Chris Callow, Lead Governor, presented a report from the Council of Governors. He outlined their work since the 2017 Annual Members Meeting, which included assisting in the recruitment of new Non-Executive Directors and Governors meeting with the Care Quality Commission. Chris highlighted that, over the next year, they would be appointing a new Chair and would be involved in the development of Bath and North East Somerset, Swindon and Wiltshire Sustainability and Transformation Plan (STP). Governors were also looking at ways of engaging members and working with the community and other patients. He encouraged members to contact their Governors via the membership office (see details in the left-hand column). You can read the Council of Governors Annual Report 2017/18 here: www.ruh.nhs.uk/governorsannualreport

Governor Constituency Meetings We have been lucky enough to receive some fantastic presentations on our topics of interest at the Governor Constituency meetings this year and wanted to share some of the information that we have learned.

Healthy Aging The North East Somerset Governors invited Claire Jackson, Occupational Therapist and Carla Link, Physiotherapist to their meeting who provided members with some information about how to stay healthy – they even gave members the opportunity to get active by joining in with some easy exercises that can be done in the home.

Their health tips:

Falls and Fractures

• The current recommendation for fluid intake is 8 glasses a day.

The North Wiltshire Governors were joined by Chris Dyer, Consultant Geriatrician who was able to provide members with information on falls and fractures with a focus on people aged over 65 years.

• Make sure you are eating enough throughout the day. • Keep active and mobile. • Making small changes to your home can help reduce your risk of falls. • lighting – avoid trailing cables, use a bedside light at night. • living areas – use non-slip underlay under rugs, use cable ties to tidy jumbled wires, never store items on the stairs. • kitchen/bathroom – ensure items are within easy reach, use a non-slip mat, consider grab rails. • garden – keep paths free of moss and leaves, ensure doors, steps and garages are well lit.

• 30% of older people fall each year. • Osteoporosis usually has no symptoms until you fracture a bone. • Tai Chi reduces the risk of falling by improving your balance. • 50% of women and 20% of men aged over 50 will break a bone in their lifetime. Thank you to all our expert guests over 2018 who’ve attended our meetings and provided a wealth of information about their work and expertise in the health care that the Trust provides. Roll on 2019.

mber, or find out more about the benefits of membership you can contact the mbership@nhs.net www.ruh.nhs.uk

Art at the Workshops on the wards We are thrilled to have two visiting artists, Edwina Bridgeman and Charlotte Stowell, delivering creative workshops alternately, with one day of workshops on the Children’s Ward and one day on the Older Patient’s (OPU) wards every week.

Artsparks Thanks to the support of St Johns Community Grant we have been able to continue Artsparks participatory workshops on the Children’s ward, allowing children to enjoy the freedom to produce their own artwork in a safe, supportive and non-judgemental setting. Bath Medical students have recently been observing and taking part in our participatory workshops, joining in with a fimo clay modelling activity with artist Charlotte Stowell, and working with children of all ages, making this an enjoyable session for everyone.

Fimo clay models made by patients on the Children’s Ward with artist, Charlotte Stowell

Student Feedback “Really lovely environment for the children; so welcoming but not so encouraging as to be forceful, which I think made those participating feel very at ease.” “I feel the entertainment provided today through the use of Fimo clay really brought up the spirits of the patients who got involved. It was also a great talking point for families and was nice to see families together in an art task using materials that may not be around at home.”

Students Xav and Josh with Edwina Bridgeman

Stitch in Time Stitch in Time workshops on Combe ward take place on Friday mornings and incorporate a range of images and creative textile processes, with one-to-one and group conversations on the wards and sharing of memories. By encouraging and supporting social skills and interaction between patients, we hope to increase patients’ self-esteem and confidence by introducing them to a new skill that they can then share with their family, friends and loved ones. Waterhouse Ward’s Therapy Room hosts Stitch in Time workshops on 16

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Friday afternoons and also invites patients from Midford ward who would like to take part. Artist Charlotte Stowell has been making models and fabric wreaths with patients using a selection of different materials, including fimo clay with moulds and textured sheets, rattan wreaths, card wreaths, coloured skeleton leaves, felt and silk flowers, plus various wools, yarns, fabric and lace.

Fabric Flower Wreath

Patients enjoy the making aspect but also being part of a group. One patient commented he enjoyed having something else to do and trying something new.

of the RUH Exhibitions

‘Thoughts of a Lone Tree’ Usha Pearce, Bath Open Studios - Widcombe

Bath Open Studios at the RUH

Frankie Simpkins entertains

Dementia projects – music and crafts Medical Students from Bristol have recently been at the RUH for work placements supervised by Dr Chris Dyer, Consultant Geriatrician. The placements included an academic as well a practical element – ‘experiential learning’ in a clinical, simulated, academic or third sector setting. The students complete a module on arts, health and wellbeing as part of their 2nd year curriculum, and have been involved in Older Patient Units (OPU) participatory workshops, as well as shadowing our musician Frankie Simpkins to see the effects live music has on patients and visitors in the OPU wards. Many students had lovely in-depth conversations with the patients, around the music and feelings and memories it evoked. The students who accompanied the visiting musicians commented how it was lovely to see the varying responses to the music, from the more subtle toe taps to the obvious and enthusiastic. Soundbite – our referral programme where musician Frankie visits patients referred by ward staff and dementia co-ordinators – and our Stitch in Time workshops are supported by The Forever Friends Appeal ‘Friendly Faces’ volunteer project.

Bath Open Studios includes the five art trails of Newbridge, Larkhall, Combe Down, Bear Flat and Widcombe, and is proud to represent and promote the art and craft makers residing in the city. Showing this selection in the hospital corridors is an exciting taste of the works which are created and available during the weekends of May or September each year. Paintings, prints, photographs, ceramics and mosaic are on view in the hospital corridors, and with a third of all sales going towards the Art at the Heart programme. This is a great opportunity not only to buy those last-minute Christmas presents but also to support the vital works of Art at the Heart. The exhibition will continue in the Central Gallery until 17th January 2019.

Andy Goodman: Graphic Design artworks Graphic Designer Andy Goodman has a collection of his bright, colourful illustrations on display in the Artsparks Gallery.

‘Clearing Beyond the Woods’ Ele Nash, Bath Open Studios – Combe Down RIV workshops artwork with artist, Edwina Bridgeman

Linney Bendell Linney has kindly donated an artwork to the Breast Cancer Unit. It is made out of shells, beads and badges to depict the breast cancer logo. She also has Breast Cancer Artwork another artwork by Linney Bendell on William Budd Ward, which has been inspired by the wonderful care from the RUH over the years to herself and now her daughter for which, she says, they are both eternally grateful. On this particular artwork, 50% of this work’s sale price will go to the Forever Friends Appeal to support the new cancer care centre. If you have seen an artwork you would like to purchase, please contact Tony Smith, tonysmith3@nhs.net or contact 01225 824987

River is the Venue (RiV) River is the Venue (RiV) is an exciting partnership project with 44AD artspace,

Art at the Heart and research academics at the University of Bath. Funded through the University of Bath Public Engagement Unit, the focus is to communicate the historic links between the flooding on the River Avon through a unique combination of art and technology. The RiV project has enabled local artists to communicate the flood history of the River Avon of the City of Bath through art installations, a sound piece, puppetry performance and participatory art workshops. There will be an exhibition at the RUH in the Central Gallery in December showing images of artwork and detailed information about the project, as well as artwork produced from community group workshops with artist Edwina Bridgeman. www.ruh.nhs.uk

Transforming Maternity Services Together - Have your say We’re proud of the maternity services we provide at the RUH, which were recently rated as ‘Outstanding’ by the Care Quality Commission. However, we think we can make them even better, and we know there are challenges ahead we need to be prepared for. We’ve been working with our Local Maternity System – the NHS organisations who plan, buy or deliver maternity services across Bath and North East Somerset, Swindon and Wiltshire. Together, we’ve listened to over 2000 mothers, families, staff and partners to look at ways we can improve the services we provide to mothers and families across our area. We want to provide: • More equal access to the different •C ontinuity of care to improve the provide targeted care close to home. birthing options available to women. relationship between mother, family • Integrated and seamless care regardless • Improved personalised care so we listen to and midwife. of where and how women choose to and understand what women want. • I mproved community support to give birth. We can only deliver these improvements if together we make some changes to how we currently do things across our area. We’ve used all the feedback we have received, along with national guidance, to develop a proposal for how maternity services could be provided in the future, this is outlined below:

What are we proposing?

Continue to support births in two, rather than four of the Freestanding Midwifery Units.

• Chippenham and Frome will continue to support births (you will be able to give birth to your baby at these units). • Trowbridge and Paulton will no longer support births (you will not be able to give birth to your baby at these units). • Antenatal and post-natal clinics will continue to be provided in all four units – Chippenham, Frome, Paulton and Trowbridge and in all other community locations e.g. GP practices.

What will this do? Free up resources to be used more efficiently so we can: • Better support continuity of care, • Provide an enhanced home birth service, • Further improve the quality of care provided to mothers and families.

Create an Alongside Midwifery Unit at the Royal United Hospital. What will this do? Provide another option of choice of place of birth for low risk women and reduce pressure on the Royal United Hospital Obstetric Unit. The current Alongside Midwifery Unit at Great Western Hospital will remain unchanged.

Create an Alongside Midwifery Unit at Salisbury District Hospital. What will this do? Provide another option of choice of place of birth for low risk women and reduce pressure on the Salisbury District Hospital Obstetric Unit. The current Alongside Midwifery Unit at Great Western Hospital will remain unchanged. 18

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Enhance current provision of antenatal and post-natal care.

What will this do? Improve the support we offer – targeted and personal support and better continuity of care.

Improve and better promote the home birth service.

What will this do? More capacity for midwives to fully and confidently promote and support a home birth service.

Replace nine community post-natal beds (five in Paulton Freestanding Midwifery Unit and four in Chippenham Freestanding Midwifery Unit) with support closer to, or in, women’s homes. Women with a medical need will still be able to access post-natal beds at Salisbury District Hospital, Royal United Hospital, and Great Western Hospital.

What will this do? Free up resources to be used more efficiently, including a greater focus on breastfeeding support and other post-natal care close to home, or in, the home which women tell us is very important to them.

Chippenham Freestanding Midwifery Unit Current Proposed

Current

Royal United Hospital Proposed

Antenatal clinics

No change

Antenatal or Postnatal beds (40 beds)

No change

Day Assessment

No change

Neonatal unit

No change

Obstetric Unit (9 beds)

No change

Great Western Hospital Swindon Current Proposed

Antenatal clinics

No change

Alongside Midwifery No change Unit (4 beds)

Birth beds (3 beds)

No change

Antenatal clinics

Community postnatal beds (4 beds)

0 beds

Postnatal clinics

No change

Supports home births

No change

Antenatal or Postnatal No change beds (30 beds) Day Assessment

No change

Neonatal unit

No change

Obstetric Unit (12 beds) No change Supports home births

Swindon

longside A Midwifery Unit

No change

GWH

Chippenham Marlborough RUH

B&NES

Bath

Trowbridge Freestanding Midwifery Unit Current Proposed

Devizes Trowbridge

Paulton

WILTSHIRE

Frome Paulton Freestanding Midwifery Unit Current Proposed Antenatal clinics

No change

Birth beds (2 beds)

0 beds

Community postnatal (5 beds)

0 beds

Postnatal clinics

No change

Supports home births

No change

We are not proposing to reduce how much we spend on maternity services, nor reducing staff numbers nor closing any buildings.

Antenatal clinics

No change

Birth beds (2 beds)

0 beds

Postnatal clinics

No change

Supports home births No change

Warminster Amesbury Salisbury District Hospital Current Proposed

Salisbury

Frome Freestanding Midwifery Unit Current Proposed

SFT

Antenatal clinics

No change

Antenatal or Postnatal No change beds (19 beds) Day Assessment

No change

Neonatal unit

No change

Antenatal clinics

No change

Obstetric Unit (10 beds)

No change

Birth beds (2 beds)

No change

Supports home births No change

Postnatal clinics

No change

longside A Midwifery Unit

Supports home births No change

Independent analysis shows that our proposal to support births in Chippenham and Frome Birth Centres rather than all four would have a minimal impact on travel times to a unit, and ensures women still have the choice of a Freestanding Midwifery Unit as place to give birth. We would like to hear what you think before we make any final decisions. We’ve launched a public consultation which will run from 12 November 2018 to 24 February 2019 so we can hear what you think about our proposal and take people’s views into account. You can fill in a survey, come along to meeting or just drop us a line sharing your thoughts. You can find our more here www.transformingmaternity.org.uk including meeting dates, and ways to provide feedback as well as our full consultation document – outlining why we need to change, how we developed our proposal, and what this means for women and families in our area.

Did you know? Between April 2017 and March 2018, across our Local Maternity System: We helped deliver 11,100 babies. 85% of births took place in an obstetric unit. 6% of births took place in a Freestanding Midwifery Unit – that means around 2 or 3 babies a week at each unit. 2% of babies were born at home. We spent around £42.6m on maternity services. Our 9 community post-natal beds were empty for around 95% of the time. www.ruh.nhs.uk

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insight Winter 2018/2019

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