Winter 2014 Patient Experience
The newsletter for members of the Royal Devon & Exeter NHS Foundation Trust
Meet the new trust Governors
New Governor Dr Rachel McInnes at work inside the Met Office
Inside: How the Trustâ€™s Members inspired a piece of medical research and a new set of dates for your diaries www.rdehospital.nhs.uk
Introduction from the Chairman, James Brent As Chairman of both the Trust and the Council of Governors, I see at first hand the important role our Governors play in the work of the Trust. That is why I am delighted to welcome a number of new Governors as well as those who have been re-elected. I want to particularly welcome our new public and staff governors who between them bring a wide variety of experience and expertise to the Council and I look forward to working with and alongside them over the coming years. I also want to welcome back those Governors who successfully put themselves up for re-election for a second term. As seasoned Governors, tapping into their experience and understanding will be ever more vital. As our members will be aware, our new Governors are joining the Trust at an interesting and challenging time with new responsibilities for Governors set against the back-drop of austerity and financial challenge. Moving forward, our Governors will play an increasingly
important role ensuring that we remain firmly rooted in and connected to our community. The Council of Governors’ role includes: • Being satisfied that the Board is effectively discharging its role in ensuring that the organisation is performing effectively • Being satisfied that the Board has the right people with the right mix of skills to perform their role effectively • Representing the interests of members of the Trust and the wider public • Ensuring that the interests of members/public are taken into consideration within the newly emerging healthcare context There are a number of different ways in which the governors individually and collectively discharge their duties from recruiting non-executive directors, playing a role in assessing the quality of our services through to playing a key role in how we engage with our members. At the heart of their work is to bind the Trust with the community it serves.
Managing capacity under winter pressures Every year winter places significant pressure on the NHS; so what have we done at the RD&E to maintain the quality of our services? We have put in place plans to manage our services in a more efficient and effective way through initiatives such as: • Medical Consultants and allied services working seven days a week • The re-designation of a surgical ward to a medical ward for three months • Opening additional beds throughout the predicted busy times • The introduction of a comprehensive assessment service for older people at our front door to reduce hospital admissions. Our experience so far is that these plans have gone a long way to easing the expected pressures, enabling us to have more control over what happens in the Trust to manage our patients safely. As a result of the investment we made last winter to increase the number of beds and the changes we made to some of our processes for managing patients, we were able to cope really well and that has also helped this winter. What is less in our control this year is what happens to patients when they are ready to leave.
We have been working hard with the Clinical Commissioning Group (CCG) and the local authority to enable the safe transfer of patients to beds in community hospitals or elsewhere. Since the joint plan was agreed, it appears that there may be less capacity in community hospitals than had been anticipated. It is important for us to have an honest assessment of this issue because delayed transfers of care could potentially impact on our capacity to cope with winter pressures as well as we did last year. That is why we are discussing with the CCG, Northern Devon Healthcare Trust (which manages the community hospital beds) and the local authority about what can be done to address this issue. Building additional capacity is out of the question so we are working with our partners to identify some innovative and creative solutions to tackle this problem. Em Wilkinson-Brice, Chief Nurse/Chief Operating Officer
Extraordinary People: the RD&E is full of them These are the eight winners of the last Extraordinary People Awards, and as this edition of the RD&E Express went to print another set of winners were about to be announced. There were 40 nominations for the five categories being judged and they will feature in the next edition. There will also be the announcement of the Winners of Winners in April. From each of the five category winners over the past year, one outstanding member of staff or team will be judged the overall winner at a special ceremony. Trust Chairman James Brent presented the winners of the second season with their certificates. Here they are:
Excellent Care Award
Rob Wickens Jo Churchill and Team (Okement)
Extra Mile Team Award
Stroke Team (Jules Jefferies) Choose and Book Team (Sara Morgan-Pritchard)
Exemplar Award Fiona Fry
Exceed Award Andy Payne
Extra Mile Individual Award Claire Bainborough (pictured) Hannah Jacks
Meet Dr Rachel McInnes, Public Governor for Exeter and South Devon Amongst the new intake of RD&E Foundation Trust Governors is Dr Rachel McInnes, a climate scientist with the Met Office, who was inspired to sign-up after being treated at the hospital. The 29-year-old only joined the Trust in August and immediately put her name forward for election to the Council of Governors in September. Her aim is to increase the breadth of involvement in the Council and Trust membership, and to make it more representative of the hospital users. “We need to get more young people involved whose experiences may be different to those of older people. We need to hear their views,” she said. After growing up in Aberdeenshire, Dr McInnes gained her doctorate in astrophysics at the University of Edinburgh and moved to Exeter nearly five years ago.
Since becoming a governor she has been selected for the Nominations Committee and was soon helping recruit two non-executive directors, getting involved in the long-listing and interviews. Council meetings and seminars to familiarise herself with the workings of the Trust have also followed. “I joined the Trust because I had been a patient and user of the hospital for a number of years,” said Dr McInnes. “The hospital had helped me when I was ill and during that time I thought to myself that when I was better enough I wanted to give something back. “I found out about the Trust, being a Member and being a Governor, at the same time and decided I wanted to be a Governor. As a patient and regular user I’d seen things that worked well and things that didn’t work so well, and I thought I would be a good person to speak up for those people who don’t have a voice.”
Council of Governors election results 2013 Thank you to all our Members who voted in our 2013 elections, particularly to the Members who stood for election. As the Council of Governors is accountable to Members and the local community, we very much value people choosing to stand and our Members taking the time to vote. The opportunity to vote for your representatives on the Council is a vital part of ensuring the Trust hears your views on healthcare.
Thank you, and goodbye!
In these elections we had vacancies in all three public constituencies but due to the number of candidates standing, an election was only needed in Mid, North, West Devon & Cornwall.
The result was as follows: • In Mid, North, West Devon & Cornwall there were two vacancies and three candidates. David Giles and Dianah Pritchett-Farrell re-elected, both for terms of three years. The turnout was 33.2%. • In Exeter and South Devon, Kate Caldwell and Geoff Barr were both re-elected, and Rachel McInnes was elected. All were elected uncontested for three year terms. • In East Devon, Dorset & Somerset, Lynne Wright was re-elected with Celia Powell and Barbara Roberts elected. All were elected uncontested for three year terms. • Staff Governor elections were also held with Ros Wade (Allied Health Professionals) elected for a one year term, and Hazel Hedicker (Non-Clinical Staff) elected for three years.
The Trust would like to thank several Governors who retired at the 2013 Annual Members Meeting. Andrew Kyle, Nick Morse, Peter Hull, Terry Roberts and Janice Cackett all chose not to stand for reelection and we are grateful for their dedication and support of the Trust.
The Council of Governors has been left with some vacancies following the 2013 round of elections. We will be looking again at how we run our elections and engage our members and how we can improve, but in the meantime the Council of Governors has decided to carry forward the vacancies to the 2014 elections.
2014 Elections More details of the exact timetable for the 2014 elections will be in the next newsletter but we plan again to hold meetings for members interested in standing as a Governor. All members who have told us they are interested in the role will be contacted and invited to a meeting or to receive further information. The meetings are likely to be held in June or July. If you would like to receive an invitation to a prospective Governor meeting, please let the Foundation Trust Office know on 01392 403977 or by emailing: firstname.lastname@example.org.
A message from our Chief Executive As readers of RD&Express will know, NHS finances are tightening as it seeks to meet increasing demand from an ageing population and a formidable savings challenge of around £20 billion over the next few years. Like other parts of the public sector, the RD&E is not immune from this climate of austerity and since 2010 we have achieved a total of £48 million of efficiency savings. However, in the face of a continued decrease in our income it is becoming increasingly difficult to find the savings we need and that is why we are forecasting a small deficit of around £2 million at the end of the year. This is less than 1% of the Trust’s total budget and our underlying financial position will help us manage our way through for the next few years, but it is important for members of the Trust to be aware that this signals a shift away from the surpluses we have achieved in previous years. Despite this, the Trust is rated as one of the safest and best performing hospitals in the UK. Monitor, the sector regulator, currently gives the Trust the best possible score (4) for its ability to continue to provide services to its catchment population. In addition, the Trust maintains a positive rating on all key national health indicators. Against this backdrop, it is important for both staff and our members to bear in mind that we are continuing to make progress in improving the services we offer to our patients. It is a testament to our staff that what drives them is the on-going and relentless focus on
improvement and providing the best possible care. Despite this, it is sometimes easy to overlook the real and significant progress we are making. As we head towards the end of the financial year, I wanted to highlight some of the improvements we have made during the previous year or so to underline the fact that we are continuing to offer improved care for our patients. Over the last 18 months we have: • Opened Yealm and Ashburn wards • Completed a £1m refurbishment of Durbin ward • Commenced the hugely successful prostate surgical robot service • Opened an Acute Paediatric Assessment Unit • Introduced “An Hour to Remember” dementia training for all staff • Markedly reduced our rate of C difficile infections • Not had an MRSA bacteraemia for 2 years • Achieved the 18-week waiting time target • Reduced on-the-day cancelled operations by 97% • Seen our Early Synovitis and Biologics Clinics honoured at the British Society for Rheumatology Awards • Received positive feedback in national patient surveys • Invested in additional nursing staff • Redesigned the emergency pathway for elderly care and introduced the ACE (acute care for the elderly) service based in the Emergency Department • Opened the Research Innovation Learning & Development Centre (RILD) So thank you to every member of staff, our volunteers, and Governors for their steadfast dedication last year and their unceasing commitment to our vision of providing safe, high quality care delivered with courtesy and respect to our patients in 2014 and beyond. Angela Pedder
RD&E Members inspire research! Inspired by the interest from the audience after her talk on blood conservation and transfusion at the ‘Members Say!’ event in September 2012, Dr Biddy Ridler is now researching the public’s knowledge of blood transfusion and its risks, benefits and possible alternatives. Dr Ridler, an Exeter doctor renowned across Europe for her work with the Royal Devon and Exeter Hospital (RD&E) Blood Conservation Team, retired from the NHS at the end of October 2013 — but she is not putting her feet up and is instead embarking upon a Master’s degree from the University of Exeter. As part of her research, Dr Ridler has written a short survey to find out what people know, or would like to know, about blood – whether it be the transfusion itself, supply from donors, benefits and risks, how blood can be conserved for those patients who really need it and
what alternatives to transfusion are currently available. If you would like to take part, the survey is online at: http://tinyurl.com/p3cw4o8. Once her study is complete, she intends to develop information for the public, to help them make informed choices about alternatives to blood transfusion. This includes techniques such as cell salvage (recycling the blood a patient sheds during surgery). (Adapted, with permission, from an article by former RD&E employee and colleague of Dr Ridler, Peter Thompson)
Events for Members Patient Experience
Council of Governors Meetings All Council meetings are 2-4pm Monday 7 April Monday 7 July Monday 13 October Venue: Research, Innovation, Learning & Development building (RILD), RD&E, Wonford, Barrack Road, Exeter. All Foundation Trust members are welcome to attend the Council of Governors meetings. There is no need to book but if you would like more details of the meetings, please contact the Foundation Trust Office on 01392 403977 or email email@example.com. Board of Directors meetings 2014 Our Board has 10 meetings in a calendar year (though it can meet in August and December if required) with each meeting having a public and confidential session. Members of the public are welcome to attend the public sessions. 2014 Board meeting dates are: Wednesday 26 February Wednesday 26 March Wednesday 30 April Wednesday 28 May Wednesday 25 June Wednesday 30 July Wednesday 24 September Wednesday 29 October Wednesday 26 November
Medicine for Members
These talks are held for Foundation Trust Members, allowing them to find out more about some of the specialist work carried out by our team of experts here at the RD&E.
Start time and Venue Board meetings start at 2pm. They are held in the RILD building on the RD&E Wonford Hospital site. The new Research, Innovation, Learning and Development building (RILD) is adjacent to Peninsula Medical School. The room used for the meetings is on the ground floor and is accessible by wheelchair. Board Papers The agenda and reports are available to view and download from the Trustâ€™s website at least two working days before the scheduled Board meeting date. A small number of hard copies of the papers are supplied at the meeting. Meeting Format The public has a designated seating area to observe the meeting discussion. At the end of the public session the Chairman will ask those in attendance whether they would briefly like to ask a question. It is asked that this question to be related to an item on the meeting agenda. The Board will then move into a confidential session and the public will be asked to leave the meeting. There is no need to book to attend but if you would like more details of the meetings, please contact the Foundation Trust Office on 01392 403977 or email firstname.lastname@example.org. The talk will be held in the Princess Elizabeth Orthopaedic Centre Theatre at Wonford Hospital. Because of limited space, please contact the Foundation Trust Office on 01392 403977 or email email@example.com to reserve your place. Our next talk is:
One of the RD&Eâ€™s Emergency Medicine Consultants, Adam Reuben, will be talking about his specialty and there will be a chance to ask him questions.
Emergency Medicine Monday 7 April, 2014 1pm to 2.30pm
Stroke team wins national award The Exeter Stroke Research team has been presented with a national award. The team came second in the annual awards by the National Stroke Research Network which gives sites the opportunity to share achievements and best practice. The focus was on innovation. They had to submit an application which summarised the number of patients who have been recruited to studies
as well as integrating research in to the clinical area. Their application talked about how they have been able to recruit patients to studies suitable for them within hours of the onset of their stroke. For this to work effectively this has involved building on the relationships the team currently has with the Emergency Department, the stroke nurse practitioners and the ward staff on the Acute Stroke Unit.
Packed day for Members’ Say At the end of September we held our most recent Annual Members’ Meeting and Members’ Say event. The next Members’ Say is due to be held on Saturday 27 September. Other smaller events are being planned for dates in the summer and these will appear in the next edition. Attracting nearly 200 members on a wet and windy Saturday morning, the event proved to be another success with 90% of those responding to the survey saying that the event was good. The day began with the Annual Members’ Meeting which included an introduction from the Chairman and an overview of the year by the Chief Executive Angela Pedder. Following a brief overview from the Trust’s external auditors and the Governors’ year from Richard May (lead governor), the audience was able to ask questions of the board. We then moved into the Members’ Say event which this time included a talk on hips, workshops on dementia and focus groups looking at the issue of compassionate care alongside a marketplace of stalls and interactive activities.
Defining Compassion In the wake of serious issues faced by the Mid Staffordshire Hospital and recent reports into aspects of care within the NHS, the issue of the extent to which care is being given with
compassion has shot up the agenda. We wanted to know what members thought about compassionate care so we asked them, in focus groups, to help us define it, to understand what it would include (and not include) and how we could ensure that it was delivered appropriately every time. The five focus groups provided a fascinating insight and we will be producing a longer report on the issue in due course once we have had similar discussions with staff and patients. The graph ‘below’ shows the themes which appeared in the discussions about what constitutes ‘compassion’. Most often and most strongly referred to were the ideals of empathy, good communication and a good bedside manner.
Patient Experience News
Prioritising money In one of the sessions at the Members’ Say event, the members were each given £50 in fake £10 notes to spend as they chose on six priorities. Time spent waiting between being referred by GP and being seen by a hospital doctor has now been
our Members’ top priority for the last four Members’ Say events. As we work hard to meet our waiting time targets, we are aware of how important this is to our Members. Reducing hospital infections continues to be a big priority for both us and our Members. This is how Members prioritised their spending:
September 2013 Time spent whilst waiting at the hospital Cleanliness of the hospital Time between being referred by GP and being seen by hospital doctor Reducing hospital infections Being treated with respect Being informed
18.3% 16.3% 17.7%
£530 £470 £510
The five key values for all Trust staff During October and November 2013 we held five ‘Staff Say’ conversations in which more than 2,000 staff were invited to help us develop the RD&E values. The values we want Trust staff to adhere to in all their work are: • • • • •
Honesty Openness and Integrity Fairness Inclusion and Collaboration Respect and Dignity
The results of the staff conversations were presented to the Transformation Board recently. The Board was interested in the themes identified during the sessions and have asked to see options (some of which were discussed in the sessions, such as a staff charter) to ‘bring to life’ the behaviours which were discussed.
Staff worked hard, with plenty of lively discussion, to describe the behaviours they thought would underpin our values and help promote a sense of community. Main themes included supporting each other, developing a ‘no blame’ culture, and promoting the RD&E as a great place to work.
Meet the RD&E’s Clinical Psychologists There are many areas in the RD&E Hospital where a clinical psychologist can help reduce a patient’s distress and promote their psychological well-being. There are 13 part-time psychologists in the RD&E team. They cover everything from pain management to breast care services, from obesity to Cystic Fibrosis (CF) and from kidney patients to neuro-rehabilitation services. A clinical psychological assessment can include psychometric testing, interviews and direct observation of behaviour in order to recommend therapy, counselling or advice for patients, families and clinical teams. Behavioural factors are implicated in the onset and course of many long-term health conditions, and psychologists are well placed to help clinical teams and patients address these to improve outcomes. The department’s full remit of services are commissioned from the Devon Partnership Trust, and all their work is carried out in the hospital. Lead Consultant Clinical Psychologist, Dr Phil Yates, explained how the department works: “We are often asked to provide support, supervision and training in psychological approaches to assist medical and other health professionals in carrying out their work. We feel this is an added value of our work with medical services and it can help to secure positive patient outcomes and support staff in working with complex patients.” Dr Doug Crix, on the CF team, said of his role: “The possible issues I may be asked to work with include adherence to treatment, depression, anxiety, relationship difficulties, preparation for transplant,
Dr Yates, Dr Delmar-Morgan and Dr Bromley
end of life issues and dying. I also work with the bereaved families after death.” Dr Yates and Dr Caroline Shinner are involved in the inpatient neuro-rehabilitation service at the Mardon Centre. Dr Mary Ivens and Dr Crix work for the Pain Service; Emma Kewin works alongside a psychiatrist to provide input for the Exeter Medical Obesity Service; Keith Nichols and Dr Guy Mizon work in General Medicine across RDE medical wards. Annie Mitchell provides input for the Exeter Kidney Unit. Elaine Vickers works with the Breast Care Oncology Service. New posts are being developed in the Cystic Fibrosis service currently. Also linked with these services are Gail Leeder, Ann Turner, Dr Phil Moore, Dr Claire Bazen-Peters from the Community Neuro-rehabilitation Service. This service is not directly commissioned by the RD&E but provides an essential service for neurology outpatients with acquired and neuro-degenerative disorders (such as MS and Parkinson’s disease) who require specialist assessments, complex therapy and who often have medically unexplained symptoms.
When coughs and sneezes attack… A national NHS campaign called “The earlier, the better” has been running since January encouraging the elderly and frail to avoid coming into hospital by seeking help sooner if they are feeling unwell. The aim is to avoid people becoming so sick that they need urgent care in hospital, rather than seeing their local pharmacist in the first instance or getting help from friends and family. Its key messages are: • If you’re feeling under the weather, get help as soon as possible. See your local pharmacist or get advice from www.nhs.uk/asap. The earlier, the better. • Speak to your friends, family or carer if you are
feeling under the weather. They can help you to get advice. • Local pharmacists provide expert advice to help you manage your long-term condition or can even help you if you have a bad cough, trouble breathing, a cold or sore throat. They have longer opening hours than GP practices, and most have a private consultation area. They’ll also tell you if they think you should see a doctor. • If you are visiting or caring for an elderly relative or friend who is unwell, get advice from www. nhs.uk/asap or see your local pharmacist to help manage their care. The earlier, the better.
Patient Experience 11 RD&E News A thousand happy returns from Kevan’s birthday bash Long-standing diabetes patient at the RD&E, Kevan Hooper, has raised enough money with his charitable birthday party for the MacLeod Diabetes Centre to buy vital equipment. Mr Hooper, who turned 61, hired a venue, rock band and topped up his friends’ donations to reach the £1,000 mark. Tracy Courtney, Diabetes Specialist Inpatient Nurse, said: “It is wonderful to receive donations, especially from our own patients. We would all like to thank Mr Hooper very much for his kindness and generosity.” Staff have been able to buy a scanner and blood pressure monitor with this gift, and planning has already begun for his next party.
Front: Tracey Coombs, Kevan Hooper and Tracy Courtney. Standing from left Trudi Darby, Bernice Olver, Shirley Brooks, Mollie Donohoe and Marie Dougal-Johnson
Hospital gains good feedback after updating patient letters to make them clearer A nine month operation to revise and correct the 8,000 letter templates used by the RD&E has brought words of appreciation from people receiving them. Three staff in the Trust’s Patient Administration team fitted the re-writing work around their usual tasks to encourage patients to read beyond the first line of the letter with the specifics of their appointment, and make sure all the information was clear. For example, one change to a child patient’s letter removed an instruction that they “should not drive” to their appointment which was leaving some parents confused. Jackie Hatton, one of the team involved, said: “We have
already had some really positive feedback from patients. One lady rang the department before her visit and asked why she needed to bring her dressing gown when previous letters hadn’t said this. “As it happens, all the letters she had received had said this but, because the information was quite well hidden before, she had never noticed it.” Our picture shows the editing team of: (l-r) Rebecca Colston, Jackie Hatton and Sara Morgan-Pritchard.
Hindu Deity arrives in Chaplaincy Centre A Marble Deity of Lord Shiva has finally arrived at the RD&E after a journey that took more than two years, many hours of craftsmanship and a 4,000 mile trip from Jaipur.
and feelings of the morning when we had our Deity set in front of us in presence of all those who took time off to be present.”
The Deity’s presence was requested by members of the local Hindu community, who felt it would be helpful for staff and patients at the hospital. Lead Chaplain, Dr Simon Harrison, said: “At the time, we did not expect things to take quite so long, but were finally able to host a service of welcome led by Panditjee Anirudh Bhatt, a priest from Bristol.”
He has kindly agreed to lead weekly prayers at 8.15 Monday mornings in the Chaplaincy Centre.
Ravi Nathwani, the University of Exeter Hindu Chaplain, has been helping Trust in making this happen. Ravi said: “I don’t have words to express my emotions
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The Foundation Trust membership office can be contacted by telephoning 01392 403977, by emailing firstname.lastname@example.org or by writing to: RD&E NHS Foundation Trust Office, Room E219, RD&E Hospital, Barrack Road, Exeter, EX2 5DW. For more information about the Foundation Trust visit the RD&E website: www.rdehospital.nhs.uk
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