In the latest edition of Heartbeat, we have lots of inspiring updates to share from across SWB.
Turn to page three to find out how to how you can nominate for this year's Star Awards. We have made it easier than ever - you don't need to be on the network or even a Trust devicesimply follow the link or scan the QR code and off you go!
Discover how a blood test for ovarian cancer could save lives and learn about how we're piloting new resus training.
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Sandwell and West Birmingham Hospitals NHS Trust
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Sandwell and West Birmingham Hospitals NHS Trust
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Daren Fradgley, Chief Integration Officer and I recently had the delight of meeting some of the local people of Moat Farm Estate in Tipton commonly known as the lost city of Tipton.
Well, I can testify that I saw it with my own eyes it certainly isn’t lost. I came to learn that’s what they called the estate, apparently because when it became one of the first council estates to be created in the 1920s it was isolated from the rest of Tipton, with only one road in and out. The name stuck even when the area was integrated with the rest of Tipton as new housing developments sprung up around it.
Upon my arrival at the local leisure centre, I spoke about the Midland Met and how it would impact the area and was surprised when the residents I met told me they had no idea the new hospital was being built! What hospital? They asked.
We spent valuable time talking about the benefits the Midland Met would bring to the area. And it became very clear that as an organisation there is still some work to do (with local partners) to improve transport links from Tipton to Midland Met – something that I know the MMUH programme company is already looking at.
I found that what mattered most to the people of the lost city of Tipton was
understanding how Midland Met would impact the services that they access on a regular basis. In essence, Sandwell Hospital will remain available for them for the majority of services including outpatients, urgent care and access to general practice.
We discussed the Trust’s plan to build a thriving town team model which places services as close to the local population as possible. This includes a strong presence at local health centres as well as retaining services on the Sandwell and Rowley sites. Residents were receptive to this approach and want to be more involved in coproducing options that would directly affect their lives.
We also went around some of the local areas and heard about the regeneration and challenges for businesses to retain a presence on the local high street.
I really enjoyed meeting the people of the lost city of Tipton and look forward to going back there again. I particularly enjoyed learning more about the activities at the local leisure centre aimed at tackling isolation and keeping people active.
I even took part in a Zumba class. Yes, I was right in the mix, taking every step to Brazilian rhythms – and I loved it! I recommend it highly if you haven’t considered it before.
Each year we host an awards ceremony to highlight and recognise those who go above and beyond within their roles and for our patients. Our 2023 awards ceremony will take place on Friday, 13 October in true Bollywood style and as always, will be the highlight of the Trust calendar.
Nominations are now open, so get thinking about those colleagues who have gone above and beyond this year, been part of something extra special or made a positive difference to the way we work or the quality of care our patients receive. Our Star Awards nominees are colleagues who consistently demonstrate our values – ambition, respect, and compassion – so have a think of people around you that showcase these values in their everyday work and make a real difference to our patients, our people, and our population.
To nominate a colleague or team, please visit https://connect2.swbh.nhs.uk/communications/star-awards/ or scan the QR code!
Our Star Awards 2023 will highlight the hard work of our colleagues and volunteers, both on the frontline and our supporting services.
From 19 to 23 June, our Trust will be participating in national Clinical Audit Awareness Week (#CAAW23). This runs every year and is used to promote the benefits of clinical audit as a quality improvement tool, as well as providing an excellent platform to shine a light on brilliant audit activity happening locally.
There are some brilliant examples of how clinical audit is being used for improvement at SWB, so we will be using this week to celebrate our audit heroes and empower more of our colleagues to get excited about clinical audit.
Daily themes
Monday 19
Tuesday 20
Patient safety Patient and public involvement
What’s happening?
• Say hello: We will be having a stand in the foyer of the Hallam Restaurant at Sandwell all week and we will be walking around City to raise awareness.
• Mobile support: We will have our laptops so can provide ad-hoc support to register and update audit records when needed - please invite us to your clinical base if this is something that would benefit your team.
• Light reading: Look out for our CAAW23 booklet that captures learning, top tips for audit and improvement, and introductions to our “SWB Audit Heroes”. If you correctly complete the crossword at the back and get it back to us, you’re in with a chance of winning a treat!
• “Learn at Lunch”: National webinars are running throughout the week on the theme of each day, free to join for all colleagues.
• Virtual Masterclass: A national conference looking at clinical audit as a quality improvement tool.
Wednesday 21
Thursday 22
Healthcare inequalities Influencing organisational change
Get in touch:
Friday 24
Sustainability
If you’d like to learn more, invite our team to your base or QIHD to receive training, or want to explore opportunities to get involved with CAAW23 please visit our Connect pages (https://connect2.swbh.nhs.uk/governance/clinical-effectiveness/), email us on swbh.auditteam-clineffec@nhs.net or contact us on Teams:
Team Member Role
Rebecca Kershaw Rebecca.kershaw2@nhs.net 07870393363
Lauren Wattley
Lauren.homer2@nhs.net 07855514324
Amelia Roberts Amelia.hilton@nhs.net Ext. 5528
Bahadur Dehar Bahadur.dehar1@nhs.net Ext. 4898
George Mason George.mason@nhs.net 07855514405
Soha Azouni Soha.azouni@nhs.net 07974106464
Tahmena Karim Tahmena.karim@nhs.net
07870382430
Head of Clinical Effectiveness (Leading the PROMs Project)
Clinical Effectiveness Manager (Leading the NICE Project)
Clinical Effectiveness Co-ordinator supporting the Admitted Care branches of the Medicine & Emergency Care Group
Clinical Effectiveness Projects Facilitator supporting the Emergency Care branches of Medicine & Emergency Care Group (Leading the LocSSIPs Project)
Clinical Effectiveness Co-ordinator supporting the Women & Child Health and Surgical Services Groups
Clinical Effectiveness Co-ordinator supporting the Primary Care, Community & Therapies Group and Corporate Nursing
Learning from Deaths Facilitator
We have now received the results of the Quarter One Pulse survey. Thank you to the 951 colleagues took the time to feedback on their thoughts and feelings about working at SWB. We would really like to increase this number, so if you have any suggestions on how we could do so, please do e-mail swbh.comms@nhs.net and let us know.
The results show:
• 65 per cent of colleagues are often or always enthusiastic about their job (same as the last survey)
• 54 per cent of colleagues would recommend SWB as a place to receive treatment (same as last survey)
• Unfortunately, only 52 per cent of respondents said they would recommend SWB as a place to work compared to 54 per cent at the last survey
• There is also a slight decrease in motivation, but a bigger increase in the amount of colleagues who feel involved and like they can make a difference in their area of work.
We are an organisation that values the opinions of colleagues and will always try to act on your feedback. The results of the annual staff survey, which we received in March, unfortunately showed that very few of you found your personal development review (PDR) useful.
A PDR should be the most beneficial conversation that you have with your manager - it should be focussed on you and how you want to progress your career either at SWB or another organisation.
Based on your feedback, we have changed the PDR process and redesigned the form. It now includes:
• A review of the past 12 months (including a wellbeing discussion and review of previous year’s objectives).
• An assessment against the Trust’s values and how the individual demonstrates the values and behaviours in their role
• SMART objectives aligned to our Annual Plan must be set for the coming year
• Discussions must also include career aspirations and a personal development plan
Save the date:
The PDR window has also been extended and will run from May to the end of December 2023. This means all PDRs must now be completed by the end of December 2023. This allows time for departments to spread their PDRs more evenly over the year, which in turn allows for line managers to hold more meaningful, good quality PDR discussions with colleagues.
These changes have been made to make PDRs more meaningful and is another example of changes we have made as a direct result of you completing the staff survey.
#Red4Research Day on Friday, 16 June 2023 aims to get as many people as possible wearing red to demonstrate their support and appreciation for all those participating, undertaking and supporting research. It is an opportunity to highlight and celebrate the phenomenal work, learning legacy and innovative treatments/systems/techniques that have arisen from research and development.
The #Red4Research concept is very simple. Wear something red, it can be any item of
clothing, then download/print or make a placard saying #Red4Research, take a photo and post it on social media with the #Red4Research hashtag.
It’s all about positivity, creativity and support in the face of adversity. #Red4Research is completely inclusive – anyone, any age, anywhere can participate – children, adults, even pets! Hopefully people might have a bit of fun along the way raising the profile and work of all those involved in the process.
Two new non-executive directors have joined the Trust Board.
We’d like to welcome Jatinder Sharma, Principal and Chief Executive of Walsall College and Andy Argyle who led the public sector team at KPMG before recently retiring, who started in their roles at the Trust on 1 May.
A qualified accountant and highly experienced leader, Midlands-born Jatinder has previously held a number of senior positions in both private and public sector organisations. He is a passionate champion of the vital role that skills and training play in the development of the West Midlands economy and the ongoing regeneration of the Black Country. He is a board member of the Association of Colleges and is a member of the Walsall Proud Partnership. Jatinder, who was awarded a CBE in the 2023 New Year Honours for his services to
Further Education, said: “I am delighted to have been appointed as a non-executive director. I look forward to contributing to the Trust’s vision and values, including its partnership work with healthcare and community-led organisations and how it uses information, advice and support services to improve the health and wellbeing outcomes of the people and families we serve.”
Meanwhile, Andy joins the Trust following a 35-year career working in corporate audit, transaction services and latterly the public sector. He qualified as a UK chartered accountant in 1989, before moving to KPMG in Germany. Andy joined the KPMG partnership in 1999 as an audit
partner and between 2005 and 2010 he led the Midlands transaction services team. Following another period in Germany, he moved into the public sector team where he was the audit lead on a number of NHS Trusts, universities and further education colleges. He also led the client relationship strategy with the Mayor of the West Midlands, the West Midlands Combined Authority and regional government.
He said: “I am excited to join the Trust Board at this important time for the Trust ahead of the opening of the Midland Metropolitan University Hospital. I look forward to using my professional experience, regional business network and local knowledge to support the Board with its patient and workforce priorities.”
Andy has also chaired CORE, a central Birmingham based academy trust and remains a member there.
Sir David Nicholson, Chairman said: “I’d like to extend a warm welcome to Jatinder and Andy. Both are bringing a wealth of experience with them and will prove invaluable additions.”
In a heart-warming display of compassion and support, the Birmingham branch of the Samaritans recently stopped by at City Hospital to offer colleagues, patients and visitors some solace and support. Their visit on Wednesday, 19 April was a resounding success, bringing comfort, hope, and a reminder that no one has to face their struggles alone. With their unwavering dedication, the Samaritans uplifted spirits and spread awareness about the vital support they provide.
The Samaritans is made up of trained volunteers who possess a remarkable ability to listen with empathy and without judgment. They understand that tough days, pressures, and worries can weigh heavily on our minds. That's why they offer a safe haven for open conversations, regardless of the size or nature of the issues troubling us. From a tough day at work to feeling overwhelmed by life's challenges, the Samaritans are here to help.
During their visit, the Samaritans engaged with our staff, patients, and visitors, providing solace and handing out cards bearing their invaluable helpline number.
These small gestures left a lasting impact, reminding everyone that support is just a phone call away. The success of the event was evident in the positive feedback received, with individuals expressing gratitude for the opportunity to share their concerns and be heard.
One of the most remarkable aspects of the Samaritans' work is their unwavering availability. They stand ready to help 24 hours a day, 365 days a year. Their freephone number, 116 123, acts as a lifeline for those in need, ensuring that no matter the time or day, a compassionate listener is just a phone call away. It is through their continuous dedication and commitment that they have become a beacon of hope for countless individuals.
We extend our deepest gratitude to the Birmingham Samaritans for their dedication and invaluable service to our community. Their recent visit has touched our hearts and uplifted spirits, leaving an enduring imprint of hope and support.
If you ever find yourself in need of someone to talk to, please remember that the Samaritans are here for you, day and night. Reach out to them at 116 123 and experience the solace and understanding that can make all the difference.
A group of year 13 students recently completed their Royal College of Nursing (RCN) placements at SWB.
The school children were sixth form students aged 17 to 18 from Holly Lodge High School in Smethwick, all taking part in the RCN Prince of Wales Nursing Cadet Scheme.
The aim of the scheme is to contribute to the development and preparation of young people whatever their background, to engage, enable and empower young people to make a valuable contribution to society and their local communities, as well as to be proactive about the health and wellbeing of themselves and others.
The young people’s placements took place over four days, accumulating a total of 20 hours at the Trust.
“The cadets undertook an observational clinical placement as part of their RCN cadet scheme programme, said Zoe Taylor, Project Facilitator from the Nurse Education Team.
“The placements were carefully tailored towards their fields of interest, with cadets
benefiting from experiences within areas from midwifery and nursing to IT and medical engineering with the purpose of offering a wide range of real-life experience of professional roles within a healthcare service setting.”
Whilst at SWB, the RCN cadets had the opportunity to gain invaluable expertise and knowledge. This included learning about how different clinical and non-clinical colleagues work together to achieve the same goals and meet the Trust values. This, in turn, aided cadets in contextualising their scheme modules, reflecting on their own emerging practices, and supported their career plans and higher education decision making.
Zoe added: “As the potential next generation and future of healthcare, the young people who visited us will have got a taste of what is it like to work in the NHS and hopefully it will have inspired them to look at it as a realistic career for their futures.
“I would also like to say a huge thank you to all ward managers and the practice development nurses at SWB as without their
co-operation and support these bespoke placements would not have been possible.”
We received an array of positive feedback from the RCN cadets – here is just a handful:
Student A: “I got to learn about wide range of things. It also made me realise that no two days are the same. All the patients on the ward had different needs and it was amazing to see how the doctors, nurses, and the healthcare assistants were working together to make sure that they were comfortable and had everything that they need. The staff are amazing, they were so friendly and made me feel welcomed.”
Student B: “I learned a lot, such as how to check a temperature and how to give an inhaler. I really enjoyed it.”
We have 14 research nurses and midwives in the Trust covering outpatients, maternity, inpatient wards and critical care, as well as our clinical research facility (CRF). Although their roles were in the spotlight during the first waves of COVID-19, the research team has always been busy in the background working to improve patient outcomes in all disease areas and continues to do so.
We asked our research team what made them choose to work in clinical trials. Below, you can learn more about our amazing research staff, how they came to work in research and why they stayed.
Manjinder Gohel: I had an opportunity to work within research in 2009 when I joined Ascot Clinic which specialised in cardiology research. This made me more aware of the importance of research within the healthcare setting. Although I went back to nursing, I rejoined the research team during the pandemic, when a secondment opportunity became available. Being at the forefront of COVID-19 was very challenging but taking part in the recovery trial helped to identify new treatments for patients hospitalised with COVID-19. I really enjoyed my time within the research setting and I am now a permanent member of the team leading on cardiology trials.
Paddy Donaghy: My background is in cardiology nursing. I worked in cardiology at City Hospital for six wonderful years, alongside our R&D lead Dr Connolly, a cardiology consultant, in the cardiac catheter lab. After expressing an interest in getting involved in research, Dr Connolly invited me to work on a cardiology study. After completing my GCP training I worked a bank shift one day a week shadowing a research nurse on the study. Unfortunately, this was at the beginning of the COVID-19 pandemic so not long after starting a lot of the research studies were suspended. I really enjoyed my short time working in research and thought that this may be something I would like to pursue further. Not long after this I applied for a research post within the Trust and began my career in research.
Anne Hayes: I became a nurse later in life; I had brought up a family and worked in retail prior to becoming a nurse. I qualified in 2009 after completing a nursing degree at the University of Birmingham. My nursing career began in an acute stroke/ neurology ward with research nurses based in the team and my interest in research was heightened as I observed it in a clinical setting. After five years as a nurse in an acute setting, I obtained a job as a band five generic research nurse. I am now a band six research nurse working with the stroke and ICU teams in Sandwell Hospital.
Lavinia Henry: I started working as a midwife at the Trust at Dudley Road Hospital in 1993. Having gained 25 years' experience in all areas of midwifery – antenatal, intrapartum, postnatal, and neonatal transitional care – I started my current post of research midwife in 2018. Research has always been a passion of mine and as a research link midwife I can offer expert knowledge of our client group, clinical environment and pathways. This practical experience helps in planning recruitment strategies and identifying and overcoming potential barriers to research inclusion.
Memory Nelson: I became interested in research following my high-risk pregnancy, when my consultant offered me the opportunity to take a part in a study that his colleague was running at a different hospital. I had no idea what it meant; all I knew was it was an opportunity to allow my pregnancy to progress.
When I returned to work from maternity, I started talking to the research nurses that came to my ward. I was guided and supported by them and I was soon accepted at a local trust as trainee research nurse. Since 2012 I have since worked in a range of specialities and am currently in rheumatology. Working in research was my way of giving back and has been by far the most rewarding thing I have done in my career.
Sibet Joseph: I have been a registered nurse since 1999. During my career, I mostly worked in cardiology before joining the CRF at Sandwell in 2019. I worked in different areas within the speciality including coronary care unit, cath-lab, cardio-thoracic theatre and in the community heart failure team. I initially joined cardiology research at Ascot Centre and at UHB. My main role as a research nurse is to lead and deliver the allocated different cardiology/lipid trials at the site.
Zoe Pilsworth: I did my undergraduate degree in biology. I enjoyed my degree and I realised that whilst I wanted to do research in healthcare, I wanted to see patients too and help them today as well as tomorrow. So, I applied to do my nurse training through a graduate entry programme. After qualifying, I worked on a busy renal ward and whilst there, I found opportunities to be involved with research on the ward. I gained funding for my own project on mental health training for staff through a National Institue for Health and Care Research (NIHR) project looking to fund research into practice ideas. From there, I then found a job as a clinical research nurse in an organisation which specialised in phase 1 trials, the first stage in human drug trials. Since my husband and I both work in healthcare and did shift work, I had to find a job that would allow me to fit around childcare. Research back within the NHS setting was perfect for this. I was able to use my research skills and knowledge and balance family commitments. I started in ophthalmology research, did some dermatology research, then moved into cancer research, and I was able to apply for funding on another NIHR course aimed at helping early career researchers to learn more and to start their masters degrees. At the moment I am a research nurse but one day I hope to complete my masters and apply for a PhD so that I can run research of my own and be a nurse researcher. If you would like to find out more about research in out Trust and potential career pathways
Authored by the clinical effectiveness team
There are lots of key documents available at SWB to support our people, but do you know there are different types of key documents (policies, guidelines and SOPs), with different publication requirements and support channels?
The clinical effectiveness team have put together some simple guidance to aid understanding of the different types of Key documents and the support available:
Policy A policy will specify must do rules, steps, and regulations that have to be followed.
A policy is a set of principles of action in a particular field, which should be based on evidence, legislation, best practice and statute and incorporate any standards laid down by recognised professional bodies or other national or NHS institutions where available. A policy, once implemented, is mandatory for all staff and failure to comply may result in disciplinary action.
Associate Director of Corporate Governance
swbh.policy-admin@nhs.net
1. Local approval (Team & Directorate)
2. Group Governance Approval
3. Policy Assurance Group
4. Publication
Clinical Guideline
A guideline provides general guidance on how to undertake a particular practice.
Clinical guidelines are systematically developed statements, based on a thorough evaluation of the evidence, to assist practitioner and patient decisions about appropriate healthcare for specific clinical circumstances, across the entire clinical spectrum. As the name implies, guidelines are suggested principles, which are set down to help determine a course of action.
Clinical guidelines are available to support but professional judgement and discretion can still be used. Guidelines may also contain clinical treatment pathways and process flowcharts.
Clinical effectiveness team and library knowledge services
swbh.guidelines@nhs.net
Or direct contact with the Clinical effectiveness Coordinator for your Group: https://connect2.swbh.nhs. uk/governance/clinicaleffectiveness/clinical-auditteam/
1. Local approval (Team & Directorate / Relevant specialist forum)
2. Group Governance Approval
3. Medicines & Prescribing Effectiveness Group (MPEG) if guideline contains medicines and prescribing
4. Publication
Standard operating Procedure (SOP)
A SOP is a set of step-by-step instructions for a team to undertake routine process.
SOPs are detailed written instructions used to document and achieve uniformity on the performance of a specific function or process. These should only contain minimal clinical information, such as how to book transfers for patients, where to store equipment etc. If more clinical information is included, consider whether this should be a clinical guideline.
SOPs may also capture how a team standardly functions.
In response to feedback from our colleagues we also wanted to use this opportunity to improve understanding about the governance requirements for key documents and share some top tips for a quick turnaround:
The need to have a good governance process for document approval can be explained by the need for key documents in general. We want to be able to confidently say: “This document contains correct information about best practice…This document does not contain incorrect information…This document enables us to do the best thing for our patients, people and population at SWB.”
Sign off can go through the following groups:
• Local sign off (team/directorate/ specialist forum): this allows the people most impacted by the guideline to voice their approval or raise queries about the content or how to apply the document in practice.
Your local team and admin support
1. Local approval
2. Group Governance for awareness
3. Local team upload to local intranet site
• Group governance sign off: groups are responsibility for monitoring governance processes and outcomes across all specialties within the group to then inform executive quality group (EQG). The attendance at group meetings provides an opportunity to consider the document from multiple viewpoints so discussion in this forum can advise about wider impact of the document, including things like risk management.
• Medicines and prescribing effectiveness group: this forum has attendance from pharmacists and non-medical prescribers as well as representation from the groups. This sign off is designed to provide assurance specifically around the medication and prescribing content of documents in view national best practice, regional procurement arrangements and local service provision.
• Complete the relevant checklist: these documents were designed based on frequently seen issues – completing the checklist will reduce the number of queries you have to rectify before publication therefore speeding up the process!
• Present your document: It is really useful to have the author or appropriate representative available in the meeting to say ‘this is my document and this is what has changed’. It also reduces avoidable delays by having an expert present to clarify any content queries.
• Final changes: It is common for “conditional approval” of documents to be granted at the various sign off stages.
As far as years go, 2023 is a momentous year for SWB. It is the year when it’s full steam ahead as teams are busy making all the changes we need, to ensure our move to Midland Met becomes a reality. The start of 2023 has seen us achieve significant milestones, including ramping up community engagement with our near neighbours, transforming services in cardiology and frailty, and opening our Sandwell same day emergency care unit. On site, there has been positive progress with the completion of level eight, and perhaps one of the most crucial achievements is appointing a move partner to help us safely and efficiently move into Midland Met.
Health Care Relocations (HCR) is an international company with an outstanding reputation and 30 years of experience. They have safely relocated 500 hospitals, with thousands of patients transferred securely from one healthcare facility to another.
HCR will be helping us refine our relocation planning. They have unparalleled expertise
in hospital moves and will guide us on all the significant elements of our move plan, including defining our operational readiness, mock patient moves, and a recovery plan to ensure we have the most robust measures for our programme. Recently, colleagues observed HCR do what they do best as they moved patients to Zealand University Hospital in Denmark from three hospitals. The new hospital is now the largest in northern Europe, expanding the organisation to 830 beds from 296.
Jayne Dunn, Director of Commissioning and Equipping, who visited Denmark, said: “I was impressed by our visit to see HCR in action and to have the opportunity to bring back some learnings and best practices to SWB. The process was incredibly smooth, considering the detail that went into the relocation of patients, which instilled confidence in our team.
“We witnessed the process from the final planning phase to services fully relocated and everything in between. The strong relationship between the HCR team and
hospital staff was evident, as was the high level of trust, respect, and control.
“A key takeaway for me was the focus on everyone having a role to play on the day and not moving away from that role at any point. Team members were easily identifiable via coloured t-shirts, so everyone knew who was responsible for what, such as IT, patient registration and the transport team.
Jayne added: “Another highlight was the focus on patient safety with the patient census meetings led by an anaesthetist, as well as the mock rehearsals and the upbeat nature of the move day. They moved 80 patients in four hours – one every three minutes and patients had medical staff take the journey with them in case of emergencies.
“Overall, it was a positive visit with some valuable learnings. The HCR team will be here again in June, and we will visit departments, establish our patient transfer committee, and speak to key stakeholders such as West Midlands Ambulance Service.”
Colleagues and children at Sandwell Day Nursery are celebrating after receiving another ‘Good’ rating following a visit from Ofsted earlier this year. The nursery, which has been open since 1979, has received a ‘Good’ after every Ofsted inspection.
In their first inspection following the COVID-19 pandemic, Ofsted looked at four areas before awarding an overall effectiveness rating. Nursery Manager, Emma Collier explains more: “Similar to CQC, Ofsted look at different domains which contribute towards the overall rating.
“They look at the quality of education, behaviour and attitudes, personal development and leadership and management.
“We achieved a ‘Good’ in all these areas and were awarded a ‘Good’ for overall effectiveness, which I am delighted with.”
The report highlighted the ‘kind and nurturing staff’ and describes the behaviour of the children as ‘excellent.’ They were particularly impressed by the outdoor education on offer at the nursery.
“We have really improved the outdoor area at the nursery since Ofsted last visited,” said Emma.
“We have an allotment area in which we grow our own tomatoes, lettuce, and carrots. We have some new imaginative play equipment and a new mud kitchen which the children absolutely love.
“I am incredibly proud of the staff; they work so hard to make coming to nursery the best experience for our children and they deserve to be recognised.”
Radiographer, Rebecca Sargent, uses the nursery to look after her two-year-old son, Otis. She said: “Otis has been coming to Sandwell Day nursery since he was nine months old and during COVID it was tough as we weren't able to go round and look but the staff were amazing and he loved it from the start.
“He goes every day with a smile on his face as the staff are so kind and caring. Every day is always full of fun, but educational things to do and with the daily updates it is so nice to know what he's been up to.
“I am going to be sad when he leaves as it has
been a wonderful place to send him.”
Jessica Downing, Data Coordinator, also uses the nursery to care for her son Archie who is two years old. She added: “Archie is excited every morning to attend nursery and is immediately greeted with a friendly welcome by the nursery staff. They are always on hand to offer advice and reassurance.
“At pick up time Archie is always happy and super excited to show me what he's made at nursery that day. It really is a brilliant nursery!”
The nursery is open from 7.15am-5.30pm Monday to Friday and can cater for up to 68 children between the ages of 0 and five years old. For more information please e-mail emma.collier@nhs.net
You can read the full report here: https://files.ofsted.gov.uk/v1/ file/50214617
Earlier this month colleagues across the organisation were able to join in with a joint celebration event organised by our Trust chaplaincy team. This special occasion brought together the vibrant cultures and traditions of Vaisakhi and Rama Navami, showcasing the rich diversity within our Trust. The event not only shed light on the significance of these festivals but also provided an opportunity for colleagues to meet and engage with our dedicated Hindu and Sikh chaplains.
Vaisakhi is a significant festival celebrated by Sikhs, marking the birth of the
Khalsa and the harvest season. Rama Navami, on the other hand, is a Hindu festival that commemorates the birth of Lord Rama, the embodiment of righteousness and virtue. Both celebrations are deeply rooted in spirituality, community, and the triumph of good over evil.
Our Trust chaplaincy team recognised the importance of embracing these diverse cultural celebrations and fostering understanding among staff members. The joint event was a testament to our commitment to inclusivity and respect for all faiths. Colleagues had the opportunity to immerse themselves in the colourful festivities, gaining a deeper appreciation for the cultural heritage of their colleagues.
Mary Causer, Lead Chaplain, expressed her joy and appreciation for the event, saying: “The joint celebration of Vaisakhi and Rama Navami
exemplifies the vibrant unity of our diverse community. It is through such gatherings that we foster connections, deepen our understanding, and strengthen the bonds that hold us together. Let us continue to celebrate our differences and create an environment of harmony and respect.
“We encourage all colleagues to take the opportunity to pop in and meet our chaplains. They are an invaluable resource, providing spiritual guidance, support, and a listening ear for anyone in need. Their presence contributes to the holistic wellbeing of our organisation and ensures that every individual feels seen, heard, and valued.”
For more information on what the chaplaincy team can support you with, contact the team on 0121 507 3552.
Over the past several months we have celebrated winners of the 2022 Star Awards, recognising them for their hard work and the positive impact this has had on our people, patients and population.
We’ve spoken directly with the winners to get their views and hear what winning meant to them. For the final month’s Our Winners, we met with SWB’s Employee of the Year, Matron for District Nursing, Andrew Churm.
Andy first stepped into his role in 2020, in a seconded position within iCares. His focus was the community COVID-19 response, specifically looking after community swabbing and running testing clinics in outbreak areas. He ran teams across two sites; Little Lane at Sandwell and Summerfield car park at City. At the former site, the community outbreak response was commissioned by the local authority, who instructed SWB to set up a team and work to stop the spread of COVID-19 across areas where outbreaks had been reported. Andy took charge of this, building a team and managing the process of getting out and testing communities en masse.
He stated that this experience was, somewhat unexpectedly, an exciting highlight of his career: “We had an unmistakable vision and sense of purpose, which resulted in a strong and dedicated team. Owing to the nature of the team, there were no previous dynamics – within our roles, we were somewhat transient as we knew we were working on a specific project.
“This meant we could have fun with it, and there was a lot of team camaraderie.”
Andy thought back to a specific example in which the team were sent to a meat processing plant in Tipton that had experienced an outbreak. He utilised skills gained in previous work experience to meet the demand, stating: “Oddly enough, I fell back on my experience working at KFC! We ran the testing centre like a drive through, giving each team member an individual role and processing people through the ‘line’, setting up swabbing pods.”
This innovative approach enabled the team to swab 750 people in three days with a team of just eight colleagues carrying out this massive task. This was one of the first outbreaks the team were responding to, and the success of the approach was key. Andy stated: “We could see that the methodology worked, and this meant we could replicate the approach at volume. It was really time-critical work, as we needed the results back as quick as possible to prevent the spread of the virus and to ensure those that needed to isolate knew about it promptly.”
In addition, around Christmas 2021 Andy’s team was asked to support with the winter wave of COVID-19 vaccines for housebound patients in Sandwell. Linking up with the vaccination team at Tipton Sports Centre, he worked to establish the best method to launch a home-based vaccine programme. This spanned multiple areas, including maximising the number of vaccines from each vial to transporting them safely. They vaccinated around 100 people in total, many of whom were highly vulnerable.
This isn’t Andy’s first Star Award win – he was Digital Leader of the Year in 2019, and he thinks this digital focus helped him clinch the award in 2022. As the digital lead for iCares, he focused on SystmOne, which provides electronic health records for every patient, ensuring this worked effectively for district nurses. He helped to streamline the system, updating clinical information, and in 2021 completed a successful business case on autoscheduling software for district nurses. The team carry out around 800 visits a day and allocate a great deal of resource to scheduling alone. Andy’s focus has been on aligning SystmOne with the new Allocate system; the scheduling software is able to go into an e-roster to see who is on duty and then assign visits to district nurses based on expertise. This new system will be rolled out by the end of 2023.
Moving forward, Andy is keen to build upon his work in digital. In October last year he began studying for an MSc in health data science at the University of Birmingham, with the aim of helping to bridge the gap between clinical and digital, and to understand what the possibilities are in terms of machine learning and AI.
“I’m learning to programme in R and python, which is a challenge, but I’m doing well. I’d love to go into digital health leadership at a regional or national level: I want to be part of the future of the NHS.”
He states the win itself was surreal, and kickstarted a fulfilling part of his life: “On the night, I remember the cheer that I got. It felt humbling and unreal.
“I won the award on 7 October and then started my MSc on 10 October. One month later, I married my long term partner Ian. To be honest, it just really felt like I was winning at life! Getting that award knocked me off my feet and to say it was lovely doesn’t even come close to how I felt.”
To – Joanne Brookes
A massive thank you to Joanne for going above and beyond her role to aid the Trust with ward-based discharges and transfers to support the site pressures over the weekend.
From – Clinical Nurse Practitioners
To
To – Amanda Hillman
Amanda has restructured the storage areas in critical care at City Hospital. During the pandemic critical care had to rapidly increase the storage areas for consumables. There has been a considerable amount of work coordinated by Amanda to ensure robust processes for ordering and ensuring compliance in storing items. Thank you Amanda.
From – Vanessa Taylor
Just a shout out to say that last night the bleep systems went down at Sandwell. The security staff on duty were extremely helpful and efficient in sorting out radios and helping me with the entire process of dealing with a stressful situation that having the bleep systems down caused. I would also like to say that they were very professional and helpful with communication with the switchboard during this process. The members in particular were Gavin and Sunny.
From – Claire Nottle
Shout out has been a regular feature in Heartbeat and it is fantastic to see colleagues regularly taking the time to give positive feedback to each other.
To nominate a colleague, visit connect2. swbh.nhs.uk/communications/shout-out/, or search 'shout out' on Connect and fill in the form.
Dr Murrin is an asset for the Obstetrics and Gynaecology department. He leads our Haem Obs clinic. Obstetrics consultants, registrars, house officers and midwives have no hesitation to contact Dr Murrin regarding any patients. Dr Murrin is approachable and answers any queries even he is not on call. We have contacted Dr Murrin during his annual leave, and he gives his valuable opinion. Recently, we had a clinical query about a patient. He contacted the on call team and gave his valuable opinion and support to the team. Obstetrics and Gynaecology are proud to have him in our team as he goes an extra mile for our patients.
From – Maheswari Srinivasan
To – City Security
For helping the City Hospital portering department in checking all the car parks via the cameras and driving around them for any wheelchairs that maybe have been left out on the car parks.
From – Michael Ingram
To – Narinder Singh
I would like to express my gratitude in the marvellous services always received from Narinder Singh. Narinder understands all our I.T issues in which we come across on our Lyndon 5 ward where he always gets all our issues sorted promptly. In addition, Narinder is always courteous and has a positive attitude in his approach with everyone.
From – Jane Ferguson
To – Niamh Mead-Weston
A patient who came in for a blood test was waiting for patient transport to pick her up. This patient had been waiting for over two hours. Niamh personally went down to Costa and bought this patient a coffee. Niamh is one of our apprentices who is on an apprenticeship wage but still she bought this patient a drink out of her own money.
From – Sandra Evans
To
Rob Kemp and guys from facilities
For being such a lovely bunch of guys that as always, worked so hard and so well to make the moving of the ENT department go so smoothly and with a laugh along the way!
From – Bev Jackson
Shout out to Ami, who is our amazing nurse on Ward M2. She goes above and beyond for all patients and always willing to help. She is an amazing team player and always willing to support midwives. She is a credit to M2 and we are all so proud and privileged to have Ami on our M2 team! Thank you for your endless hard work.
To – Lucinda Bangura
Lucinda is an amazing nurse. She showed true compassion and empathy following a patient’s relatives death. She took the time to sit with them and listen to their concerns and fears. She is a commensurate professional and a credit to the team and the nursing profession.
From – Amber Markham
Thank you so much for going above and beyond in facilitating the transport of a two week wait lady from her home to clinic 6a. Outstanding service, thank you for working hard to help us achieve this positive outcome.
From – Tiffany Jones
To – Amy (RN) on M2
She is always helpful, hard working, goes the extra mile, always has a smile, so kind and good with the patients. She is one in a million, such a wonderful person.
From – Lisa Masters
To – Harriet Clarke
A school that Harriet works in have been in touch to thank Harriet for the excellent service she provides to their school and that they value her work greatly.
From – Kay Baker
As part of the NHS clinical waste strategy, NHS England have set targets so that all waste is segregated correctly. Unfortunately, at SWB we often find domestic waste such as packaging, plastic pop bottles, coffee cups and food in offensive and orange bags which costs the Trust an excessive amount of money.
Dawn Hall, Waste and Decommissioning Manager believes colleagues in BMEC theatres are playing their part in making the area they work in more sustainable.
She said: “The staff within BMEC are engaged and have been a joy to work with. They’re keen to make a difference. Training around waste management has been delivered and will be cascaded across the department.”
As part of mission to make ourselves more sustainable, we are currently rolling out similar initiatives around waste management across the Trust including a number of wards at Sandwell and all theatres.
Dawn added: “The majority of waste generated across wards and departments is not infectious and as such can be disposed of as tiger bag offensive. This subsequently reduces costs and is more sustainable. The changeover won’t cause any additional work for staff, however, there are significant cost benefits.”
It is crucial colleagues start to become mindful of waste management as everyone generates waste. By 2026, NHS England are expecting a 50 per cent reduction in carbon emissions produced from waste management in NHS organisations which will then rise to 80 per cent by 2028.
Fran Silcocks, Head of Sustainability, echoes Dawn’s thoughts and said: “The NHS as a whole produces approximately 156,000 tonnes of clinical waste which is the equivalent to over 400 loaded jumbo jets. This has a significant environmental impact and is associated with high running costs and carbon emissions.”
As part of our continued efforts in going green and becoming a more sustainable organisation, we recently introduced an efficient waste stream in BMEC theatres.
The waste stream was introduced as part of the ongoing project to move the Trust over to using the offensive waste stream, known to many as tiger bags.
“BMEC theatres have been proactive is trying to be more sustainable and are keen to work with the Trust in trying to reduce the negative impact we have on environment as well as our carbon footprint,“said James Morrissey, BMEC Theatre Manager.
“Prior to the change, all of the waste we generated in theatres was going into orange or black bags despite it not being infectious.”
“This is why implementing a good waste strategy over the next 10 years is key as it’s estimated that the NHS can save approximately £11 million every year in recurrent revenue costs, and we can reduce our carbon emissions from waste by around 30 per cent which is equivalent to removing two million road miles a year.”
On a warm day in May, former colleagues from across the UK, Ireland and further afield joined together to say a fond farewell to their beloved City Hospital.
City Hospital, or Dudley Road as it was then known, is home to countless nurses and medical staff. Unlike today, former colleagues would receive their training on site, whilst working and living there too.
What is now the derelict Anne Gibson rooms was once home to a vibrant medical community of student nurses and doctors who called it their home.
City Hospital has a rich history dating back to 1887 when it was a workhouse. Over time it became a District General Hospital in 1920 and is recognised for its Nightingale wards and the long corridor known today as the main spine.
Mel Roberts, Chief Nursing Officer, welcomed guests, and they went on to enjoy tours of the former nursing quarters, catch up with old friends and discover our plans for Midland Met. Throughout the day, there was excited chatter, laughter and the sharing of stories from times gone by whilst everyone looked at some of the artefacts and old photos on display.
A former nursing colleague travelled from New Zealand to enjoy the reunion. She remarked: “I started on 5 May 1987 at 9am. It was the best training and really comprehensive. We covered several specialties, and we had a consolidation week at the school of nursing, and then we’d do our next placement. I went out on the ambulances, community, and haematology. “My parents lived overseas, and I wasn’t from Birmingham. It was nice to have that community with everyone pitching in.”
It's safe to say everybody had a fabulous day and thoroughly enjoyed taking a trip down memory lane.
A £2 million study will see an advanced test used at GP surgeries working with the Trust to diagnose early-stage ovarian cancer –potentially saving thousands of lives a year.
The project involves our clinicians and Walsall Healthcare NHS Trust (WHT) pairing up with primary care provider Modality and the University of Birmingham to offer a blood test called ROMA to patients experiencing symptoms of ovarian cancer.
Signs of the disease include bloating, stomach pain, needing to wee more often and always feeling full.
If they are persistent, severe, frequent or out of the ordinary, women are urged to see their GP where a CA-125 blood test will usually be carried out, which picks up 50 per cent of patients with early stage cancer.
However, the advanced ROMA test used during this trial at Modality-run GP services in Walsall, Sandwell, and West Birmingham will identify key markers of this particular disease at an earlier stage. If a patient has tested positive, they will be referred to their local Trust to attend a new one stop clinic where they’ll see a consultant, undergo a specialist scan and then a further consultation where the results will be shared. They will be referred for further treatment if needed.
Speaking about the study, called SONATA (tranSforming Ovarian caNcer diAgnostic paThwAys), University of Birmingham Professor and Consultant in Gynaecological Cancer Surgery at SWB NHS Trust, Sudha Sundar said: “Ovarian cancer is rare and there is a need to increase the understanding and awareness of the symptoms associated with it amongst our population and GPs.
“We know that 90 per cent of women diagnosed with ovarian cancer at stage one will survive, but this drops drastically to 15 per cent if it is picked up during stage four.
“Research conducted with my team at the University of Birmingham found out that the ROMA test is significantly better than current tests (CA125 and ultrasound) used in both pre and postmenopausal women.
“A previous study had found that the ROMA test detects up to 20 per cent
more early-stage cancers than the current test which only picks up 50 per cent of early-stage cancers. We are putting this research into practice by carrying out this trial.”
“With Modality-run GP surgeries trialling the ROMA test we will be able to establish if it is acceptable to patients and clinicians. By testing many samples across two large laboratories we will be able to confirm whether the ROMA test has a higher chance of detecting this cancer earlier than the current CA-125 blood test used and whether implementing this across the NHS will be cost-effective.
Prof Sundar added: “Both NHS Trusts will be working with Modality in partnership to see patients testing positive at these newly established one stop clinics with specialist scans to assess and treat them accordingly.
“The project will run for 18 months and will also involve pathology services analysing the results.”
Leading on the project, Dr Aamena Salar, Medical Director for Modality Partnership Community Services, said: “Our aspiration is to transform the care of ovarian cancer by earlier detection and better outcomes for our patients.”
Nina Jhita, Programme Director at Modality, added: “This is true innovation; we (primary care) are delighted to collaborate with key system partners across the West Midlands to really make a difference to the lives of women whilst demonstrating how this solution can be scaled across the UK.”
Tony Thomas, Consultant, Obstetrics and Gynaecology, at Walsall Healthcare NHS Trust said: “If survival from ovarian cancer in Britain equalled the best in Europe, then almost 2,400 deaths in our country could be avoided within five years of diagnosis.
“26 per cent of ovarian cancers are diagnosed as an emergency and almost six in 10 ovarian cancer cases are diagnosed at a late stage. It is high time something is done about this.
“At Walsall we’re excited to be part of this project which aims to be a refinement on the current tools available to clinicians to catch this disease at an early stage.
“Doing this, we can make a positive difference to how our women and their families fight this terrible cancer which takes such a huge toll on our society.”
The final part of the study will see 41,000 primary care samples sent to the Black Country Pathology Service and South Tyne and Wear laboratories to accurately establish whether using the ROMA test rather than CA125 will be cost effective for the NHS. The results from the study, funded by the NHS Cancer Programme and the Small Business Research Initiative, will be analysed and used to change the way this cancer is diagnosed in the future.
Professor Sundar added: “It’s an exciting study which is a great example of integrated working between all the organisations involved. We are looking forward to finding out the results so that we can change the way this cancer is detected in the future and drastically improve survival rates.”
In March, the neonatal unit at City Hospital launched the neonatal journey – a standardised document by the West Midlands Perinatal Network to promote parental involvement in their baby’s care.
Sonia Dhesi, Senior Neonatal Sister, said:
“The neonatal journey is a six-month pilot project across all the units within the West Midlands perinatal network.
“It’ll be used to promote parents’ involvement in their baby's care on the neonatal unit and to empower them as confident caregivers to their baby.
“The document was designed by previous parents and helps to obtain the information and skills parents require to care for their baby on the unit and after discharge too.
“There are many aims of the neonatal journey – to improve communication between parents, carers and staff, to support staff to understand the needs of the family, to improve delivery of personalised and culturally-sensitive care, to provide a record of parent learning to ensure continuity in their role when transferred between different neonatal units, and finally to act as a keepsake for families post discharge.
“Based on parental and staff feedback after six months this document will then be reviewed, and a final version will be implemented.
“We are a few months into the launch and have found it is going really well so far and we are hopeful that it will improve our family integrated care going forward.”
Our Trust has been recognised in a leading technology award for its work around using artificial intelligence to assist diagnosis.
The imaging team picked up the Automation, Artifical Intelligence and Machine Learning accolade in the Smarter Working Live Awards – known as the Oscars of the technology industry. We have worked with IBM to trial the software, called Clinical Review 3, which supported radiologists in analysing X-ray and CT imaging results. The software is able to pick up lung nodules, rib fractures and perforated lungs in a matter of seconds and highlight the findings to radiologists if the finding is not in the report.
Dr Sarah Yusuf, Group Director for Imaging at the Trust, explained: “This is an exciting time for us to work on an AI project, and has paved the way forward in collaborating on other future projects.
“Our aim has been to release expert clinician time to focus on reports which need specialist analysis and this project has certainly done that.
“Our radiologists analyse around 350,000 imaging studies every year, and this figure is growing. Radiological diagnoses are complex and CR 3 has aided the quality of those reports and improved patient experience and safety.
“The clinical conditions we expect the system to identify across both X-ray and CT scans are in the chest and abdomen, including rib fractures, pneumothorax, emphysema, abdominal and thoracic aortic aneurysms, pulmonary embolisms and pulmonary nodules.
“The technology uses AI algorithms to identify potential differences between what they would expect (based on data from similar tests) and what the radiologist actually reports. This is then reviewed by the radiologist who decides whether a second look is needed.
“It also highlighted that our current discrepancy rate is well below the national threshold, which is something that our Radiology team should be really proud of.
“If the radiologist is feels an addendum is appropriate, the report will be amended. Any clinical decisions are then made more promptly which will help minimise potential patient harm. Data identifying patients will not be shared with IBM or leave the UK.
“The main benefits of the trial led to improved quality of reporting, and hence improving quality and safety of radiology reports and hence improve the quality and safety of clinical care provided to the patient in a timely fashion.”
Our clinicians are always finding unique ways of working with our patients in order to rehabilitate them so they are well enough to go home.
And this has been the case for patient Oliver who is recovering from two strokes and a heart transplant at Sandwell Hospital under the care of Stacey Hesom, Advanced Occupational Therapist and Melissa Dawidow, Advanced Physiotherapist.
“Oliver’s parents brought in his electronic drum set from home and it’s been a really important part of rehabilitation for his upper limb function following his two strokes. And it’s working really well,” explained Stacey.
“Allowing him to have the kit in hospital and maintain his hobby has been an essential part of his rehab.”
Oliver, aged 27, has been under our care since January and he’s come a long way from having weakness on his left side to now being able to play the drums for an hour a day.
“Everyday he is progressing in the right direction,” added Stacey. “He also keeps the staff entertained with his drumming!”
Oliver, who has been playing the drums since the age of 12, explained: “After having the heart transplant and strokes it was really difficult to play. I found it really frustrating that I couldn’t play and when I did start it was difficult at first. But I didn’t give up.
“Having the kit here in hospital has really helped me in my recovery. It’s made me stronger. Being able to play the drums gives me that sense of freedom, excitement and expression.”
Oliver’s mum Sarah said: “The drums have been amazing for his recovery. They’ve kept him going for his mental health – it’s his passion and skill, drums are his life. Being able to bring them into hospital has been great for his recovery and getting his heart rate going.”
The cancer services team is seeking kind-hearted therapists to volunteer at its next pamper day for 350 cancer patients at the Cancer Wellbeing fair, which will see volunteers come together to carry out massage, makeovers, and haircuts for patients.
Jo Harvey, Lead Cancer Nurse, said: “This is a really great event that aims to offer emotional and practical wellbeing to patients living with and beyond a cancer diagnosis. The day brings lots of local support services together in one place, enabling patients and their carers the opportunity to discover a range of cancer wellbeing services available within the local community.
“The benefit of relaxation and physical therapeutic interventions is effective in promoting positive wellbeing. That’s why the pamper sessions, such as hand and head massages, prove to be so popular. We are calling out to therapists out there who would like to do something worthwhile to come and help us pamper our patients.
“We always have a good turnout and are expecting 350 to attend on the day. We are arranging local entertainment to perform, inviting speakers, and will have information stalls, raffles and a bingo session all on the day. This is our eighth event – we did have to pause during the pandemic so we want to offer our patients something really special.”
Jo added: “What’s best of all is receiving feedback from our patients which always shows how very beneficial they have found
the occasion, often experiencing or finding out about something that they were not aware of and meeting new friends on the way.”
It will take place at Bescot Stadium, Walsall on 1 July.
If you would like to offer your services on the day as a volunteer, therapist, makeup artist, barber or have another talent to offer please contact Jenny Donovan on 0121 507 2776 or email Jennifer.donovan@nhs.net.
Though Healthcare Science Week may have passed, our gastrointestinal physiology service based at Sandwell has recently started a cytosponge service as part of an innovative NHS England pilot.
Cytosponge, also known as a pill on a string, is a new diagnostic test to help detect the early stages of oesophageal cancer in patients with reflux disease.
“The test involves a patient swallowing a capsule consisting of a spherical sponge in a dissolvable capsule, which is attached to a thread, said John Hayman, Clinical Scientist.
“When the capsule is swallowed, the outer coating of the capsule dissolves within seven minutes resulting in the sponge expanding into small, rough-textured sponge in a person's stomach. The sponge is then pulled back up by pulling on the string and it collects cells from the lining of proximal stomach and the oesophagus as it goes.”
Clinical trials have shown it to be a safe, acceptable, and accurate way of detecting cancer and other oesophageal conditions such as eosinophilic oesophagitis (EoE), oesophageal candida, and oesophagitis.
Traditionally these patients would have undergone an upper gastrointestinal endoscopy to diagnose these conditions, however cytosponge is being used to help reduce backlogs post COVID and acts as a less invasive alternative
to normal upper gastrointestinal endoscopy in selected patients. It also helps patients as it reduces pressure on the endoscopy department, meaning that more complex patients can be seen quicker.
John believes the cytosponge service will be hugely beneficial for our patients.
He said: “The service will benefit our patients massively as studies have shown that cytosponge is more acceptable for patients when compared to conventional endoscopy. It is generally better tolerated, and it does not involve any sedation, avoiding associated risks and prolonged recovery times meaning patients can go home straight away.”
He added: “It is a quick and painless test and helps to reduce pressures on the endoscopy unit. Patients can be seen in a normal clinic room with tests lasting no longer than 30 minutes from start to finish. The general feedback so far from patients has been extremely positive, with it being a welltolerated and quick test.”
Haematology colleagues at the Trust and their wider research group were published in the prestigious Journal of Medicine.
The research group consists of senior figures in the Department of Haematology, namely Dr Sukhjinder Marwah, Dr Farooq Wandroo and Dr Hisam Siddiqi, with expertise from Dr Mandeep Marwah and Dr Hala Shokr from the University of Aston and Manchester.
They produced a study named ‘Lactate Dehydrogenase/Albumin To-Urea Ratio: A Novel Prognostic Maker for Fatal Clinical Complications in Patients with COVID-19 Infection’.
Speaking on behalf of the group, Dr Hisam Siddiqi, who will be taking up a Locum Haematology Consultant post at the Trust from June, said: “According to the official UK government website for data and insights on COVID-19, more than 3,000 patients are newly diagnosed with the virus every week with a mortality rate above 14 per cent due to respiratory complications.
“Similarly, to date, approximately 30 per cent of cases were observed to develop acute respiratory distress syndrome requiring mechanical ventilation, with the additional risk of progression to respiratory failure, shock and multiorgan failure.
“Our research group were able to identify a new prognostic biomarker (Lactate Dehydrogenase/Albumin To-Urea ratio (LAU) that can be used to stratify COVID-19 patients into well-defined risk groups based on their susceptibility to develop fatal clinical complications upon admission.
“The validity and sensitivity of this prognostic ratio was tested in more than 1,500 patients and proved to be more effective than all the currently used risk stratifying haematological biomarkers including the neutrophil to lymphocyte ratio.
“We believe the results of our study have important clinical implications since LAU can be quickly measured on emergency blood tests upon admission, which may facilitate appropriate medical treatment and prompt access to the intensive care unit at an early stage, if necessary. Consequently, this can reduce in-hospital mortality, treatment cost and alleviate medical management for COVID-19 patients.
“The Journal of Medicine is an international, peer-reviewed, open access high impact factor journal and a lot of reputable medical societies such as The International Bone Research Association (IBRA), Italian Resuscitation Council (IRC), Spanish Society of Haematology and Hemotherapy (SEHH), Japan Association for Clinical Engineers (JACE), European Independent Foundation in Angiology/ Vascular Medicine (VAS) are all affiliated with the journal of clinical medicine.
“Therefore, it was one of the happiest moments for us to be published, as we felt that all our hard work and effort has been translated into a paper which can help the medical fraternity all over the world. Along with that, it gave us all a sense of accomplishment and motivation to continue research.
“Publishing in such high impact factor international journal is not only beneficial for SWB staff, but also to the medical field around
the world. It gives our work visibility among other researchers in the field, outside of our immediate circle of contacts and colleagues. Additionally, it allows others to learn from and expound on our work so that society ultimately benefits.”
SWB’s deteriorating patient and resuscitation team work to provide guidance and training to colleagues across the Trust, ensuring they have the skills and knowledge required to effectively treat patients. A key part of this is training courses; the team aims to provide quality training and real-life simulations to clinical colleagues, both internal and external, by providing Resuscitation Council UK accredited courses.
Formed in 1983, Resuscitation Council UK is committed to ensuring that survival rates for in and out of hospital cardiac arrest improve. They do this by driving CPR education and encouraging everyone to learn life-saving resuscitation skills. The deteriorating patient and resuscitation service run courses that are nationally accredited by the council, from newborn and paediatric to adult advanced resuscitation. Recently, the service was approached by the Resuscitation Council to pilot a new course and help shape its future.
We visited the team to find out more about the training and see it in action. Lead Resuscitation Officer, Kevin Jennison explained: “We’ve developed a strong relationship with the Resus Council and were heavily involved with the creation of a basic life support instructor model that is now sold by Resus Council UK. My team and I have formed a strong relationship and it’s really exciting to be approached to pilot this new course.
“It demonstrates the calibre of the team here at SWB and we’re really proud of this achievement.”
The pilot course looks to modify the longstanding structure of the adult advanced life support recertification course. The course involves cardiac arrest simulation training and focuses on real life scenarios. Each participant is given a different patient scenario which may occur in the hospital environment and is responsible for leading the remaining team, instructing them on how to treat the patient based on changing circumstances.
The key difference between the pilot course and the traditional adult advanced life support recertification course is that the former does not include a simulated test or multiple-choice questions at the
end. Instead, experienced clinicians on the course are continually assessed, with core skills assessed embedded within each scenario. This means that the participants are evaluated based on their performance throughout the simulations, and the instructors provide real-time feedback to help them improve their skills and knowledge.
The instructors continually update the participants on the patient’s condition, and the candidates work to administer the correct treatment, focusing on lifesaving skills and clinical safety. It’s clear that the course is of real benefit to the clinicians in the room, and they’re able to use the feedback of their fellow candidates and the instructors to learn their strengths and knowledge gaps.
Kevin was clear to note the significance of ensuring these courses are of the best possible quality: “The best gift we can give someone is the gift of life. I want to encourage all clinicians to refresh their training when they need to and make sure they have the skillset to resuscitate a patient - you never know when you might need it.”
If you’re interested in refreshing your training, contact the deteriorating patient and resuscitation team on swb-tr.swbhgm-resuscitation-team@nhs.net
Rowley Regis hospital has trialled a campaign that helps patients to become more active again after an illness through fun activities and exercise. Patients, whether they are in hospital or recovering from an illness at home or in a temporary residential home, will be much less active than normal. This inactivity leads to ‘de-conditioning’, which causes people to lose fitness or muscle tone, especially through lack of exercise. It can also damage a person’s confidence when undertaking exercise such as walking.
Re-condition the Nation is a campaign designed to encourage health and care teams to work together to identify and implement ways to reduce de-conditioning. The campaign was launched in the midlands for a duration of seven months from October 2022 to April 2023, but it has had a lasting impact on all involved.
As part of the Re-condition the Nation campaign, Justine Irish, Professional Nurse Advocate at the Trust, decided to introduce the reconditioning project on community wards. Staff had seen an increase in patients being admitted who had experienced functional decline due to acute episodes of care. At the time there were very little therapeutic activity happening in the wards, so this campaign helped them focus on what was needed for their patients and staff.
The project was as inclusive as possible
in all activities, so that patients could participate regardless of being there for rehabilitation or discharge planning. The aim of the programme was to improve patient experience and wellbeing, while also supporting and including carers.
The wellbeing of staff, patients and their families has been enhanced through this project, which includes simple strength and balance exercises through fun activities like playing skittles, throwing and catching a beach ball and playing ping pong. Most days, one ward may have 15-20 patients participating for a one-hour session. Bedside sessions were offered to patients unable to attend the day room sessions, so they didn’t miss out. The project expanded to PCCT's fourth community ward, supporting 92 patients from September last year.
Justine said: “The difference Re-condition the Nation has made to us and our teams and patients has been immeasurable. We have raised the awareness for staff and patients around the impact of functional decline and de-conditioning and how quickly both can take effect. Now our patients are up and dressed earlier, usually by 10:30am and ready to start sessions pre-lunch, building a healthy appetite for a hearty meal.
“Feedback from patients, carers and staff has been very positive too; they look forward to doing the sessions. The most recent comment from one man was how he looks forward to visiting his wife so he can take part too!
“Sitting time has reduced, step counts increased, and the amount of time people are moving has increased. Our aim is to continue and build on what we started and hopefully encourage others to play their part in re-conditioning. I am eager to see some of the reconditioning principles rolled out Trust wide.”
Whether it’s providing help to support parents of an asthmatic child or a simple chat over a cup of tea, volunteers working with Heath Street Health Centre are proving that social prescribing is the perfect tonic for the community surrounding the practice. Working in collaboration with charities Newbigin Community Trust, Flourish, Earth Gardening, and Humanify, an integrated hub has been set up within the reception area of the surgery which is based at Summerfield Primary Care Centre in Winson Green.
It’s a cosy space where people can pop along to for support, as Sandra Whitelock, Heath Street Health Centre Service Manager, explained: “Anyone from the community can drop in and talk to the team about benefits, drug or alcohol
problems, education or general support.
“On average around 70 people are accessing the hub a month which has led to us increasing the number of days it operates. We are open Tuesday, Thursday and now on Mondays.
“We’ve seen and supported a variety of people, from a mother who wanted help for her child with autism, to assisting a man with his CV so he could get back into work,” added Sandra.
“The volunteers have also provided mental health support for those who’ve been bereaved.
“Most recently the parents of a child with asthma were given the support they needed to register with a GP who provided same day specialist chronic disease assessment resulting in no further admissions to A&E.”
She added: “It’s not just about providing information though – we encourage people to come along and socialise there. We have a craft area set up for young children and there’s tea, coffee and snacks available for free.
“It’s an all-age, whole population approach
that works particularly well for people who have one or more long term conditions, need support with low level mental health issues, are lonely or isolated, or have complex social needs which affect their wellbeing.”
Special events such as coffee mornings and earth gardening seed exchange sessions have been particularly successful in encouraging vulnerable groups such as older residents to view the hub as an approachable, safe space.
Sandra added: “The hub operates walk in appointments and referrals from all practices in the area and GPs have reported a positive impact on patients and staff due to improving connectivity and access during this challenging period.
“Language and interpreter services are available, and the hub has catered activities for children and young people. This has greatly improved population access to health and wellbeing services for some of the most vulnerable patient groups such as refugees, those with mental health conditions, and working families.”
Living with serious mental illness (SMI) can be challenging, especially when it comes to accessing adequate support. Many people with SMI die from preventable illnesses 15 years earlier than their peers, due to a lack of support for lifestyle changes. This inequality can be addressed by improving access to lifestyle changes and support to make these changes a part of their weekly routine. This is where the SMI project comes in.
Your Health Partnership have launched a peer support group for individuals with SMI, regardless of ethnicity or diagnosis, to provide support to patients, carers, and extended family members. Their goal is to create a community where people can feel comfortable and supported without experiencing any stigma attached to their diagnosis.
The SMI project is aimed at offering informal health and activity sessions with the goal being to create a community where there is no stigma attached to a diagnosis of SMI, and where participants can engage in leisure activities and socialise.
The group meets for two-hour sessions in a leisure centre, with an opportunity to join in activities such as carpet bowls, followed by a coffee and social catch-up, with social
prescribers available to offer continued support to patients and carers.
To establish and demonstrate the need for this group, taster sessions were held in December, with board and card games offered to keep the atmosphere light and welcoming. Interest was established, with some regular attenders accessing swimming and enquiring about gym inductions.
The group is supported by volunteers, including patients who have joined as volunteers.
Volunteers are an established part of the team, welcoming new patients, organising registers, and providing support to social prescribers.
CL, a 58-year-old man with schizophrenia, is one of the patients benefiting from the SMI project. He has physical health problems that require specialist mobility equipment, and his wife is his full-time carer. CL struggles with illiteracy, making communication difficult. His physical health has worsened, leaving him feeling vulnerable, low, frustrated, stressed, and isolated.
CL required intensive support from social prescribing and was selected to take part in the SMI project. From the initial consultation, his issues were identified, including problems with his neighbours, who were often causing arguments and complaining to the council, and his property being unsuitable for his needs as he was on the first floor and had fallen several times trying to access and leave his property.
CL also mentioned that he was physically attacked while riding his scooter and gets verbally abused regularly by other road users/pedestrians. He was also at risk of diabetes and was encouraged to make lifestyle changes. The SMI project provided him with support and solutions to these issues, including finding him a new property that was more suitable for his needs, providing him with advice on staying safe while riding his scooter, and offering guidance on healthy eating and lifestyle changes to avoid the risk of diabetes.
The SMI project has held eight sessions from February to March 2023, with 93 people attending, including staff and visitors, of whom 63 were patients and carers. Speakers covered topics such as IT, healthy eating, willow weaving, aromatherapy and hand reflexology, community library services, and board games.
The group is a testament to the power of peer support and the importance of ensuring there is equal access to adequate support for people living with SMI.
Letters, of less than 200 words please, can be sent to the Communications Department, Trust Headquarters, Sandwell Hospital or by email to
Dear Heartbeat
I have been using the Q Park parking facilities for quite a while now since joining SWB but wanted clarification about if parking charges will be coming back to the hospital staff? Times are hard at the moment and if they are coming back, it would be really harsh as money is tight for many of us here. I also heard that the charges will even be going up and not just staying the same. Some clarification of what will be happening with parking charges would be appreciated especially as financially things are so challenging.
Dear colleague,
Thank you for sharing your concerns about car parking charges. I understand your worries and would like to let you know about our plans for car parking charges.
Our Trust and fellow Black Country trusts have no immediate plans to reintroduce parking charges, despite other trusts across the country and locally reintroducing such charges.
Contractually through Q Park, we are required to uplift prices in line with inflation, but this is capped at a level which is much lower than actual inflation.
Given the pressure on our finances and those of the NHS, when we reintroduce parking charges, we will look at applying an uplift. If agreed, this will be applicable to those staff members who pay car parking charges. Any uplift will be clearly communicated before reintroducing charges.
We will share any future updates via staff communications channels. Please keep a look out for future updates.
Best wishes,
Dinah McLannahan Chief Finance OfficerAre you interested in creating positive changes in your area of work and supporting our Trust in becoming a leading sustainable healthcare provider?
Join our Green Impact programme where colleagues work together in teams to complete simple, everyday actions. This could be anything, such as turning off lights and equipment when not required, wasting less and using re-usable items, getting out and taking a walk, using the car less, empowering patients to think ‘green’, and much more.
We have just launched our 5th cycle and have a brand new toolkit. There will be a chance to win prizes throughout the year, with awards and recognition for your team.
To find out more and register, visit https:// toolkit.sos-uk.org/greenimpact/swb/login or contact Head of Sustainability Fran Silcocks on Francesca.silcocks@nhs.net if you fancy a chat.
Don’t sit back – our health and that of the population and future generations is dependent upon greener ways of working.
Following this, Julie left us for a short period of time to complete her orthopaedic training at Coventry and Warwickshire Hospital followed by a brief stint at the George Eliot Hospital within critical care.
“I returned ‘home’ so to speak following my role at George Eliot Hospital to work on the poisons unit as a ward manager at City Hospital, said Julie."
“I was then fortunate enough to be successful in gaining my position where I would have the privilege to set up and open the MAU at Citynow known as AMU.”
all. However, having such a close and hardworking team around me enabled us all to get through it and meet the challenge.”
If Julie was to give any career advice to her younger self or others just starting out their journeys as nurses she said: “I would urge everyone to be professionally curious however always follow your instincts as those more experienced than you are not always right in every situation.”
After a nursing career which spans well over four decades, Julie Thompson, Group Director of Nursing for Medicine and Emergency Care, will be retiring.
Julie started out her nursing training at the old Dudley Road Hospital in 1979 and following her training worked on D6 which at the time was a female orthopaedic ward.
Julie didn’t stop there, as she would go on to complete her masters in advanced clinical practice working before becoming matron. Further down the line in after a short spell at Derby and Burton Hospitals, Julie made a triumphant return as group director of nursing for medicine and emergency care, a position she has held for over four years including during one of the most challenging times within the NHS, the COVID-19 pandemic. When asked about the pandemic specifically, Julie said: “It has to be one of the biggest challenges I have faced during my nursing career. The distress it bought with it to not only patients but also to staff and colleagues was unimaginable, and nothing could have prepared me personally for the enormity of it
She added: “Another thing often overlooked but is so important is to make sure you are passionate about what you do and get great satisfaction and enjoyment in giving care to others.”
Julie has had an illustrious nursing career: but don’t just take our word for it. Debi Fretwell, Group Director of Nursing, has worked closely with Julie at SWB and said: “I have worked with Julie for the last four years, she is an amazing advocate for patients and staff and never afraid to speak up. Her passion for quality and safety is always a priority. She has been such an asset to the Trust and has inspired many!”
As part of her retirement Julie plans to spend more time with her loved ones and hopes to travel more often when possible.
Thank Julie for your service to the NHS and happy retirement!
This month we extend a warm welcome to Simon Mitchell, our new Group Director for the primary care, communities and therapies group. Simon brings a wealth of experience and expertise to our organisation, and we are excited to have him on board.
Prior to joining our Trust, Simon served as the executive partner for 'Your Health Partnership’, our Trust’s primary care network in Sandwell, where he continues to be involved in the care of 53,000 patients. In all Simon has been a GP in Sandwell for over 25 years.
Having previously held the role of director of Sandwell Primary Care Trust, Simon has developed exceptional working relationships with fellow GPs and hospital consultants. His commitment to creating sustainable GP practices, balancing medical advances and increasing life spans with quality of life and appropriate medication, has been pivotal in providing the best possible care to patients.
Simon has witnessed first-hand the changing landscape of medicine, where patients now require treatment for multiple serious conditions simultaneously, and his expertise in managing complex medical histories will be invaluable to our organisation.
Many of you may already be familiar with Simon, as he has been one of the exceptional
Simon Mitchell, Group Director of PCCT GPs responsible for overseeing the care of patients in our medically fit for discharge wards at Rowley Regis Hospital. His dedication to ensuring patients' wellbeing and his leadership in providing GP cover has for a long time made a significant impact on the quality of care we offer.
Aside from his clinical responsibilities, Simon has always been at the forefront of innovation when it comes to healthcare. He
Simon Mitchell Group Director of PCCThas successfully combined routine surgeries, sudden emergencies, planned care, community ward rounds, and management of a large GP practice. Moreover, Simon piloted 'consultation by Skype' well before the COVID-19 pandemic; his efforts in developing digital technology encouraged GPs to adopt similar practices.
Simon's professional journey has been filled with remarkable experiences. He served as a doctor in the military for seven years, including a deployment to Northern Ireland in the early 1990s. In 2004, he embarked on a mission to recruit physician associates from the United States to support clinicians in our area, an initiative that ultimately brought valuable colleagues to our Trust. Simon's dedication to enhancing our healthcare workforce and expanding opportunities for healthcare professionals is truly commendable.
Outside of his medical career, Simon describes himself as an average runner and a worse golfer! He also enjoys spending time with his family and finds solace in Scotland or Greece when he needs to unwind.
With Simon’s extensive experience, leadership, and commitment to providing exceptional care we are confident in his guidance and ability to provide invaluable transformative direction, making a real impact on our organisation. Welcome to the Trust Simon.
Our new ARC Leadership Programme will ensure all colleagues are able to flourish and thrive within our organisation. The last 13 years have seen the NHS face funding constrictions which were exacerbated by the global pandemic leading to severe pressure on services.
We are facing higher levels of sickness than ever with more colleagues suffering a degree of psychological burn out and national and local vacancy rates are at an all-time high. This landscape we find ourselves in means there has never been a better time for us to develop our leaders in a different type of leadership that will benefit the organisation, our staff and patients in the future.
To respond to that challenge we have agreed three strategic objectives:
• Patients – To be good or outstanding in everything we do
• People – To cultivate and sustain happy, productive and engaged staff
• Population – To work seamlessly with our partners to improve lives
Our people plan is our strategic framework for delivering that “people” objective. It
recognises the three fundamental contributors to staff engagement and morale – inclusive leadership, improved digital experience and a comfortable physical environment. It’s very simple: happy staff means happy patients and carers.
The new ARC leadership programme has three core modules:
1. Compassionate and Inclusive Leadership
2. Restorative People Management Practice
3. Leading and Inspiring Safety and Service Innovation
This year we are focusing compassionate and inclusive leadership programme. And I just want to make it clear, compassionate does not mean soft, fluffy or ineffective - it is essentially a way of leading a team, so they feel respected and valued so they are able to contribute in their own way, to our strategic objectives.
On a personal reflection – 20 years ago after being appointed in my first executive role as chief operating officer, I took part in a 360 appraisal which asked my immediate team what they thought of me.
The feedback was very powerful. It said, in essence ‘Richard will hit any target that you want him to hit but he won’t ask why and
Three Core Modules
Compassionate and Inclusive Leadership
(May 23 onwards)
wont involve people in determining how a target will be achieved’. The feedback was essentially saying I was efficient and good at driving the team for out puts but didn’t listen enough or consider their own views or opinions about how a target could be achieved or indeed why that target was important to patients, staff or carers.
This feedback had a profound effect on me and prompted me to go and work in the world of mental health and learning disabilities. I knew that environment was one which was less certain, and less target driven and would not respond to the managerial transactional style that I had developed. I honestly think if I hadn’t moved to that role, I would not have become a chief executive.
A chief executive’s primary task to service their organisation by listening and being aware of what is going on – listen, analyse and work with others. It is not about dominating thinking about certain problems or dictating solutions. That is what compassionate leadership is about.
I am delighted that many of our leaders have already made the commitment to attend this training which starts in June. Please do share your feedback about your experience on the programme.
Key principles
1. Supports the embedding of our new Trust Values and Behavioural framework
2. Supports the ambitions set out within the Trust People Plan , EDI Plan and the requirements set out within SWBH Fundamentals of Care
3. Enables a consistent approach to leadership development for all staff.
4. Evidence-based approach
Restorative People Management Practice
(April 24 onwards)
Leading and inspiring Safety and Service Innovation
(April 24 onwards)
5. Supports the MMUH OD requirements
6. Supports our journey towards embedding an improvement culture
Launch ARC Leadership Programme (end May 23)
• Full details of the programme and roll out dates will be available on Connect end of May 23
• Training to commence for “Team Members “ from June onwards (510 staff members over 12 months – half day sessions) C&I Roll-out Team Member Training- June 23 onwards
@SWBHCharity To donate to the Your Trust Charity text
“SWBH16 £5” to 70070
Your Trust Charity (YTC) recently completed a volunteering programme for young people which garnered positive feedback and great results for the participants.
The programme, which was funded by the Volunteering Futures Fund, worked to engage, recruit and support the development of young people, placing them in intern roles within departments across SWB. The programme targeted young people aged 16-25, particularly those from underserved ethnic groups or living in more deprived areas.
Interns were placed in departments across the Trust, including cardiac rehab, cath lab and the bereavement service. Interns were able to observe the work of different departments and gain a deeper understanding of the Trust’s goals for our patients, people and population. Shadowing specific roles also helped them to understand the variety of roles on offer at SWB.
The interns fed back to YTC with some really positive thoughts, emphasising the impact the placements had on their futures.
“The programme has helped me develop as a Health and Social Care student and it has supported me to expand my knowledge on the clinic and what they do. The staff have been so lovely and have never made me feel left out. They have explained every task to me and guided me through it and answered any questions I had. I have been lucky enough to experience the clinic, ward and cath lab which have all been very interesting to me. The programme has also helped me complete placement hours for college and I have mentioned the programme in my personal statement for university which they loved because it's not that common to have first hand experience in a clinic. Being on the programme has made me realise how much I would love to work in the NHS and that is my dream. I have been lucky enough to sit in on appointments with patients and it was fascinating to hear the same terminology used in college in an NHS setting. I am grateful I had the opportunity to take part in the programme because it's a once in a lifetime opportunity and I enjoyed every week.”
“I have completed my placement with the cardiac rehabilitation team and have enjoyed it immensely. During my placement. I was able to observe and understand just how versatile the roles are. I managed to shadow various responsibilities from going on the ward, to admin work and as well observing a class itself. I have made some extremely useful and detailed notes throughout my placement which I am sure will be valuable for my personal statement. My favourite week has undoubtedly got to be when I went on the ward. The plethora of different cases and the broad range of characters within the patients was remarkable and the nurse who I accompanied was completely admirable in how she articulated the severity of the heart problem as well as measures to prevent further damage. Alongside this, in the gym itself I valued how my weeks had been planned out beforehand and this showed me just how crucial the skill of the organisation is.
Overall, one immense skill I have been able to observe first hand is the skill of teamwork; from the 8am huddles in the morning where responsibilities were discussed for the day and emergency measures were allocated, this allowed the rest of the day to run smoothly. Thank you for this opportunity, it has been extremely enriching.”
“My experience at SWBH was one of the key features in this project; it gave me an opportunity to make a visible and positive effect on the community. I had telephone conversations with people who lost a loved one, listening carefully to their story, I thought about ways that the NHS Trust could make the loss easier for them post-pandemic. Overall, volunteering at the SWBH Bereavement Service has helped me to gain a new perspective on life as I feel that there is no better way to understand the values of helping people. I am also encouraged to further my education by getting an MSc in Counselling.
I must specially thank the Bereavement service team and the SWBH Volunteer service. Thank you to Sue, Angie and Jane for their support and positive impact that they passed on to me in short time with them. It’s been an honour.”
Sarah Cooke
Wendy Hunt
Katie Swift
For further information on the scheme contact Pat Hunt on 07990 351490 or email patriciahunt@nhs.net MP6846
Don’t forget that Your Trust Charity lottery costs just £1 a month and anyone who works for the Trust can join. Payment is deducted from your wages each month. To take part email johnny.shah@nhs.net.
