July August RDENews 10 July 2012

www.rdehospital.nhs.uk

Royal Devon and ExeterNHS Foundation Trust

August 2012

RD&Enews

Bed capacity boost page 4

Gold standardOlympic care page 11

A UKsurgery first page 5

UPDATE

Staff newsletter www.rdehospital.nhs.uk

2

Meet our Chairman

Q Tell us a little about your background?

Man and boy I have been a banker, though I need to be careful about admitting that now. I started at 17 and left when I was in my early forties to set up my own businesses. I have a series of business from hotels and farming to retail. I am delighted to be part of the Royal Devon & Exeter family.

Q Why did you want to be our Trust chairman?

The RD&E was always the example I gave head hunters of the type of role I would like to do because it is community focused and it’s very important to me because I have five children, and living just outside Crediton, this is our local hospital. I have not been involved in healthcare before so it is a whole new learning exercise.

Q Is it an advantage or disadvantage to be a newcomer to healthcare?

Being new to healthcare could be a disadvantage without having a very good executive team. Bringing in the petulant child who keeps asking why over and over can be useful. Quite often in any line of business, work practices can become entrenched because ‘that’s the way things were done yesterday.’ Someone who knows nothing about ‘how yesterday used to be’, can be quite refreshing to an organisation.

Q What do you know of the RD&E by reputation?

A reputation for being a caring institution which is also very business driven, very

The RD&E News had time with our new Trust chairman Mr James Brent to find out why he took on this challenging role and how he wants to see the Royal Devon & Exeter go from strength to strength.

focused and an efficient user of resources. Generally good, I hear many more compliments than complaints.

Q What is your role as chairman?

There are in my view, two roles for the chairman. The first is to provide the checks and balances to the executive management of the hospital, and challenge if necessary, to ensure the most efficient way of working to benefit our patients and make best use of resources. The other role is to be supportive of the executives – a critical but constructive friend.

Q What’s your view on staff contribution to the success of the RD&E?

RD&E staff are, in my view, the most important asset this hospital has. It’s nothing

without them. Times are challenging at the moment and will be for several more years to come but we need to work very closely with our staff across all grades to try to provide even better patient care in an environment where resources are going to be very tight. We need to look within the hospital and outside the hospital at the total patient pathway to see how we can encourage people who do not need acute services not to come into hospital; and for those that do, when they are well enough to leave hospital, ensure they have the right support to go home or back to the community.

Q What do you see as our challenge in times of uncertainty and change?

Change is absolutely critical. With medical innovation it can be a very exciting period as well as worrying as we go through change. I hope that when staff look back on this period of austerity they can say wow we are looking after our patients even better with lighter resources. I think that will be incredibly rewarding for people.

Q What do you think will be a measure of our success?

I think the patient is everything the RD&E is about. Although I am not personally a ‘touchy feely person’ I do totally recognise that our primary metric of success is our patients leaving hospital as well as they can, having had as enjoyable an experience as they can. We need to improve the quality of experience at the RD&E but also recognise increasing financial restraint.

RD&E staff are, in my view, the most important asset this hospital has.

Meet our Chairman


3

Q Why did the Trust Board recently approve plans to increase bed numbers at Wonford?

The Board of Directors, quite rightly, before I joined the RD&E, was focused on looking at the patient pathway and how we can best look after our patients outside, as well as within, the hospital. Part of this focused on the frail elderly and the environment in an acute hospital setting not necessarily being the best place for these patients. So that has naturally driven the RD&E and other hospitals into a focus on bed reduction. It became apparent as I joined the executive team that the rate of change to sort this patient pathway would not be sufficiently quick enough to ensure safe treatment of our patients and to address the concerns our staff have (regarding bed capacity pressures).

So what we are doing, which is slightly counter intuitive in a period of austerity, is opening two new wards with additional beds for medical patients during the winter months. What we are saying is that we totally buy in to the focus on greater care in the community but what we are not going to do is push well patients who require support outside an acute hospital if it is not safe to do. We will listen to our staff on how best to address concerns they have but with recognition of our financial restraints and the need to

be more efficient within our hospital as well as the wider healthcare system in Devon and Cornwall.

Q What are your first impressions from meeting staff in different roles and settings?

The thing that came across immediately, but probably not unexpectedly, is the absolute passion for care that staff from clinical and support roles, like administrative services, have at the RD&E. There’s a great passion and culture of looking after sick people. Perhaps slightly unexpected is the enthusiasm there is to see change provided it is in the best interest of the patient. There’s no resistance to change here provided the patient comes out as a winner. I think this is really thrilling. There is also the ‘smart’ or intellect of people across the hospital, and the analysis done and thought people put into making patient care better and to try to make the RD&E run more efficiently.

Q How optimistic are you about the future?

Looking forward the RD&E has an incredibly strong bedrock to build on. There will be massive change in the public and private sectors and the NHS probably does not feel as protected as we are told it is so we must do more for less. The added problem in this part of Devon is increasing frail elderly demand we need to meet. There’s a need for change but it’s really exciting and I am really proud and delighted to be part of it.

The RD&E News had time with our new Trust chairman Mr James Brent to find out why he took on this challenging role and how he wants to see the Royal Devon & Exeter go from strength to strength.

n Thanking hospital volunteers for their hard work

n Serving patient meals on Kenn & Bovey Ward

n RILD project time capsule ceremony

There’s no resistance to change here provided the patient comes out as a winner.

4

Bed capacity

The RD&E and wider local NHS community has been managing unprecedented numbers of emergency admissions, particularly of frail and elderly patients over the past year.

The Trust Board of Directors has agreed the following to alleviate bed capacity pressures at the Royal Devon & Exeter:

n Re-designation of Lowman ward from a surgical day case and admissions unit into an inpatient medical ward with recruitment of permanent staffing

n Purchase of a 48-bed modular ward with permanent staffing. The ward will consist of 28 medical beds and 20 short stay rehabilitation beds. A successful pilot between November 2011 and April 2012 provided rehabilitation which enabled patients to leave hospital and return straight home – removing the need for transfer to community-based care

n Development of a dedicated admission and day case facility on Knapp and Capener wards

n Recruitment of additional staff on two surgical/orthopaedic wards to care for medical patients on a planned basis from January-March 2013.

The plan is for the additional beds to be available by the end of November 2012.

Trust Chairman Mr James Brent said: “We have seen an almost 14% increase in the number of patients aged over 80 years, coming to our hospital, particularly between October and May. Our hospital has also responded

Plans to invest £4.6 million of capital funding to increase the number of ward beds at the Royal Devon & Exeter Wonford hospital this winter have been approved by the Trust Board.

to an unprecedented number of elective (planned) patients with complex care needs in orthopaedics, cardiology and surgery. This high demand for our services has come at a time when we continue to experience problems enabling patients who are ready to leave the RD&E but need on-going care in a community hospital or other setting. The consequence of this has been an unacceptable number of elective patients having their non-urgent procedures cancelled and failure of our Trust to achieve our 18 week from referral to treatment target.

“We recognised that the measures being put in place with our commissioners NHS Devon and other healthcare providers to ensure a timely discharge from acute hospital to a community-based service will not be realised before next winter and that, in the best interests of our patients, we

needed to take steps to resolve our bed capacity pressures.

“This investment will enable us to deliver clinically safe and financially sustainable care for our patients in an increasingly challenging economic environment. The measures to increase bed capacity for this winter will help address the more immediate operational pressures the Trust faces in the short term. Our longer term strategy, in line with government health and social service plans, is to provide more joined up care for patients in or closer to their homes, not from a larger acute hospital.

“Getting this extra capacity up and running by November, particularly the staff recruitment, will be challenging. This decision has not been taken lightly at a time of financial constraint but it is our priority to ensure patient safety and quality of care is maintained at the Royal Devon & Exeter.”

This investment will enable us to deliver clinically safe and financially sustainable care for our patients in an increasingly challenging economic environment.

A UK first


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The RD&E is the first NHS hospital in the UK to perform an innovative new surgical procedure for patients with a severe persistent form of acid reflux.

Consultant Upper Gastro-Intestinal Surgeon Mr Saj Wajed implanted the LINX Reflux Management System using keyhole surgery on a 21 year old male and 52 year old female patient with Gastro Oesophageal Reflux Disease.

The LINX System is a small flexible band of titanium beads with magnetic cores placed around the oesophagus just above the stomach to restore a barrier to reflux and eliminate painful symptoms which disrupts sleep, eating, drinking and relationships.

6

Diamond Jubilee

The Improving Working Lives Staff Lottery wants project ideas to fund – contact us via IaN (look up L for Lottery) or speak to Bernadette on ext 3977

n Clinical Service Manager Stuart Cannonier started a ‘cream or jam first’ debate when he served scones.

Being in hospital did not prevent our patients from being able to join the national celebrations of The Queen’s Diamond Jubilee anniversary.

n Kenn and Bovey Ward Matron Debbie Cheeseman, pictured with her daughter Millie, said: “For those patients who did not want to miss out on the jubilee celebration we wanted to host our own tea party. Senior managers served afternoon teas and cakes, and for patients with dementia, our nurses made memory cards with images of Queen Elizabeth to prompt discussion and recognition of this special occasion.”

n Over 3,000 individual Jubilee themed cupcakes were made for staff working on the Bank Holiday Tuesday.

n Over 70 cancer patients, their relatives and hospital staff enjoyed a buffet in the Haematology centre thanks to the support of the charity Exeter Leukaemia Fund.


Staff health & wellbeing

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The Improving Working Lives Staff Lottery wants project ideas to fund – contact us via IaN (look up L for Lottery) or speak to Bernadette on ext 3977

Colleagues who signed up to Salary Sacrifice Schemes run by the Trust were entered into a prize draw.

Michaela signed up to the RD&E Car Benefit Scheme to save money but also won a voucher from Automotive Leasing which is running this initiative. Michaela said: “My old car was approaching 10 years old and costing me £150 per month in maintenance alone. The scheme has given me the chance to lease a brand new car through my salary. It means no more spending on maintenance, tyres, breakdown cover, insurance, road tax or accident management. There was no deposit or credit check and it’s all tax free. It proved to be too good an opportunity to miss and has certainly meant that my 110 mile daily round trip is much better!”

Shirley Todd from Pharmacy signed up

to the Childcare Voucher Scheme and also won a £25 shopping voucher from Sodexo, the scheme operator. Shirley said: “We save almost £2,000 a year as a family on childcare with this scheme. With two children in nursery four days

a week, this has had a really positive impact on our monthly spend. My husband and I both work at the RD&E, so can claim the maximum in childcare vouchers. It’s a really easy scheme to use and the money goes straight into my account.”

Salary Sacrifice Lead Steven Ball said, “RD&E staff are able to save money through a government backed initiative called Salary Exchange. By exchanging part of your salary, staff can purchase a service or product. The deductions are taken from your Gross Pay which means you do not pay tax, national insurance or pension contributions and can make savings of up to 50% depending on your personal circumstances.”

Theatre Nurse Michaela Rance had good reason to smile when she won a £25 voucher in a prize draw as part of a staff benefits awareness event.

They handed out platters of fresh fruit, pots of fresh fruit salad, along with goody bags containing fruit and dried fruit samples to staff, patients and visitors, as well as providing advice on healthy eating and cancer prevention.

Dietetic Assistant Gemma Moffatt said: “Fruity Friday gave our team the opportunity to discuss and educate staff and members of the public that having five portions of fruit and vegetables on a daily basis can have a positive effect on an individual’s health. Fruit and vegetables are an important part of the daily diet. They are naturally good sources of vitamins and minerals and also contain other compounds such as antioxidants and phytochemicals which help protect the body against diabetes, heart disease and some cancers.”

Our Dietetic Team held their annual awareness day to help staff and members of the public understand the importance of diet, nutrition and cancer prevention on Fruity Friday.

Stagecoach offers RD&E staff a 10% discount on their four, 13 and 52 week season tickets for bus travel on their services.

This new discount was negotiated when the Trust reviewed the discount scheme to meet HMRC guidance to employers.

Colleagues who currently have a 52 week Megarider bus pass paid for through their monthly salary will not be affected by the changes which came into effect from 30 June 2012.

More details are available on IaN or email [email protected]

n More information on how you may be able to save money is available on the Salary Exchange pages on IaN.

8

Labour of Love

Richard, who has been part of the Estates maintenance team for over 22 years, crafted a new cross for the chapel from a tree planted on the Wonford site 40 years ago. Now more than 30 feet tall, the tree was brought to the UK as a seedling taken from an ancient Plane tree growing on the island of Cos where Hippocrates first practised.

Richard said: “This was a very unusual project for me – a great way to end my career here. We took a number of limbs from the tree in August last year and seasoned them over the winter. I love working with wood and enjoyed the challenge of finding the right shape of timber and producing the final piece.”

Lead Chaplain, Simon Harrison said: “Richard has been the backbone of our project to fully refresh our sacred space. We carried out a range of small changes to increase multi-faith flexibility but keep the distinctive identity of our Chapel. For this unique cross we worked closely together to select the wood and produced a beautiful, natural piece with a gentle curve suggestive of the human form. I hope Richard will be proud of this and his many other contributions to the fabric of the RD&E.”

Long serving colleague Richard Brown completed his final major project for the hospital Chapel ahead of his retirement.

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We have over 400 volunteers who carry out a wide range of duties from running errands for patients, chaplaincy support, greeting visitors and giving directions and being a friendly face to talk to when waiting for clinic appointments. We also work in partnership with voluntary charities and groups which support RD&E services and patient care including FORCE, WRVS, Hospital Radio, the League of Friends and The Comforts Fund.

Their hard work and commitment was recognised at the annual Volunteers’ Tea Party hosted in the main hospital restaurant. Trust Chairman Mr James Brent, pictured, said: “Our volunteers generally like to give something back to the Royal Devon & Exeter with their time and goodwill. We know that their friendly professional support enhances the hospital experience of our patients and their families and we are very grateful to them all.”

Volunteers who give up their time to support the RD&E hospital were thanked for their valued contribution to patient experience at a special tea party.

Praise page


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Clinical Biochemist Tim was presented his award by Secretary of State for Health the Rt Hon Andrew Lansley CBE, and Chief Scientific Officer at the Department of Health Professor Sue Hill OBE at Westminster Hall in London.

Thousands of children and young people will benefit from his innovative work. Tim developed a urine test which can help identify the two per cent of young people with a type of diabetes called MODY (Maturity Onset Diabetes of the Young) and results from a single faulty gene.

Importantly, the treatment of this type of diabetes may involve tablets instead of lifelong insulin injections. Genetic testing can give a definitive answer but is too expensive to use to test all children with diabetes. Tim has developed a non-invasive screening test that can identify children most likely to have MODY and therefore selected for genetic testing.

Tim, who works at both the Peninsula Medical School on the RD&E Wonford hospital site and the Clinical Chemistry Laboratory worked out how best to do the diagnostic test and created a test kit for the diagnostic assessment.

Stephen has worked in partnership with the RD&E for 14 years to enhance the hospital environment with the display of art in the buildings and grounds. Stephen was shortlisted for the Arts In Health South West award for the individual category. It is organised by Arts & Health South West and funded by the Fine Family Foundation.

Congratulations to Stephen Pettet-Smith of Exeter Healthcare Arts for achieving ‘highly commended’ award recognition for his work which has transformed the hospital experience for our patients, visitors and staff.

Dr Tim McDonald has been awarded the Young Healthcare Scientist of the Year accolade for his work which transforms diabetes screening in young people.

Congratulations to the most consistent overall performers and most improved wards for MUST (Malnutrition Universal Screening Tool) assessments of our adult inpatients.

In January 2012 we launched our Your Nutrition Matters campaign to raise staff awareness and use of this important assessment tool. Twelve months ago only 49% of our adult inpatients were being nutritionally screened within 24 hours of admission to our hospital and only 70% within the week. This position has improved with 88% of patients being screened within the first 24 hours and 97% within a week. Now we must keep up this up and improve further. We also introduced an electronic referral system with the aim of achieving a timely patient referral by ward teams to our dietetic service.

Pictured is our Director of Nursing & Patient Care Em Wilkinson-Brice presenting a 1st prize voucher and certificate for most improvement to the Acute Stroke Unit team members Alison, Kevin and Sunny.

Well done to all the winners: Most improved 2nd place Bovey Ward, 3rd place Clyst Ward, 4th place Bolham Ward and 5th place Culm Ward East. Most consistent overall performance:1st Exe Ward, 2nd Wynard Ward, 3rd Otter Ward,4th Acute Medical Unit West and 5th Dyball Ward.

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10

Improving patient care

A recent Rapid Improvement Event identified several improvements for development over coming weeks.

Later this year a new NHS Jobs2 system will be introduced to enable candidates and recruitment managers to track progress of individual applications. In the meantime, recruiting managers can support their HR colleagues and reduce unnecessary delay by correctly completing and submitting the paperwork. Information is on the IaN recruitment pages.

n Impact Assessment Forms are no longer required

n All ATRs are to be signed off by a Divisional Manager or authorising manager

n ATRs no longer have to be submitted to Finance

n Only ATRs submitted electronically to the Recruitment Inbox with the required attachments (Job Description/Person Specification and advert in correct format) will be processed

Our recruitment processes are changing for the better.

Head of Midwifery Tracey Reeves said: “The care we provide women is evidence-based and of a high quality. It is obvious that a lot of hard work and commitment from the midwives and neonatal staff has changed the way we approach breast feeding and the information we are giving to women to enable them to breast feed their babies. We decided to join forces with UNICEF UK’s Baby Friendly Initiative to increase breastfeeding rates and to improve care for all mothers delivering within the maternity services.”

The Baby Friendly Initiative, set up by UNICEF and the World Health Organisation,

is a global programme which provides a practical and effective way for health services to improve the care provided for all mothers and babies. In the UK, the initiative works with health professionals

to ensure that mothers and babies receive high-quality support to enable successful breastfeeding. The award is given to health facilities after an assessment by a UNICEF team has shown that recognised best practice standards are in place.

Baby Friendly Initiative Programme Director, Sue Ashmore said: “We are delighted that the Royal Devon & Exeter has achieved full Baby Friendly status. Surveys show us that most mothers want to breastfeed

but don’t always get the support they need. Mothers can be confident that their midwives will provide the highest standard of care.”

Infant Feeding co-ordinators Karen Read and Charlotte Kilvington explain:

“There has also been an increase in information and support given to women who choose not to breast feed their baby. Of course the work does not stop and we encourage the continued commitment to protecting, supporting and promoting breastfeeding in our work with women across the service. We would like to thank all the midwives across the Maternity unit here in Exeter, the birthing units in Tiverton, Okehampton and Honiton, and the many community midwives across the area for their hard work and support in achieving this accreditation. Plans are afoot to more formally celebrate this.”

We have done it! Our Maternity and Neonatal services are now fully Baby Friendly accredited – the first in Devon to achieve this prestigious status.

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Olympic care


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NHS professionals have given up annual leave to volunteer for this once in a lifetime experience – providing top class healthcare services for competitors in the pre-games training and during the Olympics event during July and August.

LOCOG (London Organising Committee for the Olympic Games) asked the British Society of Skeletal Radiologists to provide expert musculoskeletal imaging for all athletes and the wider ‘Olympic family.’ A project committee was set up four years ago with elected volunteers who are all Society members. Dr Silver was elected to this committee and has worked with

the other members to set up imaging facilities throughout the UK and recruit a 116-strong volunteer workforce of radiologists, radiographers and radiographic assistants.

Dr Silver said: “We anticipate providing musculoskeletal medical services to about 200 athletes daily in the state of the art polyclinic in the Olympic village. There has been multi-million pound investment in the clinic technology – including two MRI scanners, a CT scanner and three ultrasound machines. This will not only benefit the athletes, but long after the Olympics, is set to be a lasting legacy benefitting local NHS patients. Information

available from the World Games in Beijing suggests there were over 21,000 medical cases and 1,000 of them needed imaging examinations. We will endeavour to turn around the imaging service on the same day of the request which potentially could generate 100 MRI scans within 24 hours at peak demand times. It is going to be hard work but opportunities like this come about once in a lifetime and it will showcase the excellence in musculoskeletal imaging in this country.”

Consultant musculoskeletal radiologist Dr David Silver, featured on the front cover, has played a key role in the setting up of specialist imaging services for hundreds of international athletes competing in the 2012 Olympic and Paralympic Games in London.

Designed & Published by Octagon Design & Marketing Ltd, Britannic Chambers, 8a Carlton Road, Worksop, Notts. S80 1PH Tel: 01909 478822

12

Breaking news

The Royal Devon and Exeter NHS Foundation Trust has not vetted the advertisers in this publication and accepts no liability for work done or goods supplied by any advertiser. Nor does Royal Devon and Exeter NHS Foundation Trust endorse any of the products or services.

Every possible care has been taken to ensure that the information given in this publication is accurate. Whilst the publisher would be grateful to learn of any errors, they cannot accept any liability over and above the cost of the advertisement for loss there by caused. No reproduction by any method whatsoever of any part of this publication is permitted without written consent of the copyright owners.

Octagon Design & Marketing Ltd. ©2012 Britannic Chambers, 8a Carlton Road, Worksop, Notts. S80 1PH. Tel: 01909 478822

The RD&E was one of six NHS trusts shortlisted nationally for the Stroke category in the Care Integration Awards hosted by The Health Service Journal and the Nursing Times.

The awards are designed to demonstrate on a national scale how clinical collaboration is improving your care pathway; promote best practice and inspire other trusts to further integrate their services; and reward and show appreciation for hard-working, dedicated healthcare professionals.

The RD&E piloted and developed a successful initiative to help patients recover from stroke in their own homes instead of needing to stay in

hospital for treatment. Specialist nursing care and rehabilitation is provided at the same level in terms of quality as the patient would have received had they been

a hospital inpatient but it means patients leave sooner and receive their therapy in the comfort and familiar surroundings of their homes.

Consultant stroke physician Dr Martin James said: “This is terrific national recognition of great work done by our new Stroke Support Team in transforming patient experience for people with stroke in East Devon. The pilot scheme has been very highly evaluated by local patients, carers and GPs. It’s been a very exciting improvement to the Stroke Service in Exeter and Eastern Devon.”

Our Early Supported Discharge work for Stroke patients was ‘highly commended’ at a national award ceremony just as this newsletter was going to press.

July August RDENews 10 July 2012

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