RDExpress Summer 2013

www.rdehospital.nhs.uk

The newsletter for members of the Royal Devon & Exeter NHS Foundation Trust

RD&Express

Channel 4 News came to see the good practice in our Emergency Department …For the full story, see Page 8.

Summer 2013

In the national

Inside pagesn A patient’s view of our hospital 2n Our NHS Heroes at the RD&E 3 Extraordinary People Awardsn All Change for the NHS 4&5n Events for Members, Governors Elections 6

n Medicine for Members and 7 Tam’s vital organ donation workn ED in the Spotlight 8 Beating the Bugs!n Space-age eye surgery comes to Exeter 9n Jason’s wheelchair innovation 10 Cancer summit 10n RILD building construction is all on track 11

Would you recommend the RD&E? 11

Adel Jones, Clinical Services Manager, outside the Emergency Department.

spotlight

News2


Since April, patients have been more involved than ever before in inspecting the quality of the care environment. The NHS has introduced a new monitoring system, called PLACE - Patient-Led Assessments of the Care Environment. (This replaces Patient Environment Action Team (PEAT) inspections.)

Assessment teams can include patients, carers, ex-patients, Governors, and staff, but at least 50% of the team must be patients and their representatives.

Their visits focus entirely on the care environment and do not look at clinical care provision or staff behaviours, which are covered under separate arrangements.

Assessors are looking for how well a hospital is performing in relation to:• privacy and dignity• cleanliness• food • general building

maintenance.

The RD&E welcomed its first team of PLACE assessors on 21st May. Amongst them was James Bradley, a director of Devon Senior Voice. Here are some of his reflections on the process.

“I saw my role as being a critical friend, helping to identify areas for improvement and ensure they are included in any internal development programme. One of the minor issues we identified, for example, was skirting coming away from the wall, so we wanted

to make sure that materials used in future are robust and fit for purpose.

“We had been advised that if something caused us serious concern, we could take the issue beyond the hospital management and could contact the Care

Quality Commission. I’m glad to report that we didn’t need to use this option!

“All the assessors were expected to sample the food prepared and served at both the lunch and supper session.

“This is a new process, so naturally there are some things that could be improved –but there is no doubt that this is a really good benchmarking tool. I’d like to see it used more frequently than once a year.”

RD&E Faci l i t ies Service Manager, Martin Armstrong, who manages the visits on behalf of the Trust, agreed with this, saying: “The new process is a big improvement on what happened before.

Having more patients and their representatives on the team is incredibly valuable. They bring a fresh and independent perspective, and picked up some very useful points on their first ever visit. I’d definitely like to introduce a process for mini-PLACE visits to take place two or three times a year. That would give us a continuous focus on the patient’s view of our care environment.”

A patient’s view of our hospital

3


Our People

Two staff members at the RD&E have received NHS Hero awards.Consultant plastic and reconstructive surgeon, Mr Vikram Devaraj and oncology nurse, Katie Williams, both received their awards in the spring from chairman, James Brent.NHS Heroes was a recognition scheme that was launched to coincide with the NHS’ 64th birthday in July 2012.

The RD&E has just enjoyed its first ever Extraordinary People Awards season – and the response from staff and patients was very encouraging.

The judges had a difficult job deciding the overall winners (listed below) from a competitive shortlist. One judge summed up the process by saying: “It was every bit as enjoyable as I thought that it would be but much harder than I thought that it would be.”

Staff were nominated in five categories: Excellent Care, Exemplar, Exceed, Individual Extra Mile and Team Extra Mile.

There will be three seasons of awards each year and one annual awards celebration. The winners of the Spring, Autumn and Winter awards will be automatically

shortlisted for the Chairman’s Exceptional Award in the annual February celebrations.

There will be two more annual awards – the Extraordinary Volunteer Award and the Experience Award.

If you or someone you know has received exceptional care as a patient at the RD&E, you can nominate in the Excellent Care Award category or the Extraordinary Volunteer Award category. Go to our website at www.rdehospital.nhs.uk to download a nomination form.

Our NHS Heroes at the RD&E

NHS restructure4


On 1st April 2013, the biggest re-structure the NHS has ever seen came into effect. The changes were part of the new Health and Social Care Act 2012 introduced by the coalition government.

The government felt that the changes would improve the way the NHS is run and that patients will be better off under the new system because more decision-making about services is now in the hands of local communities.

The new system is also intended to deliver better value for money and focus more on preventing ill health.

Clinical Commissioning Groups (CCGs)Under the new structure, primary care trusts no longer exist. They have been replaced with CCGs, who are expected to work in partnership with health and social care providers in their area.

There are two CCGs for Devon: Northern, Eastern and Western (NEW) Devon CCG, and South Devon and Torbay CCG.

NEW Devon CCG commissions services for 900,000 people in our area and is the largest CCG in the country, responsible for £1.1 billion of NHS money. As its title suggests, this CCG is split into three localities and the RD&E is covered by the Eastern locality, chaired by Dr David Jenner.

CCGs commission hospital services but do not commission GP services, dental services, pharmacies or some aspects of optical services, military and prison health. Instead, these are now the responsibility of the NHS England area team for Devon, Cornwall and Isles of Scilly.

Many of the public health responsibilities previously undertaken by primary care trusts are now the responsibility of local authorities.

HealthwatchHealthwatch is the new independent consumer champion created to gather and represent the views

of the public. Healthwatch has a role to play at both national and local level in making sure that the views of the public and people who use health services are taken into account.

Healthwatch Devon replaces the Devon Local Involvement Network (LINk Devon) and also:

• represents the views of service users, carers and the public on the Health and Wellbeing boards set up by local authorities

All change for the NHS!

Chief Executive, Angela Pedder, and Chief Nurse/Executive Director of Service Delivery, Em Wilkinson-Brice, with the Speech and Language Therapists.

NHS restructure 5


• provides a complaints advocacy service to support people who make a complaint about services

• reports concerns about the quality of health care to Healthwatch England, which can then recommend that the Care Quality Commission takes action.

Health and Wellbeing BoardLocal authorities are now running Health and Wellbeing Boards. These offer a forum for local leaders from the NHS, public health, adult social care and children

services, elected representatives and Healthwatch, to plan how best to meet the needs of their local population and tackle health inequalities.

Speech therapists transfer to RD&EAs a result of the NHS structural changes, we have also welcomed a new team of professionals to our staff: 26 Speech and Language therapists (SLT) responsible for providing adult Acute and Community services transferred from NHS Devon to the RD&E.

Chief Executive, Angela Pedder, and Chief Nurse/Executive Director of Service Delivery, Em Wilkinson-Brice, with the Speech and Language Therapists.

Members Events6


All Foundation Trust members are welcome to attend the Council of Governors meetings. The next will be on October 14 from 2 – 4.30pm at Cardinal Newman House, Wonford Road, Exeter. There is no need to book but if you would like more details of the meetings, please contact the Foundation Trust Office on 01392 403977 or email: [email protected]

Annual Members Meeting 2013Our Annual Members Meeting for 2013 is due to take place on Saturday 28 September. As last year, we will combine our Annual Members Meeting with a Members Say! event. All the details are still to be confirmed and all members will be sent an invitation in due course.

Events for Members 2013

• There are 26 Governors on the Council of Governors, representing the public, our staff and local organisations such as Devon County Council.

• It is the Council’s role to challenge the Board and hold them to account for the performance of the Trust.

• It is their job to appoint (and remove if necessary) the Chairman and the Non-Executive Directors on the Board.

• Governors take part in events like Members Say! so that they can talk directly to Members and listen to their views.

The Council of Governors

The process for this year’s elections to Council of Governors is now underway. At the time of writing, we do not yet know if voting will be required in all three of our public constituencies but if required, voting will take place during August and September.

Where a vote is needed, voting papers will be sent out to Members on 20 August. Votes must be returned by 10 September, with election results declared by the RD&E on 11 September.

The Council of Governors is accountable to the local community and the Trust.

Members and the opportunity to vote for your representatives on the Council of Governors is a vital part of ensuring your views about the Trust are heard. So please remember to vote.

A view from a Governor:“Governors at the RD&E provide an important contribution to the Trust in representing members, communities and the public. Governors have

statutory responsibilities for holding the Board of Directors to account for the well running of the hospital and feeding back the views of the members it serves. It is therefore really important that Members have their say by voting for who they want to represent them.”

Dianah Pritchett-FarrellPublic Governor

Elections to the Council of Governors 2013

Medicine for Members 7


Medicine for MembersMedicine for Members talks are held for Foundation Trust members, allowing members to find out more about some of the specialist work carried out by our team of experts here at the RD&E.

Our next talk is:

Organ Donation6 September 2013,

1pm – 2.30pm

The RD&E’s organ donation Specialist Nurse, Tam Jackson, will be talking about the importance of organ donation. The talk will cover why organ donation is needed, what can be donated and who can be a donor. See below.

For more details of the talk, including the venue, and to book your place, please contact the Foundation Trust Office on 01392 403977 or email: [email protected]

Tam Jackson has been the specialist nurse for organ donation at the RD&E for two years.

Her role is to co-ordinate the organ donation process. She assesses potential donors, talks with the family to gauge their understanding and to offer them information and options, and then, if it is appropriate, she takes them through the consent process.

If organ donation is what the family wants, Tam speaks to nurses and organises where each identified organ will go, depending on the match. She then invites the team of specialised surgeons to prepare theatre, and stays with the donor patient throughout surgery. She then arranges for the removed organs to be transported to the recipient’s hospital and completes the paperwork.

Tam says: “My priority is to support the donor patient’s family and the

staff involved. I will contact the family at the end of surgery and if they wish, accompany them to view their relative.

“They also have the option of receiving a letter at a later date, giving them some information about those who have received transplants and how they are doing. Many people find this letter very helpful and treasure it for years to come.”

Tam has 20 years’ experience in intensive care nursing, 11 of which have been at the RD&E. She has also worked in a cardiothoracic unit where she looked after heart and lung transplant recipients and saw the benefits of organ donation.

She adds: “Out of hours (evenings and weekends), either I or one of my on-call colleagues will also be involved with talking to families about tissue donation.

Tam’s vital organ donation work

Tam Jackson, specialist nurse for organ donation.


News8

Emergency Departments have been hitting the headlines recently as hospitals across the country struggle to cope with a huge increase in attendances. At the RD&E, we have more than 90,000 attendances at ED each year and have experienced year-on-year growth of around 4% a year.

The winters of 2010/11 and 2011/12 were particularly difficult for us, with unprecedented levels of ED activity and long waits for patients. This affected the whole hospital.

In January 2012 we started a major change programme to tackle this. It was focussed on ED as the ‘source’ of the pressure, but took a wider approach and looked outside the hospital walls to start tackling the underlying issues. Initiatives included:

• Opening 48 new beds, providing a dedicated ward for frail elderly patients and a therapy-led ward to help prepare people better and sooner for discharge

• Having a senior doctor within the medical triage unit to speed up decision-making

• Ensuring that frail, elderly patients are seen quickly by our Acute Care of the Elderly team

• Running a joint public health campaign to point people to the most appropriate service for their

needs – which might be a pharmacist , NHS Direct, their GP or local walk-in centres rather than ED

• Taking a zero-tolerance approach to avoidable delay for patients

• Creating a dedicated ED assessment unit for children

• Working with GPs to extend their opening hours over the winter.

These developments have made a real difference and we experienced a significantly better winter during 2012/13 than the previous two winters. In May, we hosted a visit from Channel 4 News which was able to report: ‘No crisis here’. There is no room for complacency though: we have yet to see the introduction of 111 in Devon and the local population continues to grow, so pressure on ED is likely to increase.

ED in the spotlight

Beating the bugs!Like all hospitals, we have set ambitious targets to reduce hospital-acquired infections. One of these is MRSA, which stands for Meticillin resistant Staphylococcus Aureus (Staph. aureus). This is a common bacterium that can live, quite harmlessly, in the nose, throat and sometimes on the skin of about 30% of healthy people.

However, Staph. aureus may cause harm (infection) when it has the opportunity to enter other parts of the body.

Since 2004/5, thanks to vigorous infection control measures, we have managed to reduce the number of MRSA infections acquired in the RD&E by 98%.

This year (2012/13), thanks to the continued efforts of our infection control team and clinical staff throughout the Trust, we have had no hospital acquired MRSA blood stream infections during the entire year. In fact, we are already well on the way to two years since our last MRSA blood stream infection was identified.

Adel Jones, Clinical Services Manager, Emergency Department.

9


News

The RD&E’s West of England Eye Unit is offering new, ‘space-age’ laser surgery for glaucoma for the first time in the South West. We are one of only around 12 hospitals in the UK to have the state-of-the-art laser equipment: a micro-endoscopy unit , which makes glaucoma surgery safer, faster and more convenient for patients.

Consultant Ophthalmologist, Mr Michael Smith, is one of two specialists at the RD&E trained to use the new equipment. He explains: “Glaucoma is a condition of the eye that can lead to blindness, if untreated. Treatment involves lowering the eye pressure and in most patients this is achieved with eye drops. If this isn’t effective, surgery is required.”

Conventional glaucoma surgery is usually effective, but it takes around 45 minutes and requires the patient to lie still for all that time. It also has a number of potential side effects such as reduced vision and wound problems, which are a particular concern in elderly patients. Following the surgery the eye needs to be checked every few weeks for three months and therefore many hospital visits are required. Surgeons also usually prefer to remove any cataract which is present before undertaking glaucoma surgery, and this means an additional operation.

The new laser procedure only takes 10-15 minutes, and can be done at the same time as cataract surgery. Everything is done under local anaesthetic and fewer follow up visits are needed. Not everyone is suitable for this kind of surgery, but already over 50 patients in Exeter have benefited from the procedure, and the results so far have been very positive.

Local grandmother, Maureen WiIks, 79, can vouch for the new treatment, having had conventional surgery on her left eye, and the new laser treatment on her right eye.

She says: “I’m a keen gardener and cover a lot of miles walking, so I really value my eyesight. I had problems with pressure in my eyes which was affecting my vision. I had surgery to insert a drain in my left eye last year, but I kept having relapses. In the end, I needed three different operations. I still have a bit of double vision in that eye.

The laser surgery on my right eye was amazing. I had a single operation to remove a cataract and treat the glaucoma. It was all done under local anaesthetic and I didn’t feel a thing. I had to use eye drops after surgery to prevent infection, but I now have perfect eyesight in my right eye. I’m really thrilled to have my sight back.”

The new equipment cost £45,000 and was purchased using charitable funds donated by past and present patients of the West of England Eye Unit.

Space-age eye surgery comes to Exeter

Everything is done under local anaesthetic in the new procedure.

RD&E News10


The RD&E’s Portering Manager has come

up with an innovative way to make the

transportation of patients with medical

pumps and intra-venous (IV) drips a better

experience all round.

Currently, medical pumps either slide down

or get cross-threaded behind the IV poles

meaning they either have to be balanced on

the back of the chair, arm rest or on occasions

patients have carried them on their laps.

When Jason Maddocks heard about the

problem, he set about trying to solve it.

He said: “A member of staff came up and

told me about it so I took a look and saw the

issue straight away. The poles needed to be

thicker but still fit the current wheelchairs. I

then contacted our supplier to ask if we could

adapt the pole to hold the pumps.

“We have just taken delivery of 180 new poles

and we are putting the finishing touches to

the development before we can start using

them.”

Jason’s wheelchair innovation

During 2012/13, the Trust has experienced challenges in meeting some of the national cancer performance targets, in particular the target to commence treatment within 62 days of a referral for suspected cancer. Behind every referral is an individual with the threat of cancer hanging over them until diagnosis is confirmed. Our aim is for all individuals to receive the advice, diagnosis, treatment and support they need as quickly as possible.

Reducing waiting times for all cancer patients is one of our biggest challenges in delivering an effective,

timely and positive experience for our patients and involves a large number of departments working together.

On the March 27th, we held the first in a series of ‘cancer summits’ for staff involved in delivering cancer services focussing particularly on actions that will help achieve the cancer waiting times targets. Everyone had a shared goal: to ensure cancer patients receive the best care possible as quickly as possible.

Cancer summit

RD&E News 11


The construction of the new Research, Innovation, Learning and Development (RILD) building is progressing well and is on schedule for completion in November. Work began on the building, which is a joint venture with the University of Exeter, a year ago.

It will bring together all undergraduate medical students

and postgraduate doctors in training, along with a wide range of other staff.

An exciting development is the advanced clinical skills simulation facility which will enable the RD&E to provide innovative, state of the art learning resources for multi-professional teams. Facilities are also available for hosting seminars

and conferences. Some other good news is that there will be a Fine Fillings café with doors into a garden with picnic area. The garden faces south and south west so will be perfect for lunchtime!

Lead project manager, Julie Blight, said: “The aim is to provide a single centre for training all RD&E staff.

If you’ve ever recommended a restaurant to a friend, or written a review on Tripadvisor, you’ll know that personal recommendation is one of the best indicators of customer satisfaction.

Referrals and recommendations are part of our everyday life, and we’re using them in the NHS. The government has introduced a new ‘friends and family test’. The aim is to gain a quick and timely view of what patients feel about the care they received.

Since the beginning of February, the RD&E has been running the friends and family test, which is

completely anonymous, and the service rolled-out nationwide April.

Sandy Chivers, who is leading the project here, said: “This new test does not replace any of our existing and more detailed monitoring of patient opinion. It’s an extra measure that gives us a very quick snapshot of how our patients view the care they received with us. Every Trust in the country has to ask exactly the same questions and publish its results. The aim is for hospitals to identify and celebrate what’s working well, as well as picking up and resolving potential problems.”

Would you recommend the RD&E?

RILD building construction is all on track

Email address

Keep in touch12

Have you recently moved house or changed your contact details? Let us know so you can continue to receive information from us.

The Foundation Trust membership office can be contacted by telephoning 01392 403977, by emailing [email protected] or by writing to: RD&E NHS Foundation Trust Office, Room E219, RD&E Hospital, Barrack Road, Exeter, EX2 5DW.

For more information about the Foundation Trust visit the RD&E website: www.rdehospital.nhs.uk

We can arrange language translation if you do not speak English. We can arrange British Sign Language interpretation, and also give you this information in larger text. Please ask us on (01392) 403977.

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RDExpress Summer 2013