Royal Free London NHS Foundation Trust Staff, members and governors’ magazine // May/June 2024 We’re delivering world class care for all of our patients “ “ RFL clinical strategy special
Our hospital ambitions We’re introducing new clinical priorities for our hospitals which reflect the needs of the patients we care for. These are: supporting the needs of an ageing population and transforming same day and integrated care: BH developing different types of surgery and focusing on early diagnosis and prevention through our group clinical services: CFH establishing a national centre of academic and clinical excellence for rare diseases, and working with our partners to reduce chronic diseases and improve patient outcomes: RFH Thank you to everyone who has contributed to our plans. You can read more on Freenet and our website. Clinical excellence for all our patients 3 Hello and Peter Landstrom Group chief executive welcome to a very special edition of Freepress – which focusses on our clinical vision and our plans for delivering that into the future. We have captured our clinical priorities in our fiveyear clinical strategy which will be launched this month after engagement with staff from across our sites. In this edition you’ll find some real examples of how our strategy is already delivering for our patients – and you can read more across all of our channels in the weeks, months, and years ahead. Every single member of staff has a role to play. Our aims are certainly ambitious but that aspiring (and inspiring) mentality is in our DNA at the RFL. Underpinned by our aspiration to be a leading research organisation and best in class educator, our clinical vision will make a huge difference to our patients, the communities we serve, and you – the people delivering it. We know our plans for clinical excellence would mean nothing if we attempted to deliver them in isolation and we will continue to work closely with our partners – including University College London, North Mid, the North Central London Integrated Care System and the Royal Free Charity – to bring the best of the NHS to our patients. Key to abbreviations: Barnet Hospital: BH Chase Farm Hospital: CFH Royal Free Hospital: RFH Royal Free London: RFL 2 Every single member of staff has an important role to play in delivering our new clinical strategy and bringing the best of the NHS to all our patients. This special edition of Freepress takes a closer look at some of our teams and services putting our clinical vision into action. More than 12,000 people make up the incredible RFL team: caring for those when we need them most; ensuring our buildings are clean; providing food for our staff; transporting patients through our many corridors; and making sure our support services run smoothly. We’re setting out an ambitious plan to enable our staff to deliver world-leading healthcare for all our patients, meet growing demand and create a healthier future for local people and those further afield who come to our hospitals for specialist treatment. Our clinical vision will transform how we deliver world-class care and the way people access our services. We’ll make the most of advances in digital technology and data. Our group ambitions We’ve identified three group-wide clinical priorities: cancer; cardiovascular; and organ failure and transplantation. The RFL plays a leading role in these areas within north central London and beyond, and they have a significant impact on the health of our local populations. We’ve gathered insight from our clinicians and staff and engaged with NHS organisations, borough partners and other stakeholders – all working together to put our patients first. Our plans are underpinned by five key principles: our focus on world-class care, groundbreaking research, and best in class teaching understanding our populations’ health reducing health inequalities working in partnership continuous improvement. How I care for our patients... Sharif Yusuf, porter, RFH “I transport many patients throughout my shift and always chat with them to see how they are so that they feel at ease on their journey through the hospital.” Asia Khatun, deputy dispensary manager, CFH “I help our patients receive the right medicine at the right time, and offer reassuring guidance during their care journey.” Mhreteab Gebremedhin, diagnostic radiographer, Finchley Memorial Hospital Community Diagnostic Centre “My role is to perform CT and MRI scans for patients and ensure they are safe, comfortable and treated with compassion and dignity.” Amy Taylor, matron for children and young people, BH paediatric department “I work closely with my colleagues to develop care plans tailored to each child’s specific needs, and provide guidance to nursing staff so they have the tools to deliver the best possible care.”
5 4 Improving access to kidney transplants Kidney patients at the RFL are benefitting from a new programme which aims to help them lose weight prior to transplant. Known as Kidney Fitness for Transplant (K-FiT), the initiative focuses on improving the length and quality of life for patients living with obesity who have end-stage kidney disease. Due to the increased risks of surgery when overweight, patients must have a body mass index (BMI) of below 35 and moderate abdominal obesity to be considered for the national kidney transplant waiting list. The aim is to support patients to overcome the barrier of weight loss, so they fulfil the criteria to be listed. A team made up of dietitians, physiotherapists, psychologists, pharmacists, and a kidney transplant surgeon are working together to initially support approximately 40 patients over a year. Barnet has one of the largest and fastest ageing populations in London. Over 58,000 people are aged 65 or older, and this is expected to grow by around a quarter in the next 10 years. This presents a particular set of challenges; people living longer means that they need more care and support later in life, and access to mental health support and urgent and emergency care is vital. “Improving the care we provide to our older patients really is everybody’s business,” said David Levy, clinical lead for elderly medicine. “We have 11 medical wards, eight of which are geriatric wards, and we have 23 geriatricians which is one of the biggest specialties in medicine in the trust,” he said. For elderly patients, spending a long time in hospital can lead to an increased risk of falling, sleep deprivation, catching infections and sometimes mental and physical deconditioning. Clinical and non-clinical teams leading urgent and emergency care at BH are in the process of transforming the way in which adult and paediatric patient care is delivered. The aim is to ensure intervention happens at the right time and place to allow specialists, where appropriate, to assess, diagnose and treat patients on the same day of arrival, instead of admitting them to hospital. To do this we are focussing on the following: Opening of BH’s urgent and emergency care new front door. This space will provide a modern and spacious environment for staff and patients and will house triage, urgent treatment, and same day emergency care (SDEC) services. This is due to be completed this summer. Developing SDEC services, with the aim of delivering the same benefits as inpatient care. Expanding partnerships with external stakeholders to create a fully integrated urgent care offer for patients, in particular virtual ward services. We are working with other local trusts to design and expand this so we can deliver safe care beyond our hospital wards. After six months, most patients will either be listed on the kidney transplant waiting list, offered the opportunity to continue with the K-FiT programme, or provided with a fast referral for weight loss surgery. Jacqueline Gandy, specialist chronic kidney disease dietitian, said: “Individuals living with kidney disease often need to follow strict dietary restrictions and attempting significant weight loss can also add to the challenge of managing their lifestyle. My role involves empowering individuals to enhance their knowledge, confidence, and skills to make informed dietary choices, to help them achieve their health and weight management goals.” Mr Ammar Al Midani, consultant transplant and access surgeon, said: “K-FiT is not only about weight loss for our renal patients, it is about promoting longevity and overall wellbeing. “Through this innovative programme, our goal is to help patients with end-stage kidney disease, either approaching dialysis or currently undergoing it, to get listed on the national kidney transplant waiting list. Having a kidney transplant will significantly improve a patient’s quality of life and enable them to get back to their daily activities.” Over 800 patients visit our hospitals three times every week to receive dialysis – this is the process of removing excess water and toxins from the body to simulate the work of the kidney. Ageing well for years to come L-R: Sarah Afuwape, consultant health psychologist, Jacqueline Gandy, specialist chronic kidney disease dietitian, Ammar Al Midani, consultant transplant and access surgeon, Denise Cunningham, senior specialist renal pharmacist, Natasha Aruk, physiotherapist Natasha Aruk, physiotherapist involved in the K-FiT programme David Levy, consultant physician and geriatrician and clinical lead for elderly medicine The new urgent and emergency care front door will help triage patients upon entry To address this consultants and frailty clinical practice group (CPG) teams have been based at the emergency department and other points of entry to the hospital. They are quickly identifying patients who are suitable for other forms of care, whether that be virtual or ambulatory pathways, or community-based care. “Ageing well is about bringing care to the person’s locality or home where possible, as it is a much better experience for them,” David added. Dementia nurse specialists are also occupying and stimulating admitted patients on wards, while a physio-led ‘keep me mobile’ programme is getting patients out of bed to prevent deconditioning. Improving outcomes for frail patients by reducing time spent in the emergency department (see story above). The plan is to wrap a multidisciplinary team around patients at the start of their ED journey, as well as discharge planning from arrival and to offer a more holistic approach by linking into community services. Ageing well Reimagining urgent and emergency care at BH Organ failure and transplantation My role involves empowering individuals “ “ The team offer meal and exercise plans which are tailored to each patient’s needs, along with comprehensive support for their overall wellbeing. Some patients will also receive medication to support their fitness journey.
6 7 Technology, skills and research collide in nuclear medicine The nuclear medicine team is a shining example of bringing people, technology and research together to provide the best care and outcomes for our patients. The team uses radioactive material to diagnose and treat a range of diseases. Several techniques are used and the team consists of doctors, technologists, radiopharmacists, physicists, radiographers, healthcare assistants and administrative staff. Leading the team is Danny McCool, head of nuclear medicine. “Where the strength of the department comes from is its multidisciplinary nature,” Danny said. “Each of our skill sets are quite different and we all challenge and adapt to each others’ requirements on every day. “The technology is really exciting in nuclear medicine, but new pharmaceutical, mathematical and physics techniques are always coming through which means we can push the boundaries even further.” Earlier this year an £8m positron emission tomography (PET) scanner – the first of its kind in the NHS – was installed at the RFH which allows the team to deliver more accurate and faster diagnoses. It is 11 times more sensitive than the latest standard machines and will help diagnose lymphoma, neuroendocrine tumours, colorectal, skin and lung cancers at a much quicker rate than ever before. Danny describes the scanner as a ‘host of information’. “If different parameters are derived from patient data, we can really discover information on a cellular level that was previously unavailable to us,” he said. “The physics team are very well placed to exploit this data, with their mathematical, statistical and coding skills. “We’re also the biggest centre for radionuclide therapy in the UK, and with our own pharmacy and state-of-the-art PET centre we are positioned to be even stronger going forward.” and is heavily involved in recruitment to the department, which can be a challenge in the UK. “In most other countries nuclear medicine is an option you can do right after university,” Amy said. “To give context – of 30 colleagues here in the department, just one has a British passport, so we are truly an international team.” “With the new scanner, I have had quite a few roles to recruit to which is really exciting but that can also bring challenges as it takes over a year to train someone new.” The new scanner brings with it a range of benefits for staff experience. “Up until this year we were a single-scanner department, and we were scanning more patients that any other similar department in the UK which shows how hard colleagues have been working,” Amy said. skill set to create a better experience for patients. She has been involved in the area of radionuclide therapy since 2013, which was previously solely the remit of consultants and physicists. “That would mean that patients would have to wait for blood tests before starting therapy, which could take a few hours and overall lengthen the working day for the team,” Ivy said. “Now we can send for urgent blood tests and get quick results, and instead of waiting for the cannulation team, I can get started almost immediately which reduces the time the patient has to wait.” Ivy also reports bone density (DEXA) scans, which were previously only carried out by consultants, and ensures that the team remain up to date with changes in nuclear medicine using a quality management system. “There is no blaming culture in this department. If there is a mistake, we capture it, talk about it and find out how we can improve as a team, which I am really proud of.” Amy Pritchard, chief nuclear medicine technologist Dr Malavika Nathan, consultant nuclear medicine physician and radiologist Danny McCool, head of nuclear medicine (front) and the team pictured with the new QUADRA PET scanner Ivy Vito, deputy chief nuclear medicine technologist Cancer Dr Malavika Nathan, consultant nuclear medicine physician and radiologist, is the co-clinical lead for nuclear medicine. “Nuclear medicine has expanded hugely in the past 20 years,” Malavika said. “That expansion has mainly taken place over the past 10 years, in terms of the number of cameras, staffing and the size of the department. “We are embedded in the oncology service. So many cancer patients will at some point during their treatment come into contact with us, and we have a heavy presence within multidisciplinary team meetings for the further care of the patient. “We also see research as a new frontier for the department, and with academic posts coming along with the scanner, we will be able to take that forward,” Malavika added. Amy Pritchard, chief nuclear medicine technologist, says that her day-to-day role is a “little bit of everything”. She manages a large team of technologists and support staff “Technologists can see more patients in a shorter period of time, and our capacity has been futureproofed. The admin staff can now open the diary and book a slot without the need for active cancellation lists, making for a nicer environment to work in.” Ivy Vito, deputy chief nuclear medicine technologist, is one of the team members who has expanded her The technology is really exciting in nuclear medicine “ “ Research is the new frontier “ “
8 The lives of women across the country and north central London continue to improve one year on from the introduction of a new fibroid treatment at CFH. The RFL was the first of four centres in London to begin offering Sonata, known as sonography-assisted transcervical fibroid ablation. The treatment alleviates symptoms of fibroids by using radiofrequency energy in the uterus. It is minimally invasive and sees women across the UK travel to CFH, even from as far as 200 miles. Clinical studies have shown that it is effective, with 96% of women saying their symptoms improved within a year. Consultant obstetrician and gynaecologist Mahantesh Karoshi carried out the first procedure in March last year. Dr Karoshi said: “The Sonata treatment changes the lives of women who are troubled by fibroids. If patients meet the criteria, it is the least invasive treatment option for them to become symptom-free. Before, some women would need major surgery, whereas now, we can treat patients while talking to them and they can go home the same day.” Giving everybody the same access to healthcare is central to improving the lives of the populations we serve. Early and equitable diagnosis within the RFL’s pathology services is one way we are doing that for patients, no matter where they live. This service involves a dedicated team of approximately 60 clinical and non-clinical staff who aim for quick turnaround times for tests and results. Around 80-90% of urgent samples and 70% of routine samples are processed within five working days – a critical metric in cancer pathways. Within the service, each hospital within the group, including partner North Mid, maintains its own specimen reception area where samples are processed before being transferred to the main laboratory. Here, the bulk of the processing occurs, and then glass slides are returned to the clinical team for reporting. “A significant advancement in the field of cellular pathology this year is the adoption and implementation of ‘digital pathology’,” said Dr Dhili Arul, clinical director for Delivering world-class care for patients with rare disorders Stephanie Schandorf Gogo is the latest patient to undergo the procedure. She said: “I was having heavy and painful periods from my fibroids, but I didn’t want to put myself through surgery. I wasn’t sure if I would be able to have the treatment at first but luckily, Dr Karoshi told me he could treat some of my fibroids using Sonata. The procedure went really well.” pathology. “That is set to replace microscopes as the main way to examine samples, which should enhance efficiency and accuracy in diagnosis.” In clinical biochemistry, the team includes consultants, junior doctors, and clinical fellows, who oversee laboratory operations and provide clinical interpretation services for clinicians and local GPs. The RFL consultant team have also been part of developing an internationally recognised service for managing complex lipid disorders. They run extended clinics such as the HIV lipid clinic, joint paediatric lipid clinic, and joint fatty liver/lipid clinic. “The team is also involved in conducting clinical trials related to the treatment of lipid disorders to advance medical knowledge,” Dr Arul added. The combined efforts ensure all patients receive timely and accurate diagnostic assessments, which leads to earlier treatment and better outcomes. Changing the lives of women with fibroids Prevention and early diagnosis for our populations Obstetrics and gynaecology team at CFH Ava Jones is one of the patients using the rare diseases service at the RFH. The 22-year-old has been coming to the hospital for the past four years, having been diagnosed with Niemann-Pick disease type C (NP-C) aged 16. People with the condition are unable to process large molecules within their cells, meaning fats accumulate around the brain, liver and spleen. It’s a progressive disease and symptoms include difficulties with mobility and dementia. NP-C is caused by a rare gene mutation – neither Ava’s mother Debbie nor father Steve knew they were carriers for the gene until Ava’s diagnosis. Debbie said: “Ava was initially diagnosed with hydrocephalus, which is a build up of fluid in the brain, and was treated for that. However, the symptoms continued after the treatment, and eventually she was diagnosed with NP-C. “We wanted to be part of a clinical trial – it was why we decided to come to the Royal Free Hospital. It means coming here every six months for some tests, but we wanted to give Ava the best chance and to help expand the knowledge of this disease which has no cure. “We are so proud to have Ava as our daughter,” Debbie said. “Despite everything that she has to deal with on a daily basis, she keeps smiling through and her smiles and laughter are infectious.” Rare diseases Centre of excellence in elective surgery Early equitable diagnosis 9 Ava Jones with her parents Debbie and Steve Improving the lives of people with rare disorders through innovative treatment and research is a key part of the RFH ambitions. These disorders include amyloidosis, systemic autoinflammatory syndrome, haemophilia, immunology, lysosomal storage disorders, scleroderma and pulmonary hypertension. When patients are referred from across the country to the rare disorders service, investigations are carried out on the same day, and many of the patients are keen to participate in clinical trials in order to push knowledge forward and help find improved treatment options. Pratima Chowdary, clinical service lead for rare diseases, said the aim is to bring together support services that will enable them to deliver better patient care, increase research opportunities and create efficiencies. “We want to bring together academic and clinical research to provide the best patient care using the latest diagnostics,” she said. “We also have logistical and operational support, like accommodation for patients who have to travel to come here, pharmacy and IT. It also means comprehensive care, supporting both the physical and psychological health of our patients. “The set up will be similar for each service so if we can coordinate and pull together, that will benefit all of us.” The rare disorders service is pulling together a strategy, setting out how this approach would work in practice – and part of this is providing a new IT system that will cater to the needs of the rare disorders services. It is hoped that the new system will be available in the coming two years.
Patients with heart failure at BH are accessing consultant-led care from the comfort of their own home, thanks to a ‘virtual ward’ project aimed at helping them recover faster. Following an assessment to check they are stable, suitable patients are discharged home with a blood pressure monitor and medical-grade scales. They are asked to enter their results into an app each day and the results, along with any symptoms, are monitored by the cardiology team. Where needed, medication can be adjusted, with doctors available over the phone to respond to any concerns. Nicolas Karpasitis, 42, from Barnet, says for him the experience has been nothing but positive. He came to BH’s emergency department with breathing problems related to an enlarged heart. He said: “The cardiology team have been brilliant and I found it really interesting to monitor my own health – in fact I’ve enjoyed playing a role in my recovery. At one point I did have to come back in as an inpatient, but the majority of time was spent at home. When I was finally discharged off the virtual ward it felt a bit sad actually, it felt like losing a friend as I enjoyed chatting to the team. Now I continue to be monitored but not as intensely.” 10 11 Governors’ update Exploring Maggie’s “I’ve enjoyed playing a role in my recovery” We want to hear from you! In this special issue dedicated to our clinical vision we’ve highlighted some of the work already taking place but we know there’s so much more to share. We want to hear from you about key developments, the innovative approaches you’re adopting and what this means for our patients. Email us at rf-tr.communications@nhs.net and tell us about the incredible work your teams are doing. Become an RFL member You can become a member of the RFL for free if you live in England, are 16 or over, or are a carer for a patient that is under 16 years old. Full details can be found on our website. Our governors are elected to represent the interests of members and to hear the views of staff, patients, and the public. If you would like to get in touch please email rf.governors@nhs.net know, familiar surroundings are a significant factor in patient wellbeing.” The virtual ward utilises a user-friendly app to monitor weight, blood pressure, and any other relevant symptoms. This allows the team to promptly adjust medication as needed. Strict criteria are in place, patients must be medically stable and have the capacity to actively participate in their care. Access to a smartphone is also a requirement. Jennifer Lane, a heart failure clinical nurse specialist, said: “Previously patients were waiting up to a month for their first clinic appointment and up to nine months for a follow-up appointment. Now we’re able to review patients the day after discharge from their own home. During their two weeks on the virtual ward they come in regularly for blood tests and receive medication which is rapidly increased to the top tolerated dose. Nicolas’s case was particularly complex but being on the virtual ward highlighted the issues he was facing and prevented him returning to us via A&E. “We currently have 10 patients on the virtual ward at any one time and that number will rise.” Although the team is still collecting and evaluating the data, they believe the results will show better outcomes for patients. The project has been funded by the North Central London Integrated Care System (NCL ICS). Governors and non-executive directors celebrated the incredible work of Maggie’s staff during a visit to their new centre in the grounds of the RFH. The new centre, designed by renowned architect Daniel Libeskind, was opened by Her Majesty the Queen in January this year and has seen on average 60 people per day since then. It provides a space for people living with cancer, their families, and their friends to seek advice and support away from a hospital environment. Elected governors Natasha Leith-Smith, Sean Baine and Dov Gerber were joined by Atka Raja, nonexecutive director, for the visit. Atka said: “It’s great to see this incredible building open so our patients can get the support they need during the most difficult and challenging moments of their lives. I very much look forward to seeing what the next chapter of the partnership between the Royal Free London and Maggie’s brings.” Natasha commented: “I was very happy to hear that the local community, as well as our patients, can access the life-changing services that Maggie’s provide through the new centre. I have no doubt that this building will act as sanctuary for those affected by cancer and we are extremely lucky to have this so close to home.” L-R: Michelle Niblett, senior heart failure CNS, Jennifer Lane, senior heart failure CNS, Dr Leon Moradians, heart failure fellow and Feysiola Idowu-Olowu, heart failure CNS Dov Gerber, Sean Baine, Atka Raja, Natasha Leith-Smith and Helen Muir Nicolas Karpasitis played an active role in his recovery from the comfort of his own home Cardiovascular Patients do not need a referral or an appointment to visit the centre. Staff are on hand to provide help and information, support groups and activities and benefits advice, all designed to make coping with cancer easier. Sean said: “The centre really is an amazing space. They have gone to great lengths to make it feel homely and ensure that everyone who walks though their doors feels welcome.” Governors and non-executive directors also had the opportunity to visit the private patients’ unit at the RFH. They were shown the incredible facilities on offer to patients including inpatient ward, outpatient clinics, the oncology suite and the dialysis unit. The ‘go see’ visits give governors and non-executive directors the opportunity to see different parts of the trust together monthly. They listen to staff, meet patients and provide constructive feedback about what they have seen. Cancer Familiar surroundings are a significant factor in patient wellbeing “ “ Dr Nelson Amaral, the consultant cardiologist behind the project, said: “We recognised that a virtual ward could be a perfect fit for heart failure patients. These patients often experience lengthy hospital stays, but in many cases, close monitoring can be effectively conducted from at home where they can enjoy a better night’s sleep. As we
12 Doris Ajayi, clinical nurse specialist, dementia care at BH Janadean McDonald, endoscopy unit manager at CFH Deepa Patel, diabetes clinical nurse specialist at RFH We get to know the person who is behind the dementia. Sometimes we can forget who the person is, that they’re someone who enjoys music, exercise, likes to have a cup of tea first thing in the morning. When we understand that person, we begin to tailor their care. We’re looking at early discharges, prevention and how we link with other agencies to continue with what we put in place. The big thing is preventative steps: eating Our endoscopy team are always looking at ways to improve outcomes for patients and reduce waiting times. We see anywhere from 40 to 70 patients a day and have introduced several innovations to enhance their care, including transnasal endoscopies which are faster and more comfortable than traditional gastroscopy as they go through the nose rather than the throat. We also offer general anaesthesia cases for patients who don’t want to be sedated, providing more comfortable procedures. Endobronchial ultrasound tests for respiratory diseases such as lung cancer, which enables more precise treatments. Data from the RFL diabetes clinical practice group (CPG) shows that approximately 25% of beds are occupied by patients who have diabetes every day. At the RFH, patients with chronic illness such as diabetes are managed by the acute medical teams with specialised diabetes teams providing an advisory service five days a week. We plan to implement a collaborative and completely digitalised CPG focused on inpatient diabetes care across all the RFL hospital sites. Our aim is to improve well, sleeping well and helping the people caring for them to reduce the risk of the person with dementia developing any other long-term conditions so they don’t have to return to hospital. Recently I referred a patient’s daughter to an Admiral nurse who provides support in the community. She was also connected to Barnet Carers which offers a range of services including information, counselling and practical assistance. When I met her again a few months later she was much happier and now has a network of other caregivers and support. We are piloting face to face preassessments to address all our patients’ concerns before their procedure. This helps reduce waiting times, avoid cancellations and unnecessary delays on the day of the procedure. Our exceptional service was awarded accreditation from the Joint Advisory Group on gastrointestinal endoscopy (JAG), an independent assessment scheme. This wouldn’t have been possible without my amazing colleagues, and I’m very proud that we’re contributing to CFH’s clinical vision. safety and reduce risk of harms caused to adult patients who have diabetes. We want to achieve this by working with patient care teams to identify patients with diabetes in EPR, targeting appropriate monitoring and care. Our digitalised pathway will present real time information to help with timely clinical decisionmaking. We hope to further develop working partnerships by providing live alerts to the diabetes team, providing real time data to enable clinical teams to monitor the quality of their care. We believe this data-driven and partnered approach is the way forward for diabetes care. Making our clinical vision a reality “ “ “ “ “ “
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