Centre stage for WITH:STAND graduates Combatting racism together Staff, members and governors’ magazine // January/February 2024 Royal Free London NHS Foundation Trust
Follow our X account @RoyalFreeNHS to see what our patients and staff are saying about us Hello and Peter Landstrom Group chief executive welcome to the January/February edition of our staff, members and governors’ magazine. Firstly, I want to recognise the hard work put in for the latest period of industrial action at the beginning of January. You are all incredible and I would like to thank everyone involved in the enormous planning and preparation efforts. While this prolonged period of strike action has had a significant cumulative impact on our activity, waiting lists and patients, I also recognise the impact it has on staff. I encourage you to use our health and wellbeing resources which are signposted on Freenet should you need them. I am delighted to see we are marking the one- year anniversary of The Freedom from Racism at the Free programme (page 8) and hearing from some of our WITH:STAND graduates. I hope you will all take the time to read about this event and learn about our plans to counter discrimination, break down barriers and embrace equality. It is fantastic to see how well electrocardiogram integration is going so far (page 4) and what that is delivering for staff and patients. I look forward to its continued roll out and the difference it will make. Looking to the year ahead, we have many exciting new developments coming. Whether that be through the launch of clinical, research or education strategies, or furthering our many partnerships, with your help and support, I am confident we will continue to bring the best of the NHS to all our patients. Key to abbreviations: Barnet Hospital: BH Chase Farm Hospital: CFH Royal Free Hospital: RFH Royal Free London: RFL 2
Ring comes full circle from Radhika to Suraj … and back again Radhika reunited with her ring New Year miracle after doctor’s diamond ring is found 3 A diamond ring has been reunited with its grateful owner after travelling nearly 100 miles from Suffolk to the RFH where it ended up in the pocket of a set of scrubs. Suraj Shah, an anaesthetics registrar based at the RFH, discovered the ring in his newly-laundered green scrubs ahead of his ICU shift days before Christmas. He said: “As I put the scrubs on something clattered to the floor and a colleague spotted the ring and alerted me. At first I thought maybe one of the nurses here had lost the ring and I put the word out through the nurse in charge. I checked with the doctors as well but nothing, so I contacted our facilities team. “I knew how downhearted my wife would be if she’d lost a ring that had sentimental value to her so that was in the back of my mind. As healthcare workers we often take off rings for procedures so it’s an easy mistake to make.” The RFH facilities team contacted the laundry they use and amazingly there was a match as someone had reported the ring missing… in Suffolk. Radhika Ramasamy, a consultant anaesthetist at the West Suffolk NHS Foundation Trust in Bury St Edmunds, had put the ring in the pocket of her scrubs before giving a patient a spinal anaesthetic, five days prior to Suraj finding it. She revealed: “I meant to put the ring back on afterwards but ended up doing another procedure and forgot about it. It wasn’t until the evening of the next day that I realised it was missing and then it was the weekend so I didn’t report it to my facilities team until the Monday. To be honest I never expected to get it back as I thought it would be crushed in the machinery at the laundry.” She added: “I’m so happy to have it returned. It just shows how honest people are and I want to say a huge thank you to all the people involved – my end at the West Suffolk Hospital and at the Royal Free Hospital – in reuniting me with a ring that has real sentimental value as it was a birthday present from my husband a few years ago. I know it’s been an incredible team effort and I am so appreciative of how so many people have gone the extra mile to track me down and return it to me.” Suraj said: “It’s nice to feel part of a bit of a little miracle. I’m delighted the ring has been reunited with Radhika.” “It’s nice to feel part of a bit of a little miracle. I’m delighted the ring has been reunited with Radhika”
4 The heartbeat digital revolution coming to you A collaborative project encompassing multiple teams has successfully transformed how information about a patient’s heartbeat is recorded, while delivering significant benefits for our staff. Electrocardiogram (ECG) integration is now in place throughout the RFH’s ED, ITU and cardiology departments. It is due to roll out to the rest of the RFH shortly and will also be embedded at BH this year. CFH has benefitted from ECG integration since it opened. Staff from IT, medical electronics and clinical teams came together to ensure the success of the project, which enables healthcare staff to see a patient’s current and previous ECG readings at the touch of a button. Previously each test had to be printed out, filed, and later scanned into a patient’s notes which meant printouts could be lost and anyone who wanted to examine the ECG would physically have to track down the file. Louise Welsh, chief medical information officer of the project and an ED consultant, said: “An ECG is a simple, non-invasive test which we do hundreds of every day and gives us vital information. The machines are now able to upload the ECG images directly into the patients’ records. We initially trialled it on 10 West in cardiology and then worked hard to deliver it in the high use areas of ED, ITU and the rest of cardiology. “It was more complicated to roll out than most of us anticipated but because we all worked together really well we overcame the technical challenges. It’s absolutely fantastic to see staff using it and picking it up so quickly. They see the benefit of the information being in one place and instantly accessible for everyone involved in the patient’s care to see. Other teams are now asking for it – word has definitely got out.” She added: “As well as giving staff back precious time this also has the benefit of improving clinical care because it allows ECGs to be viewed from any location compared to previous ECGs.” John O’Hare-Price, lead critical care nurse technologist, said: “ECG integration has been embraced by our teams. It’s viewed as a significant step forward. Once you’ve shown someone how to do it, they can show their team – it’s so easy people understand it straight away.” Ranjini Shanthakumar, cardiovascular operations manager, said: “Every single patient benefits and in addition we no longer have to admit all patients presenting with suspected irregular heartbeats. Instead we can instantly review their ECG and they can be monitored at home via the atrial fibrillation virtual ward which is better for everyone.” As easy as ECG Ease: The information is available with a click of a button rather than finding the paper trail. Multiple people can look at the data at the same time. Cutting workload: Staff admin is reduced as the ECGs no longer have to be physically scanned for record keeping, which historically could take weeks meaning it wasn’t always possible to compare with the latest ECGs. Getting rid of errors: The scan can no longer be lost or inputted incorrectly as it directly uploads from the machine into the system. L-R: Kriezle Madriaga, staff nurse, Ranjini Shanthakumar, cardiovascular operations manager and staff nurses Doreen Osei and Rama Shrestha Rama Shrestha, staff nurse, with the new ECG machine
5 While more people than ever before attempt Dry January, the impact of the pandemic on our drinking habits is still being felt, with a significant rise in the number of people presenting with alcohol-related cirrhosis. New research coming out of RFH could direct help to where it is most needed. Binge drinking According to research from the RFH, UCL, the University of Oxford and the University of Cambridge, people who binge drink and have a certain genetic makeup are six times more likely to develop alcoholrelated cirrhosis (ARC). In the study, published in Nature Communications, researchers analysed data from 312,599 actively drinking adults, to assess the impact of a pattern of drinking, genetic predisposition and type-2 diabetes on the likelihood of developing alcohol-related cirrhosis. When heavy binge drinking and high genetic predisposition were at play, the risk of developing ARC was six times higher than the baseline risk which used data from participants who reported drinking within daily limits, had low genetic disposition to ARC and were free of diabetes. The addition of type-2 diabetes as well resulted in an even greater risk. Dr Gautam Mehta, a senior author of the study from the RFH and UCL Division of Medicine, said: “Only one in three people who drink at high levels go on to develop serious liver disease. While genetics plays a part, this research highlights that pattern of drinking is also a key factor. Our results suggest, for example, that it would be more damaging to drink 21 units over a couple of sessions rather than spread evenly over a week. Adding genetic information, which may be widely used in healthcare over the coming years, allows an even more accurate prediction of risk.” AlcoChange A mobile phone app which encourages patients with alcohol-related liver disease to stay sober could help save hundreds of lives every year, according to the team who developed it. The AlcoChange app uses several behavioural change strategies, including a mobile phone-based breathalyser and personalised messages, to help patients abstain, including telling them how much money they will save by not buying alcohol to sending them pictures of loved ones and providing them solutions to overcome cravings. The breathalyser allows the patients to show their families and friends that they are sober, helping to build trust. A new study, published by researchers from RFH and UCL in the journal JHEP Reports showed that 57% of those using AlcoChange remained abstinent over a three month period, compared with just 22% of those not using the app regularly. This resulted in fewer hospital admissions among the group using the app – even a year after they had stopped using it. Rajiv Jalan, professor of hepatology and consultant physician (UCL and RFL) and the senior author, as well as co-founder of Cyberliver Ltd, which developed the app, said: “It is exciting to see the positive results of this study. Harnessing digital technology has the potential to revolutionise the management of patients with liver disease as it can be delivered continuously at home, reducing the need for patients having to travel and impacting dramatically on costs of healthcare delivery.” A larger randomised nationwide study funded by the National Institute for Health Research has now been launched. Love your liver AlcoChange pioneers Professor Rajiv Jalan, Dr Gautam Mehta and Professor Kevin Moore “It is exciting to see the positive results of this study. Harnessing digital technology has the potential to revolutionise the management of patients with liver disease”
6 Meet the team – dialysis with a difference Located on the grounds of St Pancras Hospital is the unassuming Kidney and Diabetes Centre which provides crucial care to over 200 patients a day. Across its two floors you will find 34 staff who care for patients on dialysis – the process of removing excess water and toxins from the body, simulating the work of the kidney. Ida Rebello, lead nurse for frailty/dialysis, heads up the nursing team at the unit, also known as the Mary Rankin Dialysis Unit, having first begun working for the RFL in 2002. At first Ida had no interest in working in dialysis nursing, but soon grew to love the area. “After my graduation I seemed to just fall into dialysis as that is what was allocated to me,” Ida says. “Initially I wanted to work in a medical ward so that I could look after patients who were really unwell, but eventually I started to get to know dialysis patients more and I really started to enjoy it. “We see patients more than we sometimes see our own family and friends. We get to know them, and their situations and difficulties. There is something new when I speak to them every time, whether that is financial difficulties or family difficulties, and I can hopefully help them with that.” The unit sees hundreds of patients a day across three different time slots – morning, afternoon and twilight. Downstairs there are two bays with 15 beds in each. “We have a mix of ages, from 18 right up to 91,” Ida explains. “Some patients are frail and others can manage independently. We have quite a lot of stretcher and wheelchair patients who we mainly dialyse in the afternoon so they can rest in the morning. Transport has a part to play there, and I attend the transport meeting every Tuesday to present how transport has gone in the previous week. We do not want to have incidents where we delay a patient going home, but it is not always easy.” Raymond Chinehasha is senior charge nurse and looks after the three sessions of outpatient dialysis. “Patients come in on either Monday, Wednesday and Friday, or Tuesday, Thursday and Saturday, and we are closed on Sunday, but some patients might be healthy enough for just two slots a week which gives more capacity. Members of the team at the dialysis unit Raymond Chinehasha, senior charge nurse Ida Rebello, lead nurse frailty/dialysis at the unit “We see patients more than we sometimes see our own family and friends. We get to know them, and their situations and difficulties”
7 “The first thing I do is look at the following day, making sure that we have enough staff. I also look at patients who have gone for a procedure and we have to slot them in in some way, making sure we have enough consumables – fluid, catheters and needles – and that the machines are okay. No two days are the same and you get different things thrown at you all the time.” The team also works closely with services at BH, Edgware Kidney Care Centre and Tottenham Hale Kidney Centre. “Where you go depends on your postcode,” Raymond says. “If there isn’t a slot available to accommodate you, you go to where there is one and then eventually you get transferred in. Patients first might think it is too far, but they settle in and by the time I let them know there is a slot available closer to their home they don’t want to go!” Upstairs, Franel Ave, senior charge nurse, leads the unit’s self-supported care service. This is suitable for some patients, giving them the opportunity to have more flexibility and independence in their care. After receiving training, patients in the unit are able to carry out some or all of their dialysis treatment themselves, giving them greater flexibility and reducing the amount of time they spend at each treatment. Franel, who joined the trust in November, is also being tasked with expanding the unit’s home haemodialysis. “At the moment we have seven patients on home haemodialysis, and we are looking at how we can increase that,” he explains. “We have a pathway to follow to determine which patients are suitable, and a huge indicator is if the patient inquires about it or is engaged with early conversations.” If the patient progresses on the pathway, a checklist is carried out on their home to ensure it is suitable for the machine and regular stock deliveries. “The majority of our patients live in flats, so suitability with the size of the machine is really important,” Franel says. “If they pass all of that, we train them for six to eight weeks, and in the background the technical group do the installation at home. That means when they are signed off, a date can be set for them beginning home dialysis. “For the first few weeks, we usually visit them at home and continue with monthly bloods to make sure they are dialysing properly. We also set up an in-centre session to check their technique and one-to-one discussions about any concerns they might have.” Patrick Anderson is one patient who carries out selfsupported care. “It’s a great unit,” he said. “It’s small enough that you don’t feel like a number or that you are in a dialysis ‘factory’, so to speak. This is a close-knit team and you see the same people. “I come in twice a week and the whole process from start to finish lasts about four hours. The ultimate goal is to do this at home. I can have more control and more involvement in my care and not have to schedule my life around coming here.” Looking ahead to the coming year, Ida is hopeful about the outlook for the team. “With NHSE funding we have already recruited a member of staff for two years who is going to concentrate on home dialysis to further establish it,” she explains. “I also want to continue focusing on staff wellbeing. We have seen some great improvements in recent years in that area, and staff also have the tools to cope with sometimes difficult situations. “If we support staff and their morale is good, I always think patient care is better, which is our ultimate goal.” Merwin Puri, assistant practitioner, Franel Ave and Happy Aimurie, nursing assistant Franel Ave, senior charge nurse, and Patrick Anderson at the self-supported unit “You don’t feel like a number or that you are in a dialysis ‘factory’”
8 Over 60 members of staff recently graduated from the WITH:STAND programme, designed to support, recognise and encourage BAME staff in navigating through their careers and racism they may face. The course for staff in bands 2-5 comprises of two modules delivered over two days, followed by a gap of six to eight weeks, and a final two days. It is funded by the Royal Free Charity and delivered in partnership with brap, an equity and human rights organisation who are leading experts in the field of creating inclusive and fair workplaces. The graduation took place in January, with group chief people officer Crystal Akass opening the ceremony. Joy Warmington, CEO of brap, addressed those in attendance, which included guests of graduates who have helped them on their journey, whether that be a manager, colleague, friend or family member. “We’ve been partnering with the Royal Free London for about a year now, and the work has focused on how do we get to grips with racism, and what it means to be anti-racist,” Joy said. “Many organisations do not go down that path, but the Royal Free London is trying to say that if we are going to do something about racism, then we need to be honest, disruptive, open and invasive.” Diane Rutherford, educator at brap, led the programme and said the change of culture “isn’t something that BAME staff can do alone.” “We shouldn’t stand for racism collectively and we need white-presenting staff to be anti-racist.” Olayid Bayo-Tofowomo, workforce coordinator for CFH and group clinical services, was one participant of the programme. “I would say to anyone of a BAME background to get involved,” she said.“ It is an amazing programme. It changes your mindset, the way you look at things and how you might hide away from things you have experienced.” Said Bashar, nurse at BH, said the programme was knowledgeable and that he got great value out of it. “I have learned so much, came to know more about diversity and I am really grateful to have taken part. “You have the opportunity to learn more about people, cultures, racism and what it really means or how it presents itself.” Following the award ceremony, Rachel Anticoni, director of operations at RFH (who took part in the white leaders programme), also announced a new offering for graduates of WITH:STAND where they can come up with an project to develop with guidance and mentoring from an executive in the trust. Crystal Akass, group chief people officer also said the new offering “is an invitation to people who have done the programme to continue their development with the right support.” “We’ve got some ideas, and participants will have them too. We want to bring them together to make sure this is the start of important work, and not the finish line and will continue to do more brap interventions with more colleagues and cohorts across the group.” Applications for the next two cohorts of the WITH:STAND programme are now open. Visit Freenet for more information. WITH:STAND graduates celebrating their success Crystal Akass, group chief people officer, Joy Warmington, CEO of brap, and Diane Rutherford, educator at brap Said Bashar, nurse at BH, receiving his award Celebrating our WITH:STAND graduates
9 A member of staff at CFH has put her medical skills to the test when she was called upon to help a woman who had fallen unwell on board a flight from London to Ethiopia. Fatma Habib, clinical lead at the CFH urgent treatment centre, had booked a last-minute flight to Kenya to visit her father who had suddenly fallen ill, and was flying alone when the incident occurred. “I came to work as normal and then I had a call about my dad and that he was critically unwell,” she explained. Fatma quickly booked a ticket and made her way to the airport without any large luggage, just her handbag, passport and some other items. “I was on the flight for a few hours, and then a flight attendant started panicking and looking for a medical professional. “I put my hand up, but I didn’t know if I could help this person and what sort of medicine or equipment would be available.” RFL staff have paid a visit to the Veolia integrated waste management facility in Southwark to learn more about where our waste goes and to see for themselves the various ways it is treated. The group saw where waste enters the facility in recycling trucks, how it is packed and the conveyor belt used to feed waste into specific machines. They also saw the strong magnets used to extract cans and tins from other recyclables. Matthew Azzopardi, ophthalmology specialist trainee, represented his department on the tour and said he learned a lot about how waste is treated. “In ophthalmology, we are looking at the small pieces of plastic equipment that we use,” he said. “The problem is that when they go to the recycling plant in a general recycling bin, it falls through the sieve at the facility. We have passed that on to the innovation team there who are going to look into how we can address that.” Renuka Umasuthan, head of sustainability, urged staff to consider their choices, both at home and in work, when disposing of waste. Healthcare in the air “We learned a tremendous amount from this visit to Veolia and encourage everyone to have a look into their waste disposal habits,” she said. “Although it is great to recycle, recycling the wrong things can cause a lot more harm than good.” Veolia advised that recycling needs to be clean, dry, and only contain what the trust is currently able to recycle in a mixed bag, such as paper, card, plastic bottles, tins and cans. Mixed recycling bins cannot be used for food, packaging contaminated with food residue, free-flowing liquids, coffee cups or paper towels. Visit Freenet for more guidance on waste disposal. RFL staff who visited the facility Fatma was brought to the woman who had collapsed and was hyperventilating, and was soon able to take her history and learn that she was experiencing abdominal pain. “The blood pressure machine was in the controlled drugs box, where it shouldn’t be,” Fatma said. “It was also very old and I had to try to remember how to use it because it was so long ago since I last had. “The pulse oximeter also was not working and the team had to find batteries for it.” The passenger soon recovered, and Fatma advised the in-flight team of the importance of simple medicines and tools. “I explained that sometimes we just need simple things. I wrote them a list of what should be included in any future events.” Fatma’s father has since improved, and she said she would definitely help if a similar situation were to happen again. “It is something that is part of us as healthcare workers to want to help in those situations,” she said. Where does our waste go?
It has been four months since our new RFL website went live, with both patients and staff benefiting from its new look and feel. The changes are more than just cosmetic – it was clear from the extensive engagement we carried out before we built our new website that simple to understand, helpful information, was key. We also knew we needed to better explain what we do at the RFL, from the breadth of our services and our expertise, to the locations we run services from. So, our new website aims to do just that, giving patients, service users, visitors and other stakeholders access to the information they need. A huge thank you to the many people across the trust who have supported the redevelopment. What’s next? We’ve been really pleased with the feedback we’ve received so far, from both our colleagues and our patients. You’ve told us it’s easier to find information and simpler to navigate, and that it looks much cleaner. But we know there’s more to do to keep it up to date and as good as it can be. The approach with our new website is not to stand still with it. We will constantly review it, seek feedback, listen to users, and make changes where they’re needed. 10 A website to be proud of This also includes updating content. It’s key content remains fresh and up to date – from contact information to the clinicians working within a service. If you want to feedback on our website, or make a suggestion about content, please email rf.websitereview@nhs.net. Improving our accessibility Did you know that since the website went live more than 90% of our PDF formatted patient information leaflets have now become webpages – making them more accessible for users and enabling them to be easily read on a mobile phone, which is how most people access our website. If you have attended any staff wellbeing days across the trust, you may have seen or used the virtual reality headsets that have been rolled out as part of the trust’s commitment to staff wellbeing. Following a successful pilot of virtual reality across the trust, staff can now avail of a loan of virtual reality headsets for one week (pick up on Monday morning and drop-off on Friday afternoon). If you are not based at BH, CFH or RFH or the Enfield Civic Centre you can still request to loan a headset from the site nearest to you. All the information you need to complete your booking is available on Freenet or speak to your line manager. Take a break… with virtual reality
11 Governors’ update Become a 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, including the benefits of being a RFL member, can be found on our website. We are delighted to welcome Dr Michael Spence, non-executive director, to the RFL board. Dr Spence is the president and provost of University College London (UCL) – one of the world’s most prestigious universities. Dr Spence is responsible for leading UCL’s strategic direction and delivering its priorities and ambitions. The appointment further cements the long-standing partnership between UCL and the RFL which has, in recent months, seen the trust achieve top 10 status for recruitment into academic studies. Non-executive directors are board members responsible for holding the executive directors to account for the performance of the trust. One of the core functions of the council of governors is to appoint the non-executive directors. Looking ahead to 2024 As we look towards the rest of the year, the main focus of the council of governors will be to continue listening and involving our membership and local communities to ensure the best care possible is provided to our patients. The council will take an active role in representing the interests of our members and will be involved in variety of different activities including: • Medicine for Members’ events – more than 300 people joined our Medicine for Members’ events last year. We are in the process of organising this year’s programme of events and the first will take place in the coming weeks. Hosted by governors, these events showcase topics which are important to staff, patients, and the local community. • Membership engagement survey – we are committed to continually improving the way we engage with you. In 2021, over 1,400 of you told us what worked well and what could be changed. We will be sharing another survey in the coming months. • Annual Members’ Meeting – it was fantastic to be able to hold last year’s event in person for the first time in three years. Planning for this year’s meeting is underway, and details will be shared in Freepress soon. The Annual Members’ Meeting is your opportunity to hear about the trust’s operational and financial performance over the past 12 months, to hear about priorities for the future and to have your questions answered by the executive directors. Get in touch: 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 New non-executive director appointed to the RFL board
12 60 seconds with… Alice Fisher Alice Fisher is a clinical research nurse in cardiology at BH. Tell us about your role? Since university I’ve always been interested in research and using evidence-based practice. I was working at the trust in the emergency department prior to this role and felt like I needed a big change away from the hecticness, while also applying my diverse and advanced clinical knowledge. What does a typical day involve for you? I could be seeing patients who are enrolled in our Phase 2 and Phase 3 clinical trials as we monitor them closely while they are receiving the IMP (investigational medicinal product). Then there are always meetings and documentation to catch up on. I’m also currently undertaking a Level 3 Data Literacy Apprenticeship with Multiverse, an NHS scheme which upskills staff. What is particularly exciting about the work you do? It is exciting having such variation and autonomy. I get to work with a whole range of people including consultants and senior specialist nurses. Studies can last years and so you really get to know your patients who become like family. It is also fulfilling to know that the work you are doing can change future healthcare practice. How can staff get involved with research? Everyone can get involved – whether that is in your job role or as a participant. Currently I am a participant in a research study within the trust called NHS Digiwell, a study working to beat email technostress. Also check out Freenet as there is a lot of resources there. What skills do you need? To be a research nurse you must have a willingness to learn and have a curious mind. You need to be able to read protocols and use your initiative and clinical experience to make decisions. You work closely with pharmaceutical companies as well as big university institutions and so communication and organisational skills are key. Part of the role is also about taking the time to explain to patients how research works and having the patience to address their preconceptions and concerns. What obstacles have you overcome? Starting out as a novice in research and leaving ED meant adapting to a whole new style of working. However, the team has been very supportive, and my confidence continues to grow each day. How do you like to unwind away from work? I like to go on lots of holidays. I’m planning on beating the winter blues with a Caribbean cruise. Has your cardiology research job seen you make any changes to your lifestyle? Working with cardiac patients definitely makes you think more about your own heart health. I definitely drink more water and I’ve started doing a regular 5k parkrun. Start Well: Share your views Share your views on proposed changes to how and where some maternity, neonatal and children’s surgical services across North Central London could be delivered in the future. These include proposals: • to close maternity and neonatal services at the RFH or Whittington Health NHS Trust • to close the birthing suites at Edgware Birth Centre, while retaining antenatal and postnatal care on the Edgware Community Hospital site • to consolidate some surgery for babies and very young children in centres of expertise at Great Ormond Street Hospital for Children NHS Foundation Trust and University College London Hospitals NHS Foundation Trust. The aim is to ensure patients get the very best care, in the right place at the right time for many years to come. No decisions have yet been made. The consultation, led by North Central London Integrated Care Board and NHS England Specialised Commissioning, closes on Sunday 17 March 2024. For more information see Freenet.
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