Royal Free London NHS Foundation Trust Staff, members and governors’ magazine // January / February 2025 Welcoming our North Mid colleagues to the RFL family
Follow our X account @RoyalFreeNHS to see what our patients and staff are saying about us Peter Landstrom Group chief executive to the January/February edition of our staff, members and governors’ magazine. I am thrilled to introduce the first edition of Freepress for 2025, which highlights the first few weeks following North Mid joining our organisation. We have officially been merged since 1 January, and the partnership is set to enhance patient care by expanding access to vital services and reducing waiting times. We feature recent merger events, and hear from colleagues at North Mid about their hopes for the future. We also spotlight our virtual wards on page 4, which are key to improving patient choice and expanding capacity. The story focuses on a patient who had a mini heart attack but was suitable to be monitored at home. It is great to see these innovative approaches which we will continue to share. Our renal team are also leading the way with bringing sustainability to their department. They have introduced changes to eliminate waste and reduce the impact on the environment – which is key to creating healthier environments for everyone. Read the full story on page 8. We also celebrate our wonderful volunteer Evelyn Blumenthal, who was recognised in the King’s New Year Honours for her amazing work with patients who have dementia. As winter pressures continue for our staff, I want to thank you for your resilience and commitment. Please make sure to look after yourselves, and take a look at the health and wellbeing resources on the back page of this edition. Key to abbreviations: Barnet Hospital: BH Chase Farm Hospital: CFH North Middlesex University Hospital: North Mid Royal Free Hospital: RFH Royal Free London: RFL 2 Hello and welcome
Merger events highlight enhanced care and opportunities for staff 3 The merger of the RFL with North Mid has been celebrated with a series of events, marking a pivotal moment in healthcare for the populations of north London. The merger aims to cut waiting times, bring leadingedge specialist care closer to home, and better connect hospital and community services. Patients will also have greater access to the latest medical research and local people will get more help to spot, prevent, and address health problems earlier, with services better designed to meet local needs. The first welcome event took place at North Mid, followed by a celebration at CFH. These gatherings provided staff an opportunity to connect and learn about the benefits of the merger. At the North Mid event, staff received welcome booklets introducing them to the expanded group, and Mark Lam, chair of the RFL, expressed gratitude for their support throughout the merger process. “We believe passionately that the two organisations are much stronger together, and can deliver superior care to our patients,” he said. “For our staff, we can create an even better and brighter future which is full of opportunity and support from a much larger group.” Peter Landstrom, RFL group chief executive, thanked everyone at North Mid for being so welcoming throughout the merger process. “We are coming together as one organisation, and North Mid brings so much to that relationship and who we are,” Peter said. “You bring an incredible purpose and anchor in your local population, and innovative, passionate and progressive care.” Nnenna Osuji, chief executive of North Mid, said: “This is a landmark occasion for many reasons, and it takes a lot to make something like this happen. Thank you for your patience, and for moving things forward with confidence.” At the CFH event, Palmer Winstanley, chief executive of CFH and group clinical services, spoke to staff about the journey toward becoming a merged organisation and thanked those involved for their support. “The merger really does open up a lot of opportunity both for our patients and our staff,” he said. Staff also got to meet our colleagues involved in staff networks, and learn more about the council of governors, the important role they play in the trust and how they can join the council. L-R: Nnenna Osuji, chief executive of North Mid, Peter Landstrom, chief executive of the RFL group, and Mark Lam, chair of the RFL, at the welcome event CFH colleagues enjoying the welcome event Our new animation gives you all the information you need to know about our newly enlarged organisation. Scan the QR code to watch it.
4 Everything went like clockwork “ “ Virtual wards are a crucial part of NHS plans to increase capacity and tackle the increasing operational pressures facing the healthcare system. The RFL is continuing to expand and explore our virtual ward capabilities deploying face to face nursing care, as well as remote monitoring. We shine a spotlight on two virtual wards at the RFL which are already successfully supporting our patients at home… and we’ll continue to update you on our virtual ward journey as it becomes more widely adopted by different specialities and departments. Meet the heart attack patients avoiding unnecessary hospital stays Patients who have had a mini heart attack are now being allowed to go home to their families – instead of staying in hospital – while they wait for a procedure. After a mini heart attack, patients would usually remain in hospital until they have their angioplasty procedure that would unblock their arteries and prevent a heart attack in future. However, patients deemed well enough are now being monitored from their homes, helping them to avoid unnecessary stays in hospital. Patients discharged to a virtual ward are equipped with a portable device which allows them to measure their own blood pressure and heart rate. The results are reviewed by their doctor, who can take action if needed, including altering their medication. Saif Bakarian is one of those who has benefitted from being on a virtual ward. Making the most out of virtual wards After feeling unwell, Saif attended BH emergency department (ED) before being taken in an ambulance to the RFH’s cardiology unit. Following a full assessment, Saif was booked in for an angioplasty for four days’ time – and in the meantime he was allowed to go home. He said: “I really appreciated being able to go home, I felt much more comfortable there.” “They sent me home with kit to measure my blood pressure and heart rate. I filled out the results on an app each morning and was also under strict instructions to come back to ED if I felt unwell. “Everything went like clockwork and the staff have been exceptional.” Saif only spent one night in hospital, compared to a typical two or three days as an inpatient. Cardiology consultant Tushar Kotecha helped develop this new way of treating patients. “Normally these patients would be admitted onto the cardiology ward and might end up waiting a few days for their procedure,” he said. “Now they have a short period of monitoring and, if suitable, we discharge them onto the virtual ward so they can continue their observations from the comfort of their own home. “The patient is then booked in for their angioplasty to take place within a week and they go home from that procedure on the same day as usual. The patients tell us they love it because they much prefer being in their own environment, and it frees up the beds for more unwell patients. “The other big positive from our patients’ perspective is their procedure appointment is protected because they are a day case. That means it is guaranteed to go ahead instead of being postponed as is sometimes the case for those who require an inpatient bed.” Saif, pictured waiting to go home after his angioplasty, with his wife Maral
5 Staff from the North Mid hospital at home service We can care for acutely unwell children at home Parents have praised the North Mid Babies’ Children and Young People Hospital at Home service (BCYP H@H) saying it offers them the reassurance they need. One parent said: “Our son was treated for jaundice and we are so grateful this could be done at home, with the fantastic support from the hospital at home team. Every nurse that visited was professional and supportive and kept communicating with us regularly and the test results were delivered rapidly.” Another parent commented: “This was a service I was unaware of, so, when referred I didn’t know what to expect. However, it has exceeded my expectations. It gave me the reassurance I needed on the health of my child and meant I could keep my child at home in the comfort they are familiar with, which I believe aids recovery. A brilliant service.” The service, which deploys highly trained and experienced paediatric nurses, has now been running 21 months – it launched on 1 May 2023 at North Mid – and has shown that caring for acutely ill children in their homes, where they feel safest and are with their families, can be done to the highest of standards. What started as a three-bed virtual ward, has steadily grown and is due expand further to become a 16-bed operation within the next few weeks. The service sees babies, children and young people aged between 0 to 16 (and 16-18 years old with complex needs) living in Haringey and Enfield. Amongst other things the nurses are able to administer antibiotics, as well as treat respiratory conditions and other illnesses such as gastroenteritis. This is a formidable group of nurses “ “ Since the service began there have been continual incremental changes. The catchment area has increased, as well as the number of conditions treated. Referrals are now accepted from the ED, the paediatric assessment unit, Rainbow ward (a children’s ward), the postnatal ward, the special care baby unit, North Mid community midwives, as well as from other north central London wards and local GPs. The service has now treated more than 1,350 patients since its launch. The majority of patients were treated for febrile illness (fever) and asthma, and at least 13% of the total were newborn babies being treated for infection or jaundice. Malvina Benitez-Castillo, matron of the service, said: “This is a formidable group of nurses dedicated to compassionate care in the community. They have been incredibly committed, adaptive and patient, working collaboratively to tweak the process.”
6 Welcome to our North Mid colleagues To celebrate the merger, we went out and about meeting staff at North Mid who took time from their busy shifts to share their hopes for the future. For some it was also an opportunity to meet and chat with Peter Landstrom, group chief executive of the RFL, Gillian Smith, chief medical officer, and Emma Kearney, the group’s chief communications officer. Gill Adjei, an infection prevention practitioner and specialist midwife, has worked at North Mid for 30 years and said she was invested in the merger. She said: “Change is good. I think exciting times are coming.” Isaac Owusu-Agyei, has worked at North Mid for five years, currently in security. He said: “It’s been five good years and I’m hoping it continues that way. I’m feeling positive!” Gill Adjei Isaac Owusu-Agyei Staff from the radiotherapy team Members of the midwifery team Anna Roszyk Working at the maternity unit’s main reception was Rohan Arachichigh, receptionist and triage. He said: “I hope my future is here and I look forward to being part of Royal Free London.” The radiotherapy team took a minute away from fire safety training to mark the unique occasion. Sharif Shaykhoun, head of radiotherapy, said: “Of course there’s always uncertainty about the unknown but the team are keen to understand what this will mean for patients and staff.” At the delivery suite the midwifery team were in high spirits. Sophie Edwards, labour ward co-ordinator, said: “I worked at the Royal Free Hospital for two and a half years and lots of the team have also worked at the Royal Free or Barnet Hospital. We know everyone well.” Anna Roszyk, domestic supervisor, said: “The merger is a new experience for me but I think it’s going to be good. You should never think you know everything, every day we learn something and I think that sharing best practice will be useful for all of us.”
7 Peter and Gillian meet staff from the tobacco dependence team Staff from the sickle cell service Staff celebrate outside St Michael’s Spending time with the therapies team Andrea Pajak, children’s community matron, said: “I’m excited to being part of a bigger, wider organisation and my hope would be that the services, within our community services, continue to be supported appropriately.” Staff at inpatient and outpatient pharmacy chatted to Peter, Gillian and Emma. Hemant Shah, lead technician, said: “I’m looking forward to working together, implementing new ideas and sharing our experience.” Peter, Emma and Gillian also met with the digital and informatics teams. Prince Okdye, IT systems engineer, said: “I think there will be lots of benefits when we are all aligned on the same system.” Nikita Amado, senior nurse of the 40 virtual ward bed service for Enfield and Haringey discussed with Peter Landstrom about facilitating early discharge, taking a lot of patients from ED including those with cellulitis, chest infections and heart failure patients. She said: “We want to continue to get our numbers up and are planning on launching virtual ward pathways for sickle cell patients, as well as people with delirium. We are also working towards virtual ward pathways for respiratory patients and for surgical patients.” Dipu Sasidharan, community matron, working in the virtual ward team, said: “We think the merger will make things better for patients as having more access to their data will make transitioning them easier. I think we’ll see the benefits fairly quickly.” Sekayi Tangayi, consultant nurse for North Mid’s sickle cell service, said she was proud of the new emergency department bypass pathway for sickle cell patients. She said: “From recruitment to improving pathways we see a really bright future for the service, giving patients the care they deserve.” Peter, Gillian and Emma, also spent the afternoon at St Michael’s – the hub for North Mid’s community services, which includes a range of therapies for children and young people. St Michael’s is also home to the inpatient Magnolia unit, where our community tissue viability nurses offer specialist assessment and advice to patients with non-healing wounds. Frank Mahanzu, associate director of nursing for the community division, said he was looking forward to integrating North Mid’s community services with the RFL. He believes this will help alleviate pressure across our hospitals. He said: “If we have got robust discharge plans from the hospitals, we can see patients at home and perhaps prevent them from needing to come back via ED.” Helen Cooke, neurodiversity service lead, said: “I’m excited about the merger because it’s a chance for new conversations, learning from new teams, and finding out what others are doing to improve the services we provide. There is a little bit of trepidation from just not knowing everything at this stage.”
8 A new way of supplying acid concentrate to dialysis machines at the RFL is saving carbon emissions equivalent to driving a petrol car over eight-and-ahalf times round the equator. Gareth Murcutt, renal technical manager at the RFH, was asked by his clinical director to look at sustainability and at first thought any gains would be marginal, given there could be no compromise in patient care. Gareth investigated how acid concentrate – an essential component in the preparation of dialysis fluid – was being delivered to the dialysis machines. Staff loaded a new five litre cannister of acid concentrate onto each machine for every treatment and the technical team then did an audit of how much was left in the containers at the end of each session. “The results really shocked me; I couldn’t believe it at first,” said Gareth. “It turns out, on average, we were throwing away around one third of every single cannister that we bought.” Kidney dialysis gets drastic about plastic Staff with the new tanks at Tottenham Hale Kidney and Diabetes Centre We were throwing away one third of every single cannister “ “ Gareth realised that by switching to a bulk central acid delivery system, where dialysis fluid is pumped directly to the dialysis machines, this would eliminate this wastage – saving over £55,000 a year. The reduction in emissions of over 77,000 kg CO2e per year was as a result of reducing dialysis fluid wastage and over half of the carbon savings come from no longer using the cannisters. Edgware Kidney Care Centre and Tottenham Hale Kidney and Diabetes Centre, who between them have 78 dialysis stations, were chosen to trial the new system and the hardware was successfully installed. As well as financial savings the switch has realised additional benefits. Annually more than 1,000 tonnes of lifting by staff has been eliminated as well as 1,750 hours of staff time managing the cannisters, enabling healthcare teams to spend more time with patients. The cost of the installation will be recouped by the trust in just one year. Not content to stop there, the dialysis service has been inspired to investigate other changes, such as removing one unnecessary disinfection cycle on the trust’s dialysis machines. This is now saving a further £21,000 and emissions of 13,000 kg CO2e per year. Gareth, who has completed a scholar’s course in kidney care sustainability, said: “Removing even small amounts of plastic or waste from the supply chain quickly adds up to significant emissions savings when you consider the scale involved in modern healthcare.”
A new approach to treating young people who may be experiencing chronic pain, and struggling to participate in everyday activities, has been described by one parent as “life-changing”. The pilot scheme, pioneered at BH, using a multidisciplinary approach and group sessions, has been warmly received by patients and their families. In the past patients with the most complex needs would need to be referred to a specialist national service. But the scheme has enabled these patients, who may experience a number of issues which can reduce their ability to participate in everyday life, including going to school, socialising and even their mobility, to be treated locally. Patients were seen in a new MDT clinic which included a paediatrician, a mental health expert and physiotherapist, in order to determine the best course of treatment. Each patient had an hour and a half appointment with all three professionals present, resulting in more productive conversations. Nikki Thorpe, children’s musculoskeletal (MSK) clinical lead, said: “The patients were assessed and then we discussed potential solutions, from physiotherapy to psychological support. We also offered group sessions, devised by Danielle Fineman, clinical specialist paediatric physiotherapist, which we call Body and Mind Matters!. “Patients could bring a parent with them to each group session. We ran five two-hour sessions which were physiotherapy led but we adopted an acceptance and commitment therapy approach.” Young people being supported to step back into their lives Patients and families were supported in many different areas including developing routines, healthy sleep patterns, relaxation and mindfulness, resilience, building support networks and working towards integrating back into school. One parent said their child was now walking again and going to the gym with friends: “The support group your team ran has been life-changing for us and the concepts and tools over the five sessions have been invaluable. As a parent I was at a loss as to how to support my child but your team have helped us so much and for that I am truly grateful.” Debra Silver, children’s physiotherapist and clinical lead for children and young people’s physiotherapy and dietetic services, said as many as 50-75 young people a year could benefit from this tailored support at BH each year. She said: “Staff thrive delivering this kind of work. We know this is a much more effective and joined up approach and are now seeking to make this, or similar, the standard pathway for these young patients going forward.” 9 L-R: Nourane Khoweiled, speciality doctor psychiatry, Nikki Thorpe, children’s MSK clinical lead, Debra Silver, children’s physiotherapist, and Elliott Cheng, paediatric consultant Your team have helped us so much and for that I am truly grateful “ “
The charity’s volunteers play an integral role in supporting our patients with dementia and their families. They provide companionship, conversation and activities that make a big difference to a patient’s experience of care in hospital. The charity also runs a variety of music and art therapy sessions on the wards while the Royal Free Radio, our volunteer-run hospital radio station, broadcasts sundown sessions specially curated to ease the late evening agitation often experienced 10 Volunteer recognised for dementia care in New Year’s Honours List Supporting patients with dementia by patients with dementia. At BH, charity volunteers help Doris Ajayi, a dementia clinical nurse specialist, to run “Tea with Doris”, a weekly support session for patients with dementia. To find out more about volunteering opportunities, or to make a donation to enable more dementia support volunteers to spend time with those patients who need it the most, visit the charity’s website at royalfreecharity.org When Evelyn Blumenthal retired from the Marie Curie Hospice in Hampstead six years ago, she was determined to remain active. “I wanted to help make a difference and was volunteering for the Royal Free Charity a few weeks later,” she said. While she enjoys tasks like serving breakfast on the wards and generally supporting patients and families, it is helping people with dementia which is especially close to Evelyn’s heart. She said: “I have friends with varying stages of dementia, including advanced cases. I also support a friend who is caring for her partner with advanced dementia at home. The NHS provides 24-hour care for him, but I help her wherever I can.” Evelyn’s dedication to leading the charity’s dementia companionship volunteer programme was recognised in this year’s Honours List with a British Empire Medal. She said: “I will sit at a patient’s bedside, look at the “eight important things about me” and talk about their family and friends, or a pet. But I find music is often the one thing that makes patients with dementia really alert and you suddenly find them singing along to a song. “The staff do everything they can, but they’ve got the whole hospital to care for. That is where us volunteers can be really helpful. Volunteering is about time and care.” Evelyn said: “I was really amazed to get the award. People have been so happy for me, and at my age, it’s been lovely to share good news for a change. When the news went out on my tennis group’s WhatsApp, my phone pinged all afternoon with friends congratulating me.” Jon Spiers, Royal Free Charity chief executive, said: “Evelyn is a familiar face at the Royal Free Hospital and this award will come as no surprise to anyone who has worked alongside her or benefitted from her exceptional care. “Her dedication to caring for some of our most vulnerable patients, combined with her commitment to mentoring and developing new volunteers, makes her a superb role model for NHS volunteers. “We are immensely proud of her.” Evelyn Blumenthal Doris Ajayi pictured left with charity staff Carla and Diana and volunteer Sue Volunteering is about time and care “ “
Governors’ update Become a member of the RFL and help make a difference 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. By becoming a member you’ll be able to stand for election as a RFL governor or elect governors to represent your interests, be kept up to date with the latest RFL developments and news, and invited to events to increase your understanding of local health services. More information can be found on our website, or you can email rf-tr.membership@nhs.net Get in touch: Our governors are elected to represent the interests of our members and to hear the views of staff, patients, and the public. If you would like to get in touch with the council, please email rf-tr.governors@nhs.net 11 Welcoming colleagues from North Mid The Council of Governors is delighted to welcome North Mid to the RFL group. To celebrate this exciting milestone, our governors have been meeting with North Mid staff to share information about the council’s vital role and how they can get involved. They have also shared their personal experiences and reflections about being a governor. Governors will be visiting our hospital and community sites throughout the year. Looking ahead to 2025 The focus of the Council of Governors will be to continue listening and involving our membership and local communities to ensure the best care possible for our patients. It will be a year of change for our governors. We will be expanding the council in the coming months, with new elections, to ensure the voices of North Mid communities are included. We will be increasing the number of governors by four so that in total we have 27. There will be at least one elected staff governor from North Mid, one elected public governor from the London Borough of Haringey and an appointed governor from Haringey Council. More information will be shared when we launch the elections. If you have any questions about the process, please email rf-tr.membership@nhs.net. Our governors play an active role in representing the views of our members. They are involved in a variety of different activities including: Annette Heslop, staff governor • Medicine for Members’ events – over 240 people joined our Medicine for Members’ events last year and we will look to build on this in 2025. Hosted by governors, these events showcase topics which are important to staff, patients, and the local community. • Membership engagement survey results – last year, we asked you to share your feedback on how we can improve the way we communicate and engage with our membership. We received nearly 900 responses – thank you to everyone who took part. In the coming months, we will share the results of this work and the changes we are making. • Annual members’ meeting – it was fantastic to see a packed room for last year’s event. Plans for this year’s meeting are already underway. It’s your opportunity to hear about the trust’s operational and financial performance, to learn about our priorities for the future and to have your questions answered by the executive directors.
12 60 seconds with… Danielle Watts Rapid response nurse Tell us a bit about your role In a nutshell it’s all about seeing, treating and managing acutely unwell patients at home to prevent hospital admission. My team at North Mid gets referrals from GPs, health professionals in the community, London Ambulance Service, NHS 111 and our emergency department. We are that bridge between the hospital and community services. What’s your background? I started out working in EDs for three years all around London and then I went into intensive care. I worked abroad for a bit in the Caribbean in rapid response and when I came back I knew I wanted to continue in that area. What might a typical day look like? We are likely to be seeing about seven patients a day, driving from one to the other. These are patients who need more support than a district nurse can provide so their cases are escalated to us. They may have pneumonia, or be dealing with the exacerbation of a chronic condition, or have an acute infection. We can prescribe and administer antibiotics. We will make sure they are responding to the treatment and give them lots of health advice. This job suits people who are confident being autonomous. One of us is on call in the ED each identifying patients that we recognise as suitable to go home under the team’s care. The patient will have been triaged, and seen by a doctor, and then we assess if we think we can manage them back in their home or the community. This could take as little as an hour, and we are usually able to find about five patients a day that would benefit. What’s the response been from patients and staff? Patients love the service. They’re getting the same level of care but at home away from the stress and anxiety of hospital. This is especially true of our elderly patients. Staff are also very engaged, they understand the benefits of this approach and we are seeing our referrals from ED rise significantly. The key thing is we are acting in the patient’s best interests. When we get the call, we are there within two hours. What do you see as the challenges? We need to attract more acute nurses into the roles and be able to retain them. Ideally, we would also be able to refer direct into specialties and bypass ED if we needed to. Of course, like all services we are stretched but this is definitely the future. Instead of patients being admitted to wards they are coming under our care. We just need to be able to keep up with the demand. What do you think the next five years will bring? I think the service is going to expand in a big way. With our ageing population, this is the way forward. We just need to make sure we are able to offer the necessary training to ensure we have staff with the right skill set. How do you like to unwind? I love to travel and to dance. I recently took a trip to Texas and got to do some line-dancing. I also really enjoy continuing to expand my knowledge, so you’ll often find me doing a course at the London School of Hygiene and Tropical Medicine. Taking care of your wellbeing Every day, our staff go above and beyond to care for our patients. Please take the time to also look after your own wellbeing: • 24/7 helpline (out of hours) contact Care First on 0800 174319 (24/7 service) for emotional and psychological support or access online via carefirst-lifestyle.co.uk; login details can be found on Freenet • Contact the Samaritans (on 116 123), NHS Helpline (111) or your GP • Cost of living worries can have a huge impact on our mental health – visit our financial wellbeing page on Freenet • Visit Freenet for a range of resources, information and other wellbeing tips
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