Royal Free London NHS Foundation Trust Staff, members and governors’ magazine // September / October 2024 ...and have your say in the staff survey Get vaccinated...
Follow our X account @RoyalFreeNHS to see what our patients and staff are saying about us Peter Landstrom Group chief executive to the September/October edition of our bi-monthly staff, members and governors magazine. I want to begin by reflecting on the horrifying scenes of public disorder that took place across the country in August. It was shocking, upsetting and totally unacceptable. I want to reassure you that I, and all the members of the trust’s executive teams, stand in solidarity with our diverse workforce and the wider community. We are united against racial hatred and as an organisation we are determined to tackle it in all its forms. This summer the trust boards of the RFL and North Mid approved the business case for the merger of our two organisations. It is a very exciting time to be part of the trust, and coming together as one will allow us to provide better and faster care for our populations. We have a full look at the merger on pages 4 and 5, where you can read about some of the areas where the merger will bring improvements. The NHS staff survey is now sitting in your inbox, and if you have not already completed it I encourage you to do so. It takes just 15 minutes and allows you to share your views on working at the RFL in a confidential manner. Last year record numbers of staff completed the survey and we really want to beat that this year. I continue to be so impressed at the incredible things going on across our hospitals which you can read about in this edition. I couldn’t be prouder to be a part of this organisation. Key to abbreviations: Barnet Hospital: BH Chase Farm Hospital: CFH Royal Free Hospital: RFH Royal Free London: RFL 2 Hello and welcome
Lisa Shendge, patient voice partner Patient involvement strengthens all of us 3 A former occupational therapist who describes herself as an ‘extremely experienced patient’ is part of a team helping the RFL gain invaluable insight. Lisa Shendge, 83, from Hampstead Garden Suburb, signed up at a community event to become a patient voice partner via the RFL involvement register. Any interested patient or carer can sign up to this register via the trust’s website. Patient voice partners are regularly sent activities that they can choose to get involved with – all aimed at helping us to deliver the best experience for people accessing our services. Lisa said: “I’ve had all sorts of medical problems in my life and probably one of the reasons I became an occupational therapist is as a child I thought the staff were magical people who never got ill!” In later years, Lisa ended up going into judicial work, including sitting on various panels and tribunals and on disciplinary panels at the General Medical Council. She also became a magistrate. More recently Lisa cared for her husband, to whom she was married for 53 years, but since he passed away two years ago, she is determined to, in her words, still be ‘useful’. She said: “Being a patient voice partner is like treatment for me. For example, if I can give a patient perspective on an information leaflet it gives me huge satisfaction.” Lisa recently sat on a staff job interview panel. She said: “I was a proper member of the interview team. It was a lot of work, including the shortlisting process, but it was wonderful and I felt very confident that we chose the right person.” Penny Salih, a senior improvement advisor who was also on the panel, said: “Lisa brought a unique and important perspective that helped our decisionmaking. She positively influenced the discussions and reminded us, and the candidates, about the Being a patient voice partner is like treatment for me “ “ importance of putting our patients’ needs at the forefront of our work.” Lisa has also been involved in staff training and shares her experience. She said: “In day-to-day life I’m a really confident person but put me in a hospital setting and I lose my nerve. I wanted staff to realise how important a smile or a kind word is – treat me like a real person and please take the time to help people who look lost or have a question. At some point you will become the patient and feel exactly the same.” Another job that gave Lisa huge satisfaction was providing feedback when the trust’s new website was being created. Lisa said: “I was given various tasks to complete and one of the key things for me was I thought it was really important that there is a clear indication of how you get onto the patient portal. When I saw the final version I was really chuffed that it is front and centre on the home page.” Lisa added: “Over the years I’ve benefitted from the volunteers who tell you where to go for your appointment, or make you a cup of tea on the ward or provide you with a massage and it’s lovely that I can also use my different skills to help others.”
4 This summer, the trust boards of the RFL and North Mid approved the business case for the merger of our two organisations. This decision marks a significant milestone in our partnership, with 1 January 2025 the date when our trusts are expected to join together, subject to NHS England and Secretary of State approval. For seven years we have been collaborating to improve care across a range of specialties, and sharing resources to treat people more quickly and provide a better working environment for our staff. “We are proud of what we have achieved already,” says Mark Lam, chair of both trusts. “However, given the scale of the challenge that health and care services face, we believe that joining together as one will enable us to go further and faster in improving services and the health of local people without the barriers that still exist between us as separate organisations.” What will our merger mean for patients “We know that our patients want us to see beyond geographical boundaries between trusts so that we can streamline their care,” said chief medical officer of the RFL, Gillian Smith. “From speaking to some of our patient groups, we have heard that they are positive about the potential to reduce waiting times and achieve higher standards of care throughout their journey.” We have identified four initial services where we believe our merger can achieve greater benefits for patients and staff. One of these is oncology, where we aim to increase access to clinical trials, specialist advice and treatments to reduce health inequalities. Oncology services are a critical part of the cancer pathway, providing treatments such as radiotherapy and chemotherapy. Oncology services In north central London the number of people with cancer is rising and is expected to increase 42% by 2030, with the RFL currently caring for the largest number of patients with suspected cancer in London. At North Mid, the picture Spotlight on the RFL and North Mid merger Patients will still be referred to their usual local hospital and our hospitals will continue to provide the same routine services for their local patients. However, by coming together as one, we expect to deliver more joined up services for patients, reduced waiting times and more support to keep people healthy. We will also be able to provide more specialist care locally so patients don’t have to travel and better integration with community services so people can receive care at home instead of on a hospital ward. Oncology is just one area where the merger is expected to bring benefits Patient benefits Reduced waiting times Improved access to specialist care locally Better joined-up community services More opportunities to take part in research More targeted screening and early intervention service
5 North Mid and RFL staff work side by side at CFH Improving clinical services As well as oncology, we are looking at making changes to how we run colorectal surgery and our research programmes as part of the first phase of our merger, as well as establishing further surgical hubs. Research We will tackle the current inequalities in access to research trials and new treatments, where legal and regulatory barriers limit the collaboration that is possible at present. This will allow greater access to potentially life-changing innovative treatments for North Mid patients and a more diverse patient base for RFL trials. Surgical hubs We will draw on the success of our existing surgical hubs for orthopaedics and ophthalmology to create a network of centres of surgical excellence. Here patients will be seen quicker for common procedures and receive consistently excellent care. Pre and postsurgery appointments will be at whichever of our hospitals is closest to a patient’s home, travelling to the hub only for their procedure. Colorectal surgery We will realise our vision to become a centre of excellence for bowel cancer and complex surgical treatment, focused on innovation through the use of robotic technology, early screening and integrating our service as one to provide 24/7 specialist care close to home. How to find out more The latest news about the merger can be found on our website – royalfree.nhs.uk/northmidmerger We will be also holding a public and patient event about the merger in late autumn, which will be advertised on our website and via social media. If you have any questions or feedback about the merger, please email rf-tr.northmid@nhs.net Merger timeline is similar. Meeting our cancer targets is a challenge against this backdrop. The merger is our opportunity to change how we provide care where it is needed the most, reducing time to treatment and ensuring all our patients can access the latest, most effective advances in cancer care, no matter where they live. Bob’s story Bob’s first experience of cancer was with his wife at North Mid. After she passed away, he was diagnosed with cancer himself and treated at the RFH. The care was different at both hospitals which meant Bob had to get to know a whole new system at an already stressful time in his life. What mattered most to Bob during this time was not where he was treated but having an experience that was familiar to him and support on hand. “We have high levels of expertise and excellence at both RFL and North Mid and are working together to ensure our patients receive excellent cancer care, meeting their needs with the best possible outcomes,” explains Jemma O’Reilly, lead cancer nurse at the RFL. Bernie Byrne, associate director of nursing for cancer, palliative care and end of life, and Macmillan trust lead cancer nurse at North Mid, added: “By bringing our work together we can improve the patient experience with more care closer to home for patients where possible, while at the same time ensuring that we have seamless pathways that ease a patient’s treatment journey.”
6 Patients benefit from innovation at BH cath labs Younger patients are among those benefitting from innovative technology now available at BH’s cath labs. The EMBLEM MRI S-ICD system – a type of defibrillator which sits underneath the skin on the patient’s hand side, but completely outside the heart, – is now available at BH for patients in their 20s, 30s, 40s and 50s. Designed to protect patients who have dangerous heart rhythm disturbances from sudden cardiac arrest, it offers a less invasive treatment (there are no components inside the heart) than other devices, with less risk of complications. It works by providing an electric current to shock the heart back into a regular beat if needed. Cheryl Ralph, senior chief cardiac physiologist, said: “With our refurbished cath labs and general anaesthetic capability, we can now offer more complex procedures which is brilliant news for patients who can be treated in a more timely way.” Karen Holz, 40, from Hendon, had her defibrillator fitted in July. She said: “I’ve known I had an arrhythmia since I was nine years old but last year I was diagnosed with heart failure. I had all the tests and then I was back to Barnet Hospital as a day case to have the device implanted. “The staff were amazing and the defibrillator has given me peace of mind. It feels like I have someone with me 24/7 taking care of me. I have a 12-year-old son so it’s very reassuring for me and my family.” It feels like I have someone with me 24/7 taking care of me “ “ Members of the cath lab team Karen Holz In addition, conduction system pacing – a novel way of pacing the heart which mimics the heart’s own electrical system – is now being offered to some patients at BH as part of an international clinical trial. Dr Daniel Keene, consultant cardiologist and electrophysiologist and chief investigator of the trial, said: “We hope the seven-year study, which began last year and is funded by the British Heart Foundation, will show us that this new approach definitively delivers better outcomes for patients.” The team are also due to begin offering atrial fibrillation ablation from the middle of October. This procedure freezes heart cells to cause targeted scarring on the inside of the heart. This helps break up the electrical signals that cause irregular heartbeats, making it easier to help the heart to maintain a normal rhythm. Average waiting times for the procedure in London are currently around 12 months but bringing the service to BH will help to reduce this. Daniel added: “As our electrophysiology services grow the team are excited to be part of these initiatives to deliver better care and ultimately improve outcomes for patients. It also helps us to retain staff and attract the best people to come and work with us.” Cardiovascular
7 “You enabled me to keep my independence” Hundreds of patients have now experienced the benefits of the atrial fibrillation (AF) virtual ward pathway. AF is a heart rhythm disturbance, known as an arrhythmia, which affects more than 1.4 million people in the UK, with more than 15% of those aged 75 and above. People with arrhythmias like AF suffer from a lower quality of life and are five times more likely to suffer a stroke. The RFL’s AF virtual ward pathway was launched in May 2023 with the aim of reducing the risk of strokes, avoiding unnecessary hospital admissions and improving quality of life for patients. Patients are referred to the pathway via emergency services. All referrals are triaged by arrhythmia nurses and within three working days a patient is contacted to arrange a virtual assessment. Patients admitted to the AF virtual ward are also fasttracked for additional cardiac investigations if needed and benefit from regular check-ins and consultations over the phone. During consultations, patients’ symptoms, lifestyle, and risk factors are reviewed and the information is used to adjust treatment plans and medication dosages, ensuring they receive optimal and timely care. After six weeks on the virtual ward patients are referred back into the care of their GP with their personal treatment plan. Jennifer Nash, 74, from Enfield, shared her experience of being on the AF virtual pathway. She said: “I went to Barnet Hospital’s emergency department with chest pains. When I explained my symptoms, I was given an ECG, then a blood test and given a diagnosis of AF. “I was never admitted to hospital, instead the team checked in on me by telephone several times while I remained in the comfort of my own home. They were all lovely and I felt looked after. I much preferred having I remained in the comfort of my own home “ “ L-R: Ranjini Shanthakumar, cardiovascular operations manager and Rachel Brady, clinical practice group programme manager virtual appointments to having to go into hospital because it enabled me to keep my independence.” Erik Witt, ED consultant at BH, said: “The new pathway has allowed for smoother and faster discharge planning for patients presenting to the ED with their first episode of AF.” Tukayana Quaresma, who leads the cardiac nurse specialist team, said: “The AF virtual ward pathway is contributing to improved patient health outcomes by leveraging remote technology and specialised care.” Ranjini Shanthakumar, RFL cardiovascular operations manager, said: “Since introducing the new approach to care a total of 375 patients have been on it. While approximately a third of those patients are still admitted to hospital, we have succeeded in preventing 730 days of unnecessary hospital admissions, improved the quality of life of our patients and realised savings of more than £130,000.” Cardiovascular
8 A dementia clinical nurse specialist at BH has joined forces with volunteers and staff to help get patients out of their beds, moving more and to bring more fun to the wards. Doris Ajayi runs the weekly ‘Tea with Doris’ at the hospital, which aims to get patients moving, singing, and chatting – all of which help keep them healthy. It is common for patients with dementia to deteriorate further once they come into hospital. They can also face challenges such as an increased likelihood of discharge to care homes, prescription of anti-psychotic drugs, difficulty adapting to the change in their environment, increased risk of delirium and increased fragility. Doris said the main aim of the programme, which happens every Thursday on Larch and Juniper wards and Fridays in Rainbow ward, is to help bring fun to patients and settle them into an unfamiliar environment. “Tea with Doris is designed to bring fun and to alleviate any anxieties and distress that patients with dementia may experience,” she said. “All multi-disciplinary team members take 60 seconds off to join the session, which includes music, singing, dancing, chatting and much more. This has a significant benefit for patients with dementia, as it helps to stimulate brain functions. “It connects people together, evokes positive memories and emotions, reduces boredom, agitation, aggression, restlessness and provides a calming effect afterwards. The session also increases social interaction between patients and staff, reduces feelings of isolation and loneliness, and improves the overall mood of everyone involved. “If we get care right for patients with dementia, we can get it right for everyone.” Volunteers from the Royal Free Charity also help with running the activities and get involved with serving tea and treats to patients, as well as singing and dancing. Sue Young is one of the volunteers who takes part in Tea with Doris. “You meet the most amazing people doing this,” she said. “Talking to someone with dementia and gradually getting to know them – you really get to hear these amazing stories about their lives. “Patients who are maybe a bit quiet can suddenly start singing words of songs they knew from years or decades ago and they brighten up. It’s so rewarding.” Doris has also provided some tips and advice for caring for patients with dementia. See opposite and visit the dementia Freenet page for more details. How tea and tunes spark joy in dementia patients If we get care right for patients with dementia, we can get it right for everyone “ “ Doris and Sue during Tea with Doris Dementia CNS Doris Ajayi, who runs the weekly activity Ageing well
“ “ Communication • I ntroduce yourself and tell the person why you have come to see them. • L ook at the person when you are talking to them. • M inimise any environmental distractions, for example, turn the TV down/off and make sure that you have their full attention. Signs of distress • P atients with dementia may appear to be violent or aggressive, but often their actions are a result of heightened levels of distress. • D ementia impacts a person’s ability to communicate and make their needs known, so as healthcare workers we should try to get to the bottom of why they are distressed. Eight important things about me • T his tool is designed to be a starting point for the therapeutic relationship between you and your patient. The document allows staff to better understand a patient and their life, which can help with engaging them in washing and dressing, calm them when they are distressed, and inspire them to get up and move around. More guidance for caring for patients with dementia is available on Freenet. Caring for patients with dementia 9 Staff getting involved in Tea with Doris “I found my calling in healthcare” Paul Clarke, health care assistant, has worked on an HSEP (health services for elderly people) ward at the RFH for 30 years. Before this role I was never in a job for more than a couple of years. I did a lot of agency and bank in orthopaedics. I moved to north London to be with my girlfriend and applied for the job. I honestly thought I’d do the job for a year or two and then move back into orthopaedics but I fell in love with working in elderly care because of the patients, many of whom have dementia. The role is all about supporting the patient and their family and that is so rewarding. The gratitude you get is more then anything you could get paid. The job opened me up as a person and I say I found my calling in healthcare by actually getting more involved in the care side of things. What I like is you are always developing. The training is continually being updated as we learn more and more about dementia. You are given all the tools but then it’s up to you to put them into action. To do the job you do need to be able to put yourself in the person with dementia’s shoes and you have to be a strong character. You need to understand that the person with dementia isn’t responsible for their behaviour. Speaking softly and asking people their name goes a long way. It really is the small things that count. Although it can be very stressful physically and mentally, I wouldn’t swap this job for anything in the world. Honestly, when I go on annual leave after a week I can’t wait to come back. The staff are like my family. We laugh, we are serious and if you need answers everyone is here to help. It’s my home away from home.
Give yourself the best chance of staying healthy this winter by receiving your flu and COVID-19 vaccines from early October. All staff members are invited to have their vaccinations as they will help protect not only yourselves, but your family, colleagues, and patients too. Both jabs will be available for a shorter period of six weeks this year and so it’s important that you schedule your appointment as soon as they become available – keep an eye out on Freenet for more details about booking slots over the coming weeks. Julie Hamilton, group chief nurse, said: “As frontline healthcare workers in a busy NHS trust, we are more likely to be exposed to COVID-19 and flu. If we contract one of these illnesses, we can pass them on to the people we care for in our personal and professional lives. “Getting vaccinated against flu and COVID-19 10 Make your voice heard with the 2024 staff survey Winter vaccines coming to the RFL ahead of winter, when the viruses are more prevalent and spread more easily, is the most important thing you can do to keep yourself and others around you safe. Protect yourself and get winter strong at the RFL.” Staff who get their flu vaccine will receive a £4 voucher which you can use to purchase food or drink at the BH Wellspring restaurant, RFH restaurant, or CFH Costa Coffee. You can read the latest FAQs on our dedicated Freenet pages where we will also publish more details about appointment slots soon. The 2024 staff survey has been launched and is sitting in your inbox waiting to be completed. The survey is vital to understanding what working at the RFL is like, and provides information to assess how the People Promise – what people tell us is important to improving their working experience – is progressing. The survey is completely anonymous. Every response is treated confidentially by our external provider IQVIA and cannot be traced back to you. This year, as a thank you for completing the survey, you will be in with a chance of winning One4All vouchers for you and your departments. These range in value from £25 - £400 and will be given randomly every week. You can opt in to be contacted to receive the voucher, which maintains your confidentiality. “Your voice influences not just what the RFL does, but also what happens nationally in the future on issues like flexible working, retention, violence, and equality and inclusion,” said RFL group chief executive, Peter Landstrom. “Your feedback helps us to improve your working experience and ultimately ensure the best quality of patient care.” You can complete the survey during working hours. Please speak to your manager if you need to set aside time to do this. If you need help completing the survey, please email helpline-qh@iqvia.com or call the IQVIA helpline on 0800 783 1775. More information is available at nhsstaffsurveys.com.
Governors’ update 11 Spotlight on research and education Groundbreaking research and education took centre stage at this year’s RFL annual members’ meeting, held at the RFH. Members of the public, as well as staff and patients, heard from Professor Alan Salama, consultant nephrologist, and Nicole Matthew, a RFH patient. They discussed how Alan’s research into a vaccine that protects kidney transplant patients against urinary tract infections (UTI) has made a big difference to Nicole’s life. Shortly after receiving her new kidney, Nicole began experiencing recurrent UTIs. This led to her being admitted to intensive care. Sneha discussed how the Council of Governors had carried out their statutory duties and also shared their highlights of the year, including helping to develop the trust’s new public website and welcoming eight new governors to the council. Mark reflected on the challenges the trust faced. He said: “There’s been a huge demand for our services; we’re receiving almost 50,000 suspected cancer referrals each year, which is the largest in London; and our emergency departments and urgent treatment centres continue to be extremely busy. “However, staff from every corner of our organisation have responded magnificently. I would like to say thank you to them for their incredible work and dedication.” Peter and Mark also reflected on the civil unrest across the country over the summer. “These events strengthen our resolve to ensure that our hospitals are welcoming places for everyone,” Peter said. Discussing the trust’s new five-year clinical vision, Peter added: “We’ve done a lot of thinking on our future direction of travel as an organisation and earlier this year we launched our clinical strategy – an ambitious plan which will support our staff to deliver the very best of the NHS. “It is designed with the needs of our local populations in mind to ensure we deliver the best possible health outcomes.” The final message from the speakers was one of appreciation for the trust’s staff. Peter said: “We have fantastic equipment and amazing developments, but none of it would be possible without our staff – they are the life blood of the Royal Free London.” L-R: Speakers included Nicole Matthew, RFH patient and Satianand Groodoyal, endoscopy nurse L-R: Sneha Bedi, patient governor and lead governor, Alison Moore, appointed governor for Barnet Council and Sean Baine, public governor After joining the research trial last year, the number of UTIs Nicole contracted dropped significantly from six each year to only one or two. Nicole told the audience: “My quality of life has improved immensely. I had accepted I’d be in and out of hospital for treatment, but since being vaccinated, it’s just not the case.” Attendees also had the opportunity to hear first-hand about how the trust’s apprenticeship programme is benefiting staff. Satianand Groodoyal, an endoscopy nurse, shared his inspiring journey from healthcare assistant to registered nurse. The event was chaired by lead governor Sneha Bedi who was joined by group chair Mark Lam, and group chief executive, Peter Landstrom. My quality of life improved immensely “ “
12 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 60 seconds with… Janev Hassan Service manager for phlebotomy for BH, CFH and Edgware Hospital What does a typical day look like for you? Phlebotomy is an extremely busy department overseeing blood tests for an average of 1,000 patients daily. In addition to our outpatient clinics, we deliver a service to the wards, the anticoagulant clinic and maternity patients, as well as Barnet, Enfield and Haringey Mental Health NHS Trust, to name but a few. A typical day for me starts with updating and submitting staffing levels and clinic capacity. I’ll also speak with staff to update them of any absences and ensure they are supported and working within a safe environment. If needed I will work in clinic. I’ll also respond to emails, liaise with clinics who may require urgent blood tests for their patients and oversee any unusual tests which may need special handling. Alongside this will be divisional meetings, pathology meetings and more! How are things changing for patients? Introducing the online booking system for phlebotomy from what was previously a walk-in service has been a huge change which has helped massively to reduce patient waiting times. There is a telephone booking system available as well but the bulk has switched to online, enabling us to deliver a far better patient experience. How can blood tests change lives? I have worked with the pathology clinical scientist and the genetics counsellor from North West Thames Regional Genetics Service to set up and organise a genetics test for couples who can be screened for the Tay-Sachs gene. This is a genetic disorder more commonly seen among people with Ashkenazi Jewish ancestry. More recently I’ve been taking part in the preparation for the NHS Galleri trial, a multi cancer early detection test. I also work closely with the acute liaison nurse for learning disabilities. Through them and the patients’ families and carers we get an understanding of what reasonable adjustments are required in our clinic to make the patient feel comfortable and safe. We are also updating an easy read blood test leaflet so that this patient group can be better informed. How is technology supporting the trust? In the Barnet clinic we piloted and set up a system called Salutare Clearinghouse, a paperless digital phlebotomy solution to combine all GP and hospital test orders into a single cloud-based platform which can be accessed anywhere. This system is now being used across the trust’s phlebotomy clinics so we’re no longer reliant on patients remembering to bring their paperwork with them. What are the challenges for phlebotomy? Due to the growing number of blood tests being done, as well as a rise in the number of patients who need their blood regularly monitored, we face challenges around space. There are 38 phlebotomists, two team leaders and me but we are facing a 30% increase in demand each year so we need to find solutions. How do you switch off? Outside work I enjoy visiting art galleries, going to the theatre, walking, and spending quality time with my family.
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