A lifetime of specialist care
annual review 2014/15 THE TRUST His Royal Highness The Prince of Wales visits the adult cystic fibrosis centre at Royal Brompton Hospital, which “does such wonderful work”
02 Royal Brompton & Harefield Annual Review 2014/15 contents
Introduction from the chairman and chief executive 04 A values-led organisation 06 Performance and achievements in 2014/15 07 We care 08 We respect 18 We are inclusive 24 We believe in our staff 32 We are responsible 38 We discover 44 We share our knowledge 56 Awards and recognition 62 Our profile in the media 64 Our Charity 66 rb&hArts 68
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If you would like a copy of this report in large print, please contact Katherine Denney at [email protected] or on 020 7351 8670.
03 THE TRUST
introduction from the chairman and chief executive
t will come as no surprise national initiative to sequence their future and livelihoods to anyone who is familiar the genomes of 100,000 depend on both. Every one Iwith our organisation, that patients, to help better of the national issues that has any challenges encountered understand the role that been debated publicly directly during 2014/15 were greatly genes play in disease. While affects this Trust. But our outweighed by the concerns about NHS staff, in common with NHS impressive achievements finances were discussed by teams nationwide, have an recorded by staff throughout commentators and innate ability to tune out of the Trust. economists, our paediatric anything that distracts them teams were recognised for from the day job. The nursing staff The last year has been innovation and leadership that characterised by a media has seen children dependent Contained in the pages of were amazing spotlight firmly focused on on long-term ventilation being this review are a number of on AICU. The the health service. Reports of discharged after three impressive examples of how unprecedented deficits, months, rather than the patients have benefited from concentrated demand outstripping available national average time of this clear focus. It is this funding, staff shortages and seven to nine months. And commitment that encourages devotion to the introduction of seven-day while NHS provider patients to say, for example: working, have often led the organisations grappled with “patients is news bulletins. But despite challenging new funding • “I had spent more than an almost constant stream of arrangements, a team of 15 years struggling with relentless. commentary and analysis, for doctors and physicists in the breathing. All it took was staff at our hospitals it has cardiovascular biomedical for one specialist been business as usual, with research unit was developing consultant to do an a focus on the one thing a new MRI technique to offer endoscopy and identify about which they care a unique insight into the the problem. I can’t tell passionately – delivering structure of the heart so that you the jubilation I felt at high-quality patient care. more informed diagnoses that point, knowing that it can be made. would be sorted out.” While furious debate erupted over the use of temporary That is not to say that staff • “Meeting my surgeon for staffing agencies, our are disinterested in the the first time, 18 months research teams celebrated healthcare environment or the after my transplant, is being chosen to take part in a financial stability of the health quite incredible. Neither three-year £300 million service. Quite the contrary – of us recognises the ” 04 Royal Brompton & Harefield Annual Review 2014/15
other – me because I I would have survived patients with vascular was too drugged up in past Christmas. I am diseases on site; offer remote 2014/15 in intensive care to deeply indebted to the heart monitoring via mobile remember much, he team at Royal Brompton devices as standard practice; numbers because my health has – if it wasn’t for them I and develop a new blood test improved so drastically would never even have to give patients with lung The Trust carried that I am unrecognisable. known I could be disease a better idea of their considered for a prognosis and the suitability out more than • “The nursing staff were transplant.” of treatments. amazing on AICU. The 174,000 concentrated devotion to And it is this commitment that There is no doubt that patients is relentless. I has seen Trust experts: carry 2015/16 will be as outpatient, was included as part of out complex heart surgery on challenging, if not more so, diagnostic and his nursing team and a baby weighing just 2lbs 10 than 2014/15. But by everything they needed ounces; introduce life- maintaining a sharp focus on imaging to do for him was changing lung volume what they do best, our explained to me.” reduction surgery for patients dedicated teams will ensure appointments with chronic obstructive patients experience the • “Without having the pulmonary disease; open a expert, specialist care that and saw 35,706 transplant I don’t think new aortic centre to treat they deserve. inpatients
By maintaining a sharp focus on what they do best, our Sir Robert Finch Mr Robert Bell Chairman Chief executive dedicated teams “will ensure patients experience the expert, specialist care that they deserve.
”05 THE TRUST
a values-led organisation Royal Brompton & Harefield NHS Foundation Trust is a specialist heart and lung centre based in Chelsea, London and Harefield, Middlesex.
Demand for our specialist We believe in being inclusive Our mission Our values services continues to grow so that our specialist year-on-year. Our patients, services are available to he Trust’s mission is to he Trust’s values are at from the unborn to the very everyone who needs them. be the UK’s leading the core of the elderly, come from all over We are committed to the Tspecialist centre for Torganisation; our beliefs the UK, Europe and further principle of shared care heart and lung disease. reflected in thought and afield to be treated by our and maintain a strong behaviour. world-class clinical teams. presence in referring general We to aim achieve this We use our values to guide hospitals and in the mission with strategic, There are seven values, and support every decision community. focused growth in aspects of developed by our staff. Three and action we take, ensuring heart and lung treatment, of the values are patient the delivery of safe, high- An engaged and motivated such as congenital heart focused and demonstrate quality care to patients workforce is vital to our disease, arrhythmia, heart how we look after our whose medical needs are success. As a specialist failure and advanced lung patients to ensure their needs often unique in their Trust, we recruit the best diseases. are met – whenever and complexity. clinical and non-clinical staff wherever they need our from around the world and expertise. Our approach We care about and respect invest in their development. our patients. We understand Several members of staff • We care • The continual that coming into hospital can hold national leadership development of leading be an anxious time, not only positions, and many are • We respect edge services through for patients but also for their awarded and recognised as clinical refinement and • We are inclusive families and friends, and we influential and respected research. aim to ensure that each innovators. The other four values act in person involved has the • The effective and efficient support of them: information he or she needs With our academic and delivery of core specialist to make informed decisions industry partners we play a treatment. • We believe in our staff about the care and treatment vital role in pushing forward offered. We challenge the boundaries of medicine • The transition of • We are responsible ourselves to improve every through research, and by appropriate routine day and are keen to take on sharing what we know services to other centres • We discover board comments and through teaching, what we to release capacity for suggestions from patients learn can help patients new interventions. • We share our knowledge and carers. everywhere.
06 Royal Brompton & Harefield Annual Review 2014/15
performance and achievements
Our experts in 2014/15:
4 Carried out more than 174,000 outpatient, diagnostic and imaging appointments and saw 35,706 inpatients 4 Scored over 98 per cent from patients in the NHS England Family & Friends Test
Achieved a world first by implanting a Tendyne transcatheter mitral valve system to treat mitral regurgitation 4 (a leaking mitral heart valve) 4 Performed 2,899 angiograms and 2,344 coronary angioplasties 4 Fitted 3,395 pacemakers and implantable cardioverter defibrillators (ICDs) 4 Pioneered homecare support to shorten the length of time patients need to stay in hospital 4 Recommended by 92 per cent of staff in the NHS England Family & Friends Test 4 Performed 708 paediatric cardiac procedures and admitted 2,546 children with heart and lung conditions 4 Conducted 8,473 appointments with paediatric (under 16 years of age) cardiology and respiratory outpatients 4 Carried out 6,169 inpatient and 8,986 outpatient CT scans 4 Performed 18,445 echocardiograms at Royal Brompton Hospital and 13,191 at Harefield Hospital 4 Helped nearly 1,000 cystic fibrosis (CF) patients 4 Recruited 3,149 patients into more than 175 research studies
Achieved the 18-week NHS standard referral time for admitted patients every month between April 2014 and 4 March 2015
Achieved the 18-week NHS standard referral time for non-admitted patients every month between April 2014 4 and March 2015
07 WE CARE
we care We believe our patients deserve the best possible specialist treatment for their heart and lung conditions, in a clean, safe place.
New service for patients
n a rapidly changing have heart problems also leading centres in the world. are made aware of what the environment such as have other arterial problems, Professor Cheshire, who is Trust can now provide. Ihealthcare, providing the such as aortic aneurysm or an expert in minimally- best possible specialist care carotid stenosis, narrowing or invasive techniques, Commenting, Mr Rosendahl for patients is an evolving blocking of the arteries. commented: “Centres across said: “The Trust is concept. Services are Similarly, people with vascular the world have begun to internationally known as a regularly reviewed to ensure diseases frequently need to recognise a need to bring pioneer within its field and is patients are experiencing see a cardiologist or cardiac clinicians together to offer a only one of two NHS trusts high-quality care, delivered surgeon. Previously, there more patient-focused service. nationally that has the in the most effective way was little option but to Our surgical expertise and knowledge, expertise and possible. operate in separate hospitals. knowledge, coupled with our equipment to offer a This could often be a international reputation, comprehensive service for It is not unusual for patients traumatic experience for means it makes sense for us patients with complex aortic with heart disease to have patients and their families. to be leading the way in problems. Developing the other problems with their Now they can be treated for England and Wales.” new aortic centre will further circulatory system. Until both conditions without cement in people’s minds recently, services were not leaving our hospitals.” The multidisciplinary team of that clinical teams within the available at the Trust to treat specialists – doctors, nurses, Trust are constantly striving to these patients, meaning they Since his appointment in radiologists and other health provide the best possible were often transferred to a January 2015, patients with professionals – have between specialist care for patients.” different hospital. aortic aneurysms have been them amassed thousands of successfully treated with the hours treating the most With the appointment of the combined surgical efforts of complex cases in England. Trust’s first vascular surgeon, Professor Cheshire and Mr They are all now working and Professor Nick Cheshire, Ulrich Rosendahl, consultant accepting referrals under the patients with vascular cardiac surgeon. banner of the new aortic problems can now be treated centre. on site. A new aortic centre Clinicians are spreading the Professor Cheshire has an The appointment of Professor word around the UK about Clinicians can international reputation for his Cheshire means clinicians the new service, offering work in vascular surgery and can now focus on the referring surgeons the now focus on the is one of the founders of the development of a chance to join them in theatre British Society for comprehensive aortic centre, to learn more about the development of a Endovascular Therapy the first of its kind in the UK. combined specialist (BSET), which was set up to The centre will combine techniques. comprehensive promote best outcomes traditional surgery with aortic centre through the use of safer, minimally-invasive The number of patients using modern techniques. techniques. This will put the the new aortic centre is likely Explaining the concept, he Trust at the forefront of to grow significantly as “ says: “Many patients who medical thinking, rivalling hospitals across the country
08 ” Royal Brompton & Harefield Annual Review 2014/15
PATIENT EXPERIENCE
John Flowers, Royal Brompton cardiac patient, aged 72
John was diagnosed with a severe thoracoabdominal aneurysm (an abnormal enlargement of part of a blood vessel) and had his operation earlier this year (2015). He has made a full recovery and is extremely grateful for his care at the hospital.
John said: “Royal Brompton was always my first choice of hospital for the surgery, and my wife and I have not been disappointed. A routine scan of my heart found that I needed a triple heart bypass before my Professor Nick Cheshire, vascular surgeon aneurysm could be treated. Thankfully, Mr Rosendahl insisted on bringing in Professor Cheshire, who is an expert in this type of Major investment in technology complex condition, for the second procedure. elivering the best improve the quality of patient tools that enable clinicians “Throughout it all the two possible specialist care care by transforming our to analyse significant surgeons showed such Drequires the support of digital systems, improving volumes of structured and compassion and nothing the best possible IT systems. knowledge management unstructured data. was too much trouble – it Following the appointment of processes and expanding our was a pleasure to see. The the Trust’s first chief research capabilities.” • The electronic prescribing nurses and other members information officer (CIO), and medicines of staff were first class too. Joanna Smith, a multi-million Over the last year a major administration (EPMA) pound investment programme of upgrades to system is now used on programme to update IT core IT infrastructure, several wards at Royal “I have always enjoyed life, infrastructure and significantly including network PCs Brompton Hospital with but before my surgery even improve clinical and data and servers, has been further rollout to the rest of the most simple of tasks systems was launched carried out. the Trust to follow. was becoming more and in 2014. Benefits of electronic more difficult. Now I’m Significant progress has also prescribing include back to spending time “If the Trust is to achieve its been seen with the Digital reduced errors, swift doing what I love most; mission to be the UK’s leading Care Transformation represcribing for repeat running around after my 20 specialist centre for heart and Programme (DCTP): admission patients, and grandchildren and great- lung disease, it is vital that remote access to grandchildren. The staff can access systems and • The clinical data medication records. treatment offered by the information whenever, warehouse (CDW) is now team at Royal Brompton wherever, and however they up and running. The • A new patient has been nothing short of need them,” explains Joanna. warehouse provides a administration system life-changing.” repository of key Trust (PAS) has been procured “Delivery of our information clinical data with and the project to and technology strategy will sophisticated analytical implement it is already
09 WE CARE
underway. The system will hold “real time” data and provide precise tracking of a patient’s admission, bed and ward location, clinic appointments, transfer and discharge. If the Trust is to achieve its mission to be the UK’s leading specialist centre for • An electronic document management (EDM) heart and lung disease, it is vital that solution has been procured and will be staff can access systems and introduced shortly after the new PAS. The major information whenever, wherever, and benefit of EDM is that staff however they need them. will have access to full “ online patient histories in one secure place. At the click of a button records can be searched, created, stored and retrieved. EDM eliminates manual paper-based Joanna Smith CIO (right), with Joy Anderson, processes including lead nurse electronic transformation, inspecting a digital “whiteboard” transporting paper case notes, and moves the Trust towards a paper- light environment.
• Digital “whiteboards” are replacing traditional boards in clinical areas. ” The new electronic screens provide an automated display, improving data quality and reducing time spent by ward staff on updating the board manually.
The EPMA and EDM systems were both jointly funded by NHS England as part of its integrated digital care fund (the Trust received one of the three largest awards from the fund).
The Trust is now among the top-rated hospitals for its use of information and technology as measured by the Clinical Digital Maturity Index (CDMI). A recent CDMI report specifically referred to the rollout of complex administrative and clinical systems.
10 Royal Brompton & Harefield Annual Review 2014/15
Amenities awards improve the experience for patients
o support staff in the A significant number of spec electronic hoist • The lounge that serves delivery of high-quality emergency patients are makes changing position patients being Tcare, the Trust’s elderly and frail, and smoother and more discharged from Maple charity created the Patient they particularly relaxing for patients, and and Cedar 1 and 2 Amenities Fund. On appreciate the comfort as the weight wards at Harefield average, up to 90 the blankets give. mechanism is already Hospital was in need of applications are made attached to the powered decoration. A successful annually to the fund’s • A successful application hoists, patients can be application to the Patient selection panel, which is by the team from Royal weighed at the same Amenities Fund enabled made up of patients, staff Brompton’s Foulis ward time as they are moved. a full redecoration to take and governors. has made manoeuvring The entire hoisting place and the lounge and weighing patients an process is now quicker now has comfortable, Applications are invited for easier and more dignified and less disruptive to soft furnishings, a hot any project that improves process. A new high- everyone. drinks machine and a patients’ and / or visitors’ wide variety of reading experience of the Trust. materials. A desk and computer have also been Joy Godden, director of The refurbished lounge serves patients being discharged and added so that a member admitted to Maple and Cedar 1 and 2 wards at Harefield Hospital nursing and chair of the of staff can work in the Patient Amenities Fund lounge and be on hand panel, said: “We are very to help patients as they grateful for the charity’s wait for their discharge support. It is always prescriptions, follow-up satisfying to approve arrangements and applications with obvious transport home. benefits to patients. Projects range from ambitious ones • The provision of three that need a large investment portable CD and six MP3 through to straightforward players was quite a ideas that don’t cost a great modest request to the deal, but still have a big Patient Amenities Fund, impact on the quality of but the machines are care.” being put to excellent clinical use. Relaxation Some recent projects techniques are often include: used by the psychological medicine • Staff in the catheter labs service with patients on at Harefield Hospital general wards, the adult noticed that some intensive care unit (AICU) patients felt and the high dependency uncomfortable in the cool, unit (HDU). The CD and air-conditioned MP3 players have atmosphere. They applied allowed the team to to the Patient Amenities develop this therapeutic Fund for a blanket approach and provide an warming cabinet. Now option for patients to patients are given warm continue with relaxation blankets after their outside therapy sessions. procedure. Warmed The CD or MP3 tracks blankets are also available can be used by patients to patients who are on their own devices, so waiting for procedures the therapeutic approach and who may be feeling can be continued after anxious. discharge.
11 WE CARE
STAFF PROFILE
Dr Julia Selby, clinical lead speech and language therapist for voice, ENT and respiratory services at Royal Brompton
Dr Julia Selby joined the multidisciplinary upper airways service at Royal Brompton Hospital in March 2014.
The team, led by Dr James Hull, consultant respiratory physician, treats and supports patients with upper airway conditions including cough, vocal cord dysfunction and other voice box conditions. Patients are referred to the service from all over the UK and Europe. The appointment of a specialist speech therapist Dr Julia Selby, clinical lead speech and language therapist for voice, ENT and respiratory services, in conversation with a patient means patients can receive on-site expert support for:
• vocal cord dysfunction treatments and the right have shown that speech team means we can now • swallowing difficulties expertise,” said Dr Hull. “In therapy is an effective offer a full and co-ordinated • vocal cord complications London and the south of treatment for patients with approach. We also work England, there is currently a chronic cough and is often closely with a world expert • chronic cough great shortage of specialists better than the standard laryngologist and ENT with the expertise to treat drug treatments used. The surgeon at Chelsea and • voice disorders conditions where the voice results Dr Selby has Westminster Hospital, Mr box closes. This condition achieved are impressive Gurpreet Sandhu. • vocal nodules caused by mimics asthma and often and, with some patients, trauma patients suffer with daily quite remarkable,” said “I advise patients that we symptoms and need to Dr Hull. are a team, working in a • laryngospasm (a spasm attend regular hospital partnership to get the best of the vocal cords). appointments. The upper Dr Selby commented: “I results from the various airway service at Royal specialise in treatments for therapies within my “Prior to the appointment of Brompton is being patients with more complex expertise. These can range Dr Selby, patients needing developed specifically to speech therapy needs like from vocal exercises to specialised speech therapy address this unmet need”. muscle tension voice breathing work or giving a would have to attend disorders and laryngeal massage to a Charing Cross Hospital in Dr Selby sees patients, on hypersensitivity within the patient.” London, or, be referred average, for four to six larynx; that’s the feeling that back to their primary care sessions, and those something is stuck in the provider where there was a presenting with persistent throat. My appointment as a strong possibility of them cough typically attend for member of the upper not being able to access two to four sessions. “Trials airways multidisciplinary
12 Royal Brompton & Harefield Annual Review 2014/15
13 WE CARE
Paediatric rehabilitation care programme leads the way in the UK
n November 2014, the cardiologists and specialist influence decisions about the pioneering rehabilitation care nurses to ensure patients are timing of surgery, and may Iprogramme (RCP) was referred to the right specialist also influence the outcome. launched at Royal Brompton at the right time. Other Hospital to support children members of the team include Procedures to correct these diagnosed with complex occupational therapists, types of defects account for congenital heart defects. The speech and language approximately 30 per cent of service is the first of its kind in therapists and dietitians. paediatric surgeries the UK. performed at Royal Brompton Children with complex heart each year. The programme provides conditions, such as a assessment and ongoing ventricular septal defect (a Before the RCP was co-ordinated care for children hole in the wall that separates launched, no rehabilitation in need of intensive the right and left ventricles of and therapy clinics were rehabilitation and therapy the heart) or tetralogy of Fallot available at the Trust for these support before and after their (a problem with the heart’s patients. Now there are surgery. The programme was structure and function due to outpatient clinics at both developed by Philippa Wright, abnormal development sites, including an innovative Trust lead for paediatric before birth), are often at risk behavioural feeding clinic at rehabilitation and therapy. of feeding difficulties, Harefield Hospital, which is resulting in malnutrition and jointly run by speech and The RCP multidisciplinary developmental problems. language therapists and team works alongside Both these issues can dietitians.
14 Royal Brompton & Harefield Annual Review 2014/15
Commenting on the surgery, swallowing as he had Mr Olivier Ghez, consultant been tube fed since he paediatric cardiac surgeon, was born.” said: “Although Joshua was born with a relatively Twelve weeks after his first common congenital heart operation, he was ready for defect, he was the smallest his second, this time baby we had ever operated weighing 5lbs 5oz. on with this condition. We decided we needed to carry The surgery, again out the operation despite performed by Mr Ghez, the risks associated with was a success. Joshua him being so small. The was allowed to go home procedure was a success 22 weeks after he was and allowed him to survive born, having spent 19 and grow.” weeks on PICU.
The operation was swiftly Suzy explained: “I was very followed by surgery for a nervous about bringing him life-threatening bowel home as we were so used condition, common in to having everyone on hand premature babies, which in hospital. But we had was performed at Royal fantastic support – the Brompton by a paediatric referrals to our local nurses surgeon from Chelsea & and community workers Westminster Hospital. were all sorted out for when we got home.” Following this, it became obvious that Joshua would Joshua is reaching all his need further heart surgery normal developmental once he had grown milestones and is a happy, Joshua playing on his tractor stronger. Again, the RCP boisterous toddler. He won team worked hard to get the Pride of Essex, ‘Child of him well enough for Courage’ award in PATIENT EXPERIENCE Suzy, his mother, surgery. November 2014. explained: “He needed Joshua Newman, surgery on his heart, but Suzy said: “His first Suzy said: “I’m indebted to congenital heart the clinicians caring for him operation bought him some everyone at Royal disease patient, Royal wanted him to grow first. time; without it he wouldn’t Brompton. I think the Brompton That’s where the have survived. We needed rehabilitation care rehabilitation care to get him strong enough for programme is fantastic – it Joshua Newman was born programme came in. further major surgery and helped Joshua get to a at 28 weeks, and weighed Philippa (Wright) was the team was fantastic. point where he could have just 2lbs 7oz. He was involved in Joshua’s case Physios kept his muscles the surgery and that was diagnosed with congenital from the start, modifying and joints moving and also invaluable. Having the team heart disease while in the his diet to ensure he had helped with exercises to plugged into his care from womb and at just one day extra calories to help him strengthen his lungs. day one really made a old was transferred to Royal grow quicker.” Dietitians devised a high- difference. We will be Brompton’s paediatric calorie diet and forever grateful.” intensive care unit (PICU). Eventually, surgeons had to occupational therapists He had two holes in his operate when Joshua still worked with the play team heart and a narrowing of the only weighed 2lbs 10oz to provide stimulation for aorta, the main artery in and his heart was the size him. The speech therapists the body. of a walnut. also helped Joshua with his
15 WE CARE
PATIENT EXPERIENCE Born in 1981 with cystic fibrosis, I was lucky enough Sharon Brennan had a to receive a double lung double lung transplant transplant at Harefield at Harefield Hospital Hospital in Middlesex in August 2013. Celebrating its centenary this year, Harefield is a place that has long conjured everyday miracles behind its utilitarian exterior.
Harefield's drab brick façade, flat roofs and white- framed windows do not do justice to the work that goes on there. Inside this building of large, glass-sided corridors and stunning artworks by the likes of Grayson Perry, walk nurses, receptionists, porters, @SharonBrennan cleaners, doctors and canteen staff. They go Harefield’s annual family day and fun run about their jobs, seemingly oblivious to how This is an edited version of a extraordinary their roles are incredulous, I answered, sentiment I can relate to. feature that appeared in the in helping to transform the "The transplant!" "Don't Meeting my surgeon for the Independent newspaper in lives of people often given worry", he said, "we do first time, 18 months after March 2015. only a year or two to live. them all the time." my transplant, is quite incredible. I shake his As I mounted three flights of Clinical nurse specialist This matter-of-fact attitude is hand, fully aware that it had stairs, the highest I'd been Mandy McCurry, 60, has perhaps fostered by the fact once held my new lungs. able to climb in more than worked at the hospital since that Harefield is a relatively Neither of us recognises five years, the feeling of 1983. She helped to small hospital in a close the other – me because I pride overwhelmed the prepare the very first heart village community was too drugged up in exhaustion. My and lung transplant patient surrounded by English intensive care to remember physiotherapist was by my for surgery. Although she countryside. It's not unusual much, he because my side, providing recognises the real impact to see badgers, owls and health has improved so encouragement and that the hospital can make even deer in the hospital drastically that I am carrying the two surgical on people's lives – "we see grounds. Fabio De Robertis, unrecognisable. drains that had been [patients] walking out the 43, the surgeon who carried inserted 10 days before, door without any oxygen out my own transplant, I feel an almost familial during my double lung when before they came in in describes the hospital as connection with him and it transplant at Harefield a wheelchair" – she says "not very shiny", but says doesn't surprise me when Hospital. As I reached the that on a "day-to-day basis" that when you enter, "you he tells me that his four- top, there, pencilled on the she doesn't think that what find an amazing team. and five-year-old children wall in front of me, was a she does is "miraculous". Everybody says 'Let's get are always asking to meet small "Hello". One of the on with it, let's save lives'." his patients. There is a thousands of transplantees Indeed, a few hours before closeness at Harefield that that had come before me my own transplant, a doctor De Robertis says of his job is born from the dedication had left their mark. To me, noticed my shaking hands that "transplantation is the shown to its patients, what it meant "Welcome to the and said, "What are you closest to motherhood I De Robertis calls a gang". scared of?" Rather can get", and it is a "vocational calling".
16 Royal Brompton & Harefield Annual Review 2014/15
If the hospital is a family, then Mr Fabio De Robertis, consultant cardiac the patriarch is Professor Sir and transplant surgeon Magdi Yacoub. It was his groundbreaking work that laid the foundations for Harefield to now offer one of the largest transplant programmes of its kind anywhere in the world, performing almost 3,000 transplants since Sir Magdi carried out the first one in 1980.
Things have come a long way since Sir Magdi first pioneered cardiothoracic transplant. McCurry explains that the first transplant patients were kept in complete isolation for the first seven days. "It was scrubs to go in and out and you [nurses] were in there for the whole shift [without leaving]." These early patients could only eat fruit and vegetables if they were from a tin and had to have sterilised milk because of the risk of infection. Now, transplant patients are encouraged to see the operation as one that allows them to enjoy their life again without many restrictions. She points out, though, that Harefield "is not only about transplant and that mustn't be forgotten".
McCurry is still in touch with patients that she nursed in 1983, and for her, seeing a patient through their life journey is partly what makes Harefield unique. "We never say goodbye to them," she says. As I drive away from Harefield the day I met De Robertis, I realised that this hospital is more than just the venue for life-changing surgery. For me, it is a place in which I can feel at home.
17 WE RESPECT
we respect We believe that patients should be treated with respect, dignity and courtesy and that they should be well informed and involved in decisions about their care. We always have time to listen.
AICU patient experience day
ny hospital admission first for us, and gave us memories (emotionally the aortic valve). During the can be a stressful quality time to really listen to arousing memories linked to operation, Simon had a Aexperience, both for what our patients and their them) can last for several chronic asthma attack and, a patients and their families families had to say.” months after treatment has day after the surgery, his and carers. For critically ill ended. The content of kidneys failed. patients who are brought More than 60 people intrusive memories can into the Trust as emergency accepted the invitation and sometimes merge the Catherine said: “The nursing cases, this is particularly so. travelled to London from as far factual experience from ICU, staff were amazing on AICU; Many of these patients are afield as Northern Ireland and such as pain, with the concentrated devotion to at their most vulnerable Scotland. Twelve members of hallucinatory, delusional patients is relentless. I was when they arrive, some are the AICU multidisciplinary memories such as included as part of his unconscious. With a desire team, including doctors, persecution or torture. The nursing team and everything to gain a deeper nurses, therapists, a patient was coming to terms they needed to do for him understanding of how consultant clinical psychologist with her experience but was explained to me. patients experience Royal and administrative staff were found it extremely helpful to Brompton’s adult intensive on hand to facilitate the day- share her story and hear “But to see my partner who, care unit (AICU), Darzi long event. other similar ones. only a short time previously Fellows Dr Julian Lentaigne had been enjoying day-to- and Dr Claire Boynton, with The programme was carefully Dr Anne-Marie Doyle, day activities, in such an the support of consultants structured to allow significant consultant clinical incapacitated state, was Dr Anthony Bastin and Dr time for discussion and in psychologist, discussed the beyond frightening. Seeing Simon Finney, invited former feedback those attending psychological medicine him attached to numerous patients back to the hospital said that being able to share service, which is available to tubes made me feel so to hear first hand how they experiences was the most all Trust patients, and went helpless. His time on AICU felt about their stay in AICU. valuable aspect of the day. into some depth about the was the most harrowing of effects that traumatic my life.” “Coming to AICU can be a One patient spoke in depth experiences can cause in very stressful experience for about her individual times of severe physical For several patients, being patients and relatives. We’ve experience. Although she felt distress. able to chat to others who been working at improving her care was excellent, she had been supported on AICU that experience for some was troubled by disturbing To represent the views of was very cathartic. One time. We felt the best way to hallucinations for much of her families and carers, Catherine former patient said the relief explore some of the issues time on the unit and found Quirke from Hampshire he felt at being able to talk was to invite former patients the experience deeply shared her experience. about what he had gone and relatives back to Royal unsettling, even after Catherine’s partner, Simon, through was like “a great Brompton to ask them: ‘How discharge. was a patient on AICU for 11 weight lifting from my can we help you, and how days following an operation shoulders”. can you help us?’ explained Intensive care hallucinations for an aortic valve Dr Lentaigne. “The patient and delusions are not at all replacement as a result of “I feel much better having experience open day was a uncommon and intrusive aortic stenosis (narrowing of shared my experience with
18 Royal Brompton & Harefield Annual Review 2014/15
(left to right) Dr Anthony Bastin, Dr Simon Finney and Dr Julian Lentaigne talk to patient Mr Richard Weeks and his wife, Rosalyn
other patients” was a equipment used during a Brompton Hospital is one of know exactly what to expect frequently expressed feeling. heart-lung bypass operation to only five centres in the during their time with us.” And relatives also benefitted: oxygenate the blood outside country commissioned to “It was a relief to know I the body when the lungs are carry out ECMO. Jan McGuinness, director of wasn’t alone in some of my unable to do so. He explained patient experience and feelings. It was great to be that patients are generally Commenting on the AICU transformation at the Trust, able to revisit the site of such transported by ambulance, open day, Dr Finney said: said: “The AICU event ‘trauma’ in these now, from as far afield as Cornwall “The critical care team is very provided a very concrete happier times,” said one. and the north of England, but grateful to all those who example of how inviting for patients from Northern attended and for being so patients and families to Gaining closure Ireland and Scotland, the instructive as to how we can co-design their care and care team will travel by air improve our service. It was environment with teams from For some of those taking part ambulance to bring them beneficial for the team to see the Trust can result in a it was their first “conscious” back to Royal Brompton. the service through their eyes strong partnership, with each experience of the AICU. To and listen to their opinions. side bringing particular help them “have closure,” “The total process of retrieval We are reviewing the points strengths to the table.” AICU senior nurse, Ian from leaving Royal Brompton raised as ongoing actions. Naldrett, led a guided tour of Hospital, collecting and For example, we are the unit. And, as many assessing patient, putting addressing the need to patients had needed ECMO them on ECMO (if required), provide a more pleasant (extracorporeal membrane stabilising for transfer, and the waiting area with greater oxygenation) life support journey back and stabilising privacy for relatives. during their stay, Dr Bastin on arrival can take 12 to 15 gave a presentation about this hours or longer, depending “We have also worked on vital treatment and how it on the distances involved and improving information works. ECMO uses a how complicated the medical available on the Trust website machine similar to the case is,” Dr Bastin said. Royal so that patients and families
19 WE RESPECT
PATIENT EXPERIENCE In January, David attended the unexplained “For the first time I breathlessness service at felt I was being Royal Brompton Hospital, listened to”. under the care of consultant physician, Dr James Hull. David Southall, a Royal Brompton “For the first time I felt I was patient being listened to. Dr Hull asked about my symptoms In 1991, David Southall from and then I had many tests Chelmsford in Essex, was during a six-day stay, involved in a motorbike including sleep and fitness accident that left him with tests. When the doctors punctured lungs and several tried to put a tube with a broken ribs. He spent three camera on the end into my months recovering in lungs, the tube wouldn’t go hospital and experienced further than my throat. So I breathing problems due to had an endoscopy, where scarring of his lung tissue. the tube went down my Once the scars had healed nose instead. his breathing problems decreased, but during the “The team spotted the following years he started to problem on the monitor struggle again. His doctor straight away – an area at After surgery, David completed a 62-mile non-stop charity bike ride diagnosed asthma and the top of my windpipe, prescribed inhalers, but his close to my voice box, was condition did not improve. very narrow and meant I was breathing through a very disciplinary team at Royal stopping. I’ve recently “I told my GP that I didn’t small area. I was told that Brompton that investigates signed up to do the Three think I had asthma. My lungs this uncommon condition, patients with complex Peaks Challenge. I could always sounded healthy glottis stenosis, was to narrowed airways, carried never have dreamed of when doctors listened to blame for my breathing out a 20-minute procedure doing those things before them with a stethoscope difficulties and wheezing. at Charing Cross Hospital to my treatment – it’s given and my peak flow readings laser the blockage away. He me my life back. didn’t improve after taking “I had spent more than 15 then used a special balloon inhalers, which suggested I years struggling with to inflate David’s narrowed “I have check-ups at Royal didn’t have asthma. breathing. All it took was for airway. Brompton every six months one specialist consultant to and my lung function had “Then I was told that my do an endoscopy and “I was quite emotional when increased by 70 per cent at problems were still down to identify the problem. I can’t I took my first breath after my last appointment. the impact of the accident tell you the jubilation I felt at waking up because I felt on my lungs, and was told that point, knowing that it normal for the first time “The care here has been to try breathing exercises. would be sorted out. since before my accident. I second to none. Dr Hull has But nothing helped and as had no whistle or wheeze. explained every stage and the years went on my “Dr Hull thought the The first night after the process, as have the breathing deteriorated even narrowing was due to being procedure, my other half nurses, the ward sister and more. I sounded like Darth intubated when I was in had to check I was still alive other doctors. Everyone has Vader with my raspy intensive care after my because she couldn’t hear been so friendly and breathing. There was no accident. He said the me snoring or wheezing. welcoming. respite – it was always bad. breathing tube may have ruptured the top of my “My breathing has been “I’m so thankful for “Finally I’d had enough. I windpipe when it was put in phenomenal since. Two everything that the team has saw my doctor again, he or taken out, and over time it weeks after leaving done for me. If I’d paid said there was nothing more got worse.” hospital I completed a half money for the experience I he could do for me and marathon, and earlier this would have come away referred me to Royal Consultant ENT surgeon Mr summer I did a 62-mile thinking it was worth every Brompton.” Guri Sandhu, part of a multi- bike ride for charity without penny.”
20 Royal Brompton & Harefield Annual Review 2014/15
Doing more for patients before surgery
The pre- admission unit helps the Trust avoid delaying or even cancelling “procedures, because potential complications are picked up.
Allison Pottle (second from right) and members of the Woodlands team
he Woodlands Hospital colleagues say they given to them when they are pre-admission unit was know which patients have diagnosed. We can take the Tset up by Alison Pottle, attended the assessment time to talk about the nurse consultant in centre from the ones that reasons they are coming cardiology, in June 2013. haven’t. Patients who have into hospital, listen and allay During 2014/15, the service been assessed are better any anxieties they may have. peaked with 2,551 patients informed and more relaxed Importantly, we can talk to being referred from eight on the day of admission.” them about what they can clinics ranging from expect to happen when they angioplasty and cardiac The pre-admission unit are admitted.” surgery to ablation and helps the Trust avoid chest drain. This was the delaying or even cancelling Patients are seen in the unit first service of its kind for the procedures, because seven to 14 days before ” Trust and is proving its value potential complications are their admission and are both to patients and the picked up. For example, examined to ensure they are organisation as a whole. patients presenting with fit for their operation. The anaemia can be treated in assessment includes: “I felt strongly that we advance of their inpatient height, weight and blood needed to do more to stay. pressure checks, an MRSA support our patients before bacteria test and blood they came to the hospital “While patients are having tests. There is also a review and to ensure they were fit their assessment, they can of medication with the for the operations and ask for any information they cardiac pharmacist and all procedures they were going need. We find, as nurses, paperwork required prior to to have,” said Alison. “Pre- they ask us the questions admission is completed. admission assessment they may not like to ‘bother’ Patients from other parts of prepares patients physically, their doctor with,” explains the UK have a telephone mentally and emotionally for Alison. “And often patients assessment with one of the their admission to hospital. can’t retain all the details team members.
21 WE RESPECT
PATIENT EXPERIENCE “I think the service at procedure were completed “operation fit”. That really Woodlands is marvellous. on the morning of does take away a lot of Susan Jefford, aged Everything you need is admission. Sometimes that worry.” 61, has coronary done, from a blood pressure could be rather a rush and I artery disease and has check to medication review worried that the theatre staff been a Harefield and all under the same roof. might be waiting for me. patient for 17 years “All the staff are so friendly “Also, there was always the In 1999, Susan underwent a and efficient. If you do have uncertainty that one of the triple bypass operation and, to wait, it’s a pleasant place tests would show up in the years since, has had to be as you can make a something that meant you four stents implanted. Susan cup of tea, and if you want couldn’t have the procedure returns to Harefield Hospital to, watch television to pass as scheduled. for a repeat angiogram the time. whenever a potential new “I don’t feel like that problem is found, and each “Before the Woodlands anymore because all the time has the pre-admission service was available, all the pre-op checks and tests assessment for her tests and checks you have been done well in Susan waits to be called for short stay. needed before the advance and I know I’m her angiogram procedure
Emily Dobbs, healthcare assistant, measuring a patient in the pre-admission unit
2014/15 in numbers Admissions at the Woodlands pre-admission unit peaked with 2,551 patients being referred from eight clinics ranging from angioplasty and cardiac surgery to ablation and chest drain.
22 Royal Brompton & Harefield Annual Review 2014/15
PATIENT EXPERIENCE and waiting for the inevitable and who knows, they may He was fortunate to have a end, I decided to make the be my children or lung transplant in the John Williams, from most of the time and quality grandchildren.” summer of 2015. Derbyshire, took part of life I have left and do all I in a clinical trial for can to help find a cure for In early 2015 John was “I’m still recovering from the idiopathic pulmonary the condition.” asked if he had considered operation but I can now fibrosis (IPF) at Royal being assessed for a lung walk further than before and Brompton Hospital A friend of John’s who transplant: “I thought I was I feel a lot better overall. works in healthcare too old for a transplant. But I Without having the “In August 2013, at the age suggested that he wrote to was told the cut off was 65, transplant I don’t think I of 64, I was in excellent Dr Toby Maher, consultant the age I then was.” would have survived past physical health enjoying hill respiratory physician, to ask Christmas. I am deeply walking, skiing and playing if he could be considered John was later assessed for indebted to the team at league squash two or three as a potential candidate for a transplant and put onto Royal Brompton – if it times a week. Without any a research trial. John’s the waiting list at wasn’t for them I would warning I developed a bad friend was aware that Dr Wythenshawe Hospital, in never even have known I cough during squash Maher’s is a leading name south Manchester, his could be considered for a games, which stopped in the field of IPF research. nearest transplant centre. transplant.” when I finished playing. “I was pleased and “Over the following weeks surprised at the fast and the cough increased and enthusiastic response from became continuous, Dr Maher’s secretary especially during intense following my enquiry. physical activity, when I also Everyone who works at the noticed I was becoming centre has been so helpful, breathless more quickly. friendly, cheerful and After spending a fortune on professional. From the every brand of cough minute I entered the medicine without any research centre I was benefit, I visited my excellent treated as a VIP and I felt GP, who quickly sent me off the team was genuinely for an X-ray. I was informed interested in me and my that the X-ray needed condition. further investigation.” “They immediately made my John had subsequent tests wife, Liz, and I feel part of and a CT scan, and was the team. Once I had been diagnosed with idiopathic accepted onto phase two of pulmonary fibrosis (IPF) the hospital’s monoclonal around four months later. antibody trial in the summer of 2014, I felt that my “I had never heard of the contribution was valued. At condition before, so I each monthly visit I always researched on the internet received a full explanation of and found a local support what was happening and I group in Birmingham, which felt reassured knowing that I I visited to talk to other was being so well people at different stages of monitored and cared for at IPF. It rapidly brought home a centre of excellence. to me that there is currently no cure for this condition. I “I was no longer left in the found out things about IPF wilderness, as I had been that I didn’t really want to before coming to Royal know, but had to accept. Brompton. It also felt good to know that I was playing “Rather than collapsing in a my part in finding a cure for Happy times for John with his wife, Liz heap feeling sorry for myself other people in later years –
23 WE ARE INCLUSIVE
24 Royal Brompton & Harefield Annual Review 2014/15
we are inclusive We believe in making sure our specialist services can be used by everyone who needs them, and we will act on any comments and suggestions that can help us improve the care we offer.
Ongoing outreach and collaboration
The Trust has a history of if undiagnosed, can be targeted antibiotics that • Pulmonary rehabilitation working closely with other fatal. By extending the enable patients to lead classes are now available hospitals and community service into the normal lives. in Hillingdon and Harrow, services to ensure patients community, the team in addition to have access to our wide- hopes to increase the Royal Brompton Hospital programmes run at both ranging services and number of diagnoses and is one of only four clinical Trust hospitals. The treatments for heart and lung provide early intervention. centres commissioned by service had nearly 1,000 disease. Our experts promote the NHS to look after new referrals between the principle of “shared care” Patients found to have FH children with PCD and, March 2014 and April through an expanding system are also offered treatment with more than 300 2015. More than 90 per of consultant-delivered at the lipoprotein paediatric and adult cent of patients reported outreach clinics at over 30 apheresis service at patients, is the largest and feeling better and less hospitals across the South Harefield Hospital – one of busiest PCD specialist breathless following the East, covering Essex, 10 designated centres in service in Europe. eight-week programme of Sussex, Surrey, Hertfordshire the UK. education and exercise and Middlesex. This system • Collaboration between classes. allows patients to benefit • Development of the Harefield and Hillingdon from specialist expertise in national paediatric primary hospitals and Hillingdon Royal Brompton’s proximity to their local environment, with ciliary dyskinesia (PCD) clinical commissioning the specialist cancer hospital, inpatient care at our hospitals satellite clinic service, groups and community The Royal Marsden, enables available as needed. with a multidisciplinary services to provide an the two trusts to jointly run team including a Trust integrated cardiology one of the largest lung cancer Examples include: consultant, nurse and service. programmes in the UK. Close physiotherapist, at Luton collaboration with • Outreach clinics in the and Dunstable and Milton • Provision of an e-digital neighbouring Chelsea and Hillingdon borough for Keynes hospitals. They support service for GPs to Westminster Hospital allows cascade testing of familial also provide one-off access cardiology advice both trusts to provide hypercholesterolemia (FH) home visits to families. to help reduce significantly enhanced funded by the British PCD is a rare, inherited unnecessary referrals. services to patients of all Heart Foundation and led condition, which may ages with heart or lung by clinical nurse affect the lungs, sinuses • Expansion of access to disease. Harefield teams specialists from Harefield and ears. If left untreated electrocardiography (ECG) continue to enjoy ongoing Hospital. FH is an it can lead to a form of and echocardiogram support across a range of inherited condition that lung damage, known as services at Harefield and non-cardiothoracic specialist results in very high bronchiectasis. The Hillingdon Hospitals. This disciplines from The cholesterol levels that can mainstay of treatment is has resulted in a rise in Hillingdon Hospitals NHS lead to heart disease and, chest physiotherapy and GP referrals. Foundation Trust.
25 WE ARE INCLUSIVE
Rehabilitation and therapies Clinical homecare medical outreach services supplies service aediatric rehabilitation • A new paediatric speech and therapies outreach therapy satellite service at Pservices available in Chelmsford Hospital 2014/15 include: started in early 2015. The service is linked to the • Home visits by Trust Trust’s pioneering cardiac physiotherapists for rehabilitation care cystic fibrosis (CF) programme. (For more patients. The details about the physiotherapy team also programme see pages liaises with schools, local 14 to 15). hospitals and community health teams to ensure • Paediatric CF outreach / everyone involved in a shared care clinics are patient’s care is updated held at 11 centres in the with any progress and south of England and at changes in clinical St Helier in the Channel management. Islands. Patients and their families attend their • Dietetic home visits are local hospital and are offered to paediatric CF reviewed by the Trust’s patients whose nutritional multidisciplinary CF status is an ongoing team, which includes concern. This includes physiotherapists and cases of faltering growth, dietitians. This service behavioural eating also facilitates the problems and patients training of local hospital who use gastrostomy teams in the tubes. management of CF.
This was my fifth visit... uring 2014/15, more and venue e.g. their home or the staff were so kind and than 2,000 patients with workplace. Deliveries are helpful... treated you with Dlong-term conditions made monthly or quarterly received their specialist depending on the medicine dignity and respect… medicines via the homecare or diagnosis. When service. Trust pharmacists necessary, deliveries can be medical staff are fantastic in who specialise in cardiology, made to patients when they paediatrics, respiratory and are on holiday within the UK. their care for you... cannot transplantation, dispense “ prescriptions that are made up Medicines are usually recommend this hospital by registered, off-site supplied in tablet and highly enough. homecare pharmacy capsule form, but some providers. cardiology and respiratory patients require intravenous The medicines are then injections. The homecare delivered to patients team can provide this service throughout the UK at a at home so patients can convenient pre-arranged time avoid a hospital visit. 26 ” Royal Brompton & Harefield Annual Review 2014/15
STAFF PROFILE needs. Bibi visits patients exercising again and how to from the local community, stop smoking (if needed). CARE IN THE and travels as far north as She also liaises with GPs to COMMUNITY Luton, as far south as ensure patients receive the Bedfordshire, and correct medication and Bibi Persaud-Rai, eastwards to Enfield in follow-up appointment clinical nurse Essex. information. specialist (CNS) in homecare and During a home visit, Bibi “Patients find the home discharge carries out a range of visiting service very checks to ensure patients reassuring. As much as a Bibi Persaud-Rai covers a are making progress as patient wants to go home radius of 200 miles a week expected. She checks after a major operation, it can to see patients in their own blood pressure and ensures be quite daunting to leave homes. Her work supports the wound site is healing the safety and support of the the recovery of patients who well, comparing against a hospital and manage your have been cared for at photograph taken on the care at home,” said Bibi. Harefield Hospital. day of a patient’s discharge. Bibi also takes blood for “My main aim is to prevent The service provides post- various tests, gives advice patients returning to hospital operative care to patients on medication and wound due to post-operative who have had cardiac care, and enables steady complications. By spending surgery, with a minimum of patient progress towards time and paying attention to two home visits, and follow- post-operative good health their condition, I can help up telephone monitoring if a by giving lifestyle advice, make sure that doesn’t patient has further care such as how to start happen.”
Diverse membership guides service provision
Since becoming a foundation concentrated in north west Hospital in autumn 2014. trust on 1 June 2009, London and on certain ethnic Feedback showed a high patients, families, carers, staff minority groups. The demand for such events and members of the public recruitment campaign and more are planned for have been invited to join the attracted 500 new members. 2015/16. Trust as members to support and help influence healthcare Our programme of events • Valerie Lapworth, services within our hospitals expanded during 2014/15 diabetic specialist nurse and the communities we with members enjoying (CNS), gave a serve. Membership now popular and well-attended presentation about the exceeds 11,000. Members activities including: disease and led an provide valuable feedback, interactive session with local knowledge and support. • Peter Collins, professor of members at Harefield clinical cardiology, gave a Hospital. In October 2014, the Trust presentation entitled: contracted Membership “Easy ways to help • Also at Harefield Engagement Services (MES) women (and men!) live Hospital, consultant to undertake a recruitment longer” at Royal Brompton cardiologist, drive for new public members. Hospital. Dr Mark Mason, shared his knowledge of The membership profile was • Members were invited to pacemakers with analysed to identify any under- tour the cardiac members and discussed represented groups. catheterisation laboratory new developments in Recruitment efforts were then at Royal Brompton monitoring devices.
27 WE ARE INCLUSIVE
The Friends and Family Test
By monitoring the many feedback channels that exist, and providing our own forums for discussion, we are in a strong position to understand and act on the comments and suggestions of patients, their families and carers.
he Friends and Family The Trust started using the “Very good staff, treated like Acting on comments Test (FFT) was Friends and Family Test in adults and given chance to and suggestions “Tintroduced by the December 2012 and be involved in day-to-day Government in May 2012. It “recommended scores” have management of meds etc.” The Friends and Family Test provides a simple headline been consistently high, (FFT) also enables trusts to metric which, when greater than 90 per cent. “The staff are friendly and make changes and combined with follow-up keep you informed about what improvements where questions, can help to ensure Comments from patients is happening and answer your necessary. Across the Trust transparency, celebrate when asked why they are questions; if they can't, they “You Said – We Did” posters success and make “Extremely Likely” to get someone who can.” are displayed to demonstrate improvements where recommend our wards / to patients that we listen and necessary. All hospital trusts hospitals include: “Everyone on the ward has act on their feedback.” are required to ask inpatients: been exceptionally kind, “How likely are you to “I was treated very friendly and reassuring. You In our children’s ward, as a recommend our ward / clinic professionally and the nurses feel it is an incredibly safe result of comments and to friends and family if they were helpful and friendly. If I environment and this makes feedback from parents, the needed similar care or had a question to ask it was a frightening situation so following improvements were treatment?” explained clearly.” much easier.” made:
• The waiting room was refurbished and seating HOW LIKELY ARE YOU TO RECOMMEND ROYAL BROMPTON AND extended. HAREFIELD NHS FOUNDATION TRUST TO FRIENDS AND FAMILY? 2014/2015 • New name badges were provided. 100.0% • A campaign was 99.0% introduced to remind all staff to introduce 98.0% themselves to parents when treating a child. 97.0% • Improved information 96.0% packs were provided.
95.0% • A theatre group was asked to provide teaching 94.0% on cross-cultural expression of
93.0% compassion. OCTOBER NOVEMBER DECEMBER JANUARY FEBRUARY APRIL MAY JUNE JULY AUGUST SEPTEMBER MARCH 92.0%
Percentage of patients who said “Extremely likely”
28 Royal Brompton & Harefield Annual Review 2014/15
RESPONDING TO PATIENT COMMENTS
“I was nervous about leaving the intensive therapy unit waiting room at Harefield Hospital to get a cup of tea or something to eat, in case I wasn’t there to see my husband immediately after his procedure. We had to ensure that one of the family was always near the intercom in case we were called back in.” (relative of patient)
Trust action: A new restaurant-style pager system was provided for ITU, which enables staff to notify visiting relatives when a patient’s procedure has finished. This means families are not limited to the waiting room area only; the pager range includes any part of the hospital including outside and in the canteen.
“Some of the pictures in the rooms and corridors are miserable, and the day room is not very comfortable.” (respiratory patient)
Trust action: The day room was refurbished and the Trust’s arts team undertook a project to incorporate patients’ designs in a themed series of artworks.
“The room has too many beds, it’s like a dormitory.” (respiratory patient)
Trust action: Smaller bays have been introduced and a new bathroom built within the main ward for patients with high-care needs. Beds for carers / family members have also been provided.
29 WE ARE INCLUSIVE
PATIENT EXPERIENCE his size and the fact he was on a ventilator. Paul Scoble, aged 49, had open heart “We started to research surgery at Royal other solutions and Brompton in contacted a number of chief December 2014 executives at specialist heart hospitals, including In August 2014 Paul Scoble Royal Brompton, to see if had a stroke and was taken anyone else could help – by ambulance to a hospital we wanted to give our dad in Essex. He received clot- a chance at life and knew busting treatment but he didn’t have much suffered another stroke, his time left. oxygen saturation levels dropped dramatically and “Bob Bell, chief executive of he had difficulty breathing. Royal Brompton and He was taken to the ICU Harefield, was our knight in and intubated; two weeks shining armour, our guardian later he had a tracheostomy angel. He wanted to help (the insertion of a tube into and soon after we the windpipe) to help him contacted him, Dr Cliff breathe. Paul developed Morgan, clinical director of infections, was later found critical care and to have fluid on his lungs, anaesthesia, and Dr and his heart rate started Susanna Price, consultant fluctuating dramatically. cardiologist and intensivist, arranged to come to the “It was very scary and he hospital in Essex to see had panic attacks, which Dad. made his heart rate drop very low” explains his “They agreed that open Paul with his daughter, Dannii, at his bedside at Royal Brompton daughter, Dannii. “Dad was heart surgery was his only following open heart surgery in a really bad way.” option and took his hospital data back to Royal In October a blood test Brompton to discuss found that Paul had options in a multidisciplinary Paul was transferred by he was back on the AICU elevated levels of certain meeting. A couple of weeks ambulance to Royal we were called to say that proteins, which suggested later, Dr Morgan and Brompton in early he was settled and stable. that he had endocarditis, a Professor John Pepper, December and taken That was all that mattered to potentially fatal infection of consultant cardiac surgeon, straight to the adult ICU. us. We popped in so he the inner lining of the heart. came back to give us the could hear our voices and This was confirmed by an good news – they could do “We met Mr Ulrich held his hand, even though ultrasound scan and open heart surgery when a Rosendahl, the consultant he was heavily sedated. transoesophageal bed was available at Royal cardiac surgeon who would echocardiography (TOE), Brompton. We were told be performing Dad’s “He started coming to within which also identified severe that there was a higher operation. He was so happy a week or two, opening his damage to the aortic and chance that Dad would and enthusiastic about eyes and moving his mouth mitral valves in his heart. survive the surgery than he doing the surgery and didn’t so we could lip read him. wouldn’t, which was better bat an eyelid despite the Bob Bell visited Dad a “The doctors told me and than we expected. Because complexity of his case. His couple of times, even on my brother, Leon, that there Royal Brompton is a confidence made us feel so Christmas Day – and we was nothing more they specialist heart hospital, we much better about what was were all given a Christmas could do for Dad and to understood that the teams going to happen, despite lunch. Even though we expect the worst. They said there had the necessary knowing about the risks. spent Christmas Day in the only option was open skills and expertise to hospital, it was lovely. heart surgery, which he treat complex patients like “A couple of days later Dad wouldn’t survive because of our dad.” had the surgery, and once Gradually the doses of
30 Royal Brompton & Harefield Annual Review 2014/15
Dad’s drugs were reduced, though they were incredibly “He did brilliantly due to the and his tracheostomy was busy they were brilliant, and help and encouragement he removed in January. That so caring, loving and had from all staff.” month he also had ablation friendly. They were always to correct his atrial flutter. happy to see us. They In April, Paul was transferred treated Dad with respect to a rehabilitation unit, where “It was as if he was a new and joked with him, which his physiotherapy and care man after the heart surgery made him feel comfortable continue. and ablation – he was and settled there. That’s himself again. His speech what you need from a “There is still some way to also returned quickly after hospital, but you don’t get go, but we are so grateful to the tracheostomy was that everywhere. the teams at Royal taken out. Brompton for everything “Dad was slowly improving they did for him – they gave “He was moved to a all the time. The him a chance at life, and specialist respiratory ward physiotherapists got him gave us our dad back.” and the staff there were an back on his feet, so he absolute dream. Even could walk with a hoist. Mr Ulrich Rosendahl, consultant cardiac surgeon
31 WE BELIEVE IN OUR STAFF
32 Royal Brompton & Harefield Annual Review 2014/15
we believe in our staff We believe our staff should feel valued and proud of their work and know that we will attract and keep the best people by understanding and supporting them.
ttracting and keeping jointly delivered by the Trust high calibre staff at all and Imperial College). Lessons learned from Alevels within the organisation is vital if the A comprehensive programme Formula One Trust is to provide the best of leadership, management possible care to patients. and personal development courses is also available to Continuing professional staff, with many providing the n June and October 2014, each other and against the development and learning opportunity to take accredited five multidisciplinary groups clock, they were required to opportunities are key to qualifications. The Trust is Ifrom both hospitals, focus, collaborate and retaining a skilled and also recognised as an including catheter lab communicate while changing committed workforce. accredited provider of physiologists, nurses and the tyres on an F1 racing car Through partnerships with coaching and coach radiographers, participated in as quickly and efficiently as Imperial College London’s development. creative team-building possible. School of Medicine, South events. The sessions, funded Bank University and other Twice each year, individuals by the Health Foundation, Jeremy Bishop, quality and academic institutions, world- and teams across the Trust were designed to build on a safety lead at Harefield class clinical and are honoured for their hard cardiology checklist project; a Hospital and organiser of the postgraduate medical work, service and exceptional three-part procedure training sessions, explains: education is delivered on contributions at staff checklist recently developed “The pit stop training both sites. champion awards, made all and introduced in the cardiac highlighted that the more popular because catheter labs and theatres. communication and teamwork Staff of all grades are they are nominated by their The checklist aims to improve are essential. The cardiology encouraged to undertake colleagues. efficiency, patient safety, checklist is designed to internal courses and attend communication between staff improve teamwork and we internal, national and and staff wellbeing. wanted to maximise its international conferences, benefit by providing training seminars and specialist Delegates discussed where communication and medical courses. leadership, communication teamwork are essential – after and teamwork and worked all, the difference between Both clinical and non-clinical The Trust is such together to complete a series winning and losing in Formula staff can apply for financial a friendly place of challenges and activities One is often only seconds. support in the form of study designed around those These skills are particularly funding for short or long to work and has themes. At the end of the important in an atmosphere courses, and bursaries to day, as two teams, they like an operating theatre or help with conference fees, a strong nursing translated learnings from the catheter lab where staff need travel costs and day into action, in a practical to feel comfortable to express accommodation (for example, research profile. Formula One pit stop opinions and challenge a number of nurses have exercise. Competing against ideas.” received funding for the MSc in cardiothoracic nursing, “ 33 ” WE BELIEVE IN OUR STAFF
Greater recognition for nurse educators
n October 2014, Liz sharing of best practice Compassionate Allibone, head of clinical nationally.” Ieducation and training Care leadership (nursing development), jointly The network currently has founded Britain’s first national over 230 clinical nurse development network for clinical nurse educator members from all educators with Dr Bill over the UK and has gained Whitehead, head of nursing recognition from various n February 2015, a group at the University of Derby. nursing and healthcare of nurses completed the The need to champion the organisations. Iyear-long Compassionate nurse educator role became Care leadership clear while Liz was Support and training for development programme. researching an MA in clinical healthcare support education. workers The course was a collaboration between the “A clinical nurse educator is a Liz is also the Trust lead for the nursing department and the senior clinical role that has roll-out of the National Care Liz Allibone speaking at CNEnet Royal College of Nursing London the potential to be a powerful Certificate, which is mandatory (RCN). Launched in January entity in an organisation. I felt training for healthcare support 2014, the programme is the role should be formally workers, who are “new to role designed to support staff in recognised and supported,” and new to care”. leading service improvement said Liz. “By forming the initiatives based on the six network we can help to The certificate equips support should have the same basic core elements of the nursing ensure a standardised staff with the skills, care training, based on framework: compassion, framework is put into place knowledge and behaviours current best practice. competence, for the recruitment, support, needed to provide high- communication, courage, and ongoing development of quality and compassionate The introduction of this care and commitment. vital clinical educators. care, in line with The qualification enhances Cavendish Report, which established care training and Fifteen band 6 and 7 nurses “Membership is growing by recommended that all offers existing staff presented the results of their the day. It is clearly fulfilling a healthcare assistants (and opportunities to refresh or work to colleagues at need and promoting the social care support workers) improve their knowledge. Harefield Hospital, describing the improvements that had been Development and education made as a result of their work. These included better programme communication with patients and relatives; more effective o support the ongoing Nursing staff are offered discharge planning and career development of opportunities to: improved collaborative Tnursing staff, a working with other clinical We are proud dedicated nursing • Undertake Open areas. to work in a development and education University distance programme is well- learning, such as the post Helen Doyle, matron in highly respected established at the Trust, graduate MSc in transplantation, who along with in-house and cardiorespiratory nursing completed the programme, Trust with high external education and said: “The course provided training opportunities. Kathryn • Lead and manage a the structure and tools to standards of Farrow, director of nursing range of national projects implement change within the patient care development, explains: “With clinical area. It encouraged over 1,200 nurses in the • Enhance their leadership us not only to celebrate what “ Trust, it is very important to and service development we do well now, but to look have highly trained and skills at what we could do in the stimulated staff who are future to make the patient encouraged and inspired to experience even better.” develop their careers.” 34 ” Royal Brompton & Harefield Annual Review 2014/15
STAFF PROFILE keenness to look at ways to develop and improve the Penny Agent joined service that led to her the Trust as a junior interest in leadership and physiotherapist in management. 1996 “In 2000, I did a 14-month In 2013, Penny became leadership course alongside director of rehabilitation and my day-to-day therapies. physiotherapy role. Two years later, with support Penny identifies the from the Trust, I completed following as key contributing a postgraduate diploma in factors to her career management for health and progression: social care. All the while I was progressing clinically • excellent training and and in my career. I became career development chair of the Association of opportunities Chartered Physiotherapists in Cystic Fibrosis (ACPCF) • networking opportunities and sat on various national and international • respect for her skills committees to support the development of standards • ability to work proactively and guidelines for best to lead organisational practice. and service changes. “Leading on from my work “Senior staff at the Trust at the Trust I was able to encouraged my creativity attend and present at and innovation. There is a national and international freedom to challenge the conferences. As my career way things are done and I became more managerially Penny Agent, director of rehabilitation and therapies find this attitude focused, I had the empowering. I’ve always opportunity to be involved in received support to try out the Allied Health with extensive personal • The Cleveland Clinic in new ways of doing things,” Professional NHS London leadership assessment Ohio (executive visitors’ Penny says. “I have also advisory group, and and evaluation programme) learnt first-class clinical, became the lead for research, education, specialist hospitals and • Completed a High • The Virginia Mason leadership and managerial organisations like the Performance Leadership Institute in Seattle skills by working alongside London Ambulance Service programme at the (transformational change) inspirational colleagues and The Royal Marsden internationally renowned throughout the years.” Hospital.” Cranfield University • The Disney Institute School of Management (leadership course). In her first year at the Trust Since her appointment as Penny was involved in director of rehabilitation and • Received mentoring from “I’m proud of my significant research studies, therapies, supported by the the chief nurse at NHS achievements and the way which fired her interest to Trust, Penny has won a England (London). I’ve developed personally concentrate her clinical Florence Nightingale and in my career. I’ve career in cystic fibrosis (CF). Foundation Leadership As part of the Florence always felt valued, Scholarship, and: Nightingale Foundation supported and encouraged “I was encouraged to award, Penny will also in my work. I am certainly practise clinically at the • Completed a Leading develop a seven-day very grateful for the highest level in Change and service for rehabilitation and excellent opportunities I physiotherapy.” Although Organisational Renewal therapies. She has also have had throughout my she found her clinical work course delivered by secured training career here.” absorbing, it was a Harvard Business School opportunities at:
35 WE BELIEVE IN OUR STAFF
Training the consultants and GPs of tomorrow
In October 2014, Dr Jo of Medicine (NW London), Szram, consultant respiratory the academic health science physician specialising in partnership UCL Partners occupational lung disease, (North East and Central) and was appointed director of Health Education South medical education. She is London (HESL). responsible for the education and training of all junior "Before they join us some of doctors at both hospitals. the doctors won’t know what Excellent patient Dr Szram is also an honorary to expect about working in a clinical senior lecturer at the tertiary hospital, and they are feedback makes National Heart and Lung naturally nervous coming to Institute, Imperial College, an organisation where us feel proud to and a Fellow of the Higher complex procedures and Education Academy. treatments are carried out work here; using specialised equipment. knowing that Dr Szram is supported in her Dr Jo Szram, consultant respiratory physician and director role by dedicated educational “A key part of our success in patients value of medical education administrators, simulation and medical education is due to “ training teams, HR teams and the expertise and skill of our being cared for divisional leads. consultants, who take immense pride in supporting by us from the “I’ve always had a passionate junior medical staff,” says interest in education and I Dr Szram. outset and can never resist a challenge – that’s why I Additional training have high wanted to take on this support offered: expectations. additional role. Most of my family are teachers and from • 1:1 support from clinical It’s vitally an early age I have been and educational aware of the benefits training supervisor, tutors from the important with and education can offer,” Royal Colleges and explains Dr Szram. “It’s vitally regional advisors. each new important with each new allocation of allocation of junior doctors to • “Leading from the front” the Trust that we give them leadership and junior doctors the best training, experience management sessions, and understanding of what skills and simulation that we give we do. That way they will training. “ always remember their them the best training period with us and be • Schedules devised with excellent advocates for the specific free time to training, Trust.” attend training.
experience and In 2014/15 over 150 junior • Opportunities to broaden clinical and research delegates and are” also in understanding doctors spent time at the Trust via local education and skills. discussions to develop of what we do training boards (LETBs), externally accessible which constitute around half “This is a dynamic time to be e-learning modules in the junior medical staff within involved in education and sub-speciality areas with a the organisation; the training provision,” Dr Szram variety of commercial remainder are appointed concludes. “We are education partners, who have directly and funded by the expanding the programme of approached us to collaborate Trust. In general, they attend training courses offered to in delivering learning in the from Imperial College School internal and external Trust’s areas of expertise.” 36 ” Royal Brompton & Harefield Annual Review 2014/15
37 WE ARE RESPONSIBLE
we are responsible We believe in being open about where our money goes, and in making our hospitals environmentally sustainable.
he Trust is committed to four months. These are public authority in England, The Trust’s FoI team to openness and largely based on information Wales and Northern Ireland, acknowledges FoI requests Ttransparency. submitted by the Trust to the and by UK-wide public from the public within two systems outlined above, but authorities based in Scotland. working days and provides a A great deal of information is also include information response within 20 working reported to external reported directly to CQC, The Trust supports Freedom days. regulators, and a clinical such as the results of the of Information (FoI) requests quality report is provided to national patient surveys. by providing clear and easily From 31 March 2014 to the Trust board each month accessible information on the 1 April 2015, the Trust to ensure that both executive These processes ensure Trust website via the received 630 FoI requests, and non-executive directors accountability by enabling Publication Scheme, a covering a wide range of are fully appraised of relevant open debate at board complete guide to the topics. The two largest information. Trust board meetings on the basis of information routinely categories were expenditure meetings are held in public up-to-date information, which published by the Trust. and clinical performance. and questions from members highlights areas of good of the public are invited and performance and any areas encouraged. of concern.
The NHS Standard Contract Freedom of stipulates which information Information the Trust must provide to regulators. This includes The Freedom of Information activity and performance Act 2000 provides public information that is submitted access to information held by to the Department of Health. public authorities. Reports relating to serious incidents and “near misses” It does this in two ways: are sent to the National Reporting and Learning • public sector System (NRLS) and are organisations are obliged accessed by the Care Quality to publish certain Commission (CQC) from this information about their source. Some information is activities; and reported directly to the CQC as required through their • members of the public are system of statutory entitled to request notifications. information from them.
The CQC publishes “Intelligent The Act covers any recorded The Trust is committed to reducing carbon emissions and uses Monitoring” reports every three information that is held by a greener technologies wherever possible.
38 Royal Brompton & Harefield Annual Review 2014/15
Royal Brompton & Harefield NHS Foundation Trust accounts for year ended 31 March 2015
Statement of comprehensive income Statement of financial position as at 31 March 2015 as at 31 March 2015
Year ended Year ended As at As at 31.03.15 31.03.14 31.03.15 31.03.14 £000 £000 £000 £000 Operating income from patient Non-current assets care activities 308,753 337,979 Property, plant and equipment 189,224 179,765 Other operating income 31,179 32,413 Investment properties 30,612 31,205 Total operating income from Total non-current assets 219,836 210,970 continuing operations 370,392 339,932
Current assets Operating expenses (366,301) (333,090) Inventories 11,186 9,676 Operating surplus from continuing operations 4,091 6,842 Trade and other receivables 46,828 27,384 Cash and cash equivalents 9,476 19,146 Finance income 36 50 Total current assets 67,490 56,206 Finance expense – financial liabilities (160) (30) Finance expense – unwinding of Current liabilities discount on provisions (11) (16) Trade and other payables (46,724) (41,657) PDC dividends payable (6,681) (6,355) Borrowings (10,039) (4,640) Net finance costs (6,816) (6,351) Provisions (856) (1,989) Movement in the fair value of Total current liabilities (57,619) (48,287) investment property and other Total assets less current liabilities 229,707 218,889 investments (593) 4,050 (Deficit)/surplus for the year (3,318) 4,541 Non-current liabilities Borrowings (10,000) - Other comprehensive income (will not subsequently Provisions (2,234) (2,267) be reclassified to I&E) Total non-current liabilities (12,234) (2,267) Impairments - (6,878) Total assets employed 217,473 216,622 Revaluations of operational properties 1,320 1,764 Other reserve movements 1 (3) Financed by Total comprehensive Public dividend capital 108,152 105,304 expense for the period (1,997) (576) Revaluation reserve 49,924 48,603 Income and expenditure reserve 59,397 62,715 Total taxpayers’ equity 217,473 216,622
39 WE ARE RESPONSIBLE
Governance
oyal Brompton & performance of the foundation trust is delegated The Quality Account Harefield NHS organisation. The council of to the Trust’s board of 2014/15 is available at RFoundation Trust has governors, which comprises directors. There are three www.rbht.nhs.uk/qa and been an independent legal both elected and appointed formal committees of the on the NHS Choices entity with a unique parties, challenges the board Trust board: the audit website: www.nhs.uk governance structure since and holds the non-executive committee, the risk and 1 June 2009. The powers of directors to account for the safety committee and the Visit our website to read the Trust are set out in the board’s performance. The nominations and the Trust’s full annual report National Health Service Act elected parties are drawn remuneration committee. and accounts for 2014/15 2006, as amended by the from the membership and the – www.rbht.nhs.uk/report- Health and Social Care Act appointed parties represent Quality Account accounts – and for more 2012. The Trust governance key stakeholders. We have information about our arrangements are enshrined around 11,000 members with High Quality Care for All policy and performance – in the Royal Brompton & whom we regularly consult on (2008) proposed that all www.rbht.nhs.uk/ Harefield NHS Foundation Trust strategy and service providers of NHS healthcare performance Trust Constitution and include planning. Members are drawn services should produce a the Trust membership, the from three constituencies: Quality Account: an annual “Champion of council of governors and the patient, public and staff. report to the public about the nurses” retires board of directors. Independent regulation of the quality of services delivered. Trust is undertaken by The Health Act 2009 made In February 2015, Dr Caroline The Trust board plays a key Monitor. this a statutory requirement Shuldham OBE, director of role in shaping the strategy, and in 2010 Quality nursing and clinical vision and purpose of the The governance Accounts were introduced. governance, retired from the organisation. Board members structures comprise: Trust after 24 years of service. are responsible for assuring During 2013/14, Monitor that risks to the Trust and the The council of governors introduced some additional At an event to mark the public are managed and appoints the external auditor. requirements that mean occasion, Sir Robert Finch, mitigated effectively. Led by A sub-committee, the foundation trusts are chairman, began the an independent chair, nominations and required to produce a speeches by thanking Dr Sir Robert Finch, and remuneration committee, Quality Report. Shuldman for her “kindness, composed of a mixture of considers the appointment of professionalism, commitment both executive and the chairman and the other This contains all of the and high standards”. Sir independent non-executive non-executive members of elements of the Quality Robert described her as “the members, the board has a the Trust’s board of directors. Accounts plus the additional epitome of what nurses of the collective responsibility for the Management of the Monitor elements. highest quality should be... a champion of nurses and a champion of our hospitals”.
Caroline Shuldham joined the Trust in 1990 as head of education. She was awarded an OBE in 2009 for services to healthcare.
Chief executive, Robert Bell, said: “Caroline’s wise counsel has been an important and welcome feature in board discussions, but her influence has extended far beyond the boardroom. Her leadership has ensured the Trust benefits from a highly skilled and engaged nursing workforce whose enthusiasm for professional development is a direct result of Caroline’s commitment in this area.”
40 Royal Brompton & Harefield Annual Review 2014/15
OUR BOARD MEMBERS OUR COUNCIL OF OUR COUNCIL OF GOVERNORS GOVERNORS (continued) Executive members – full year Public governors Appointed governors – full year Professor Robert J Bell Councillor Mrs Victoria Chief executive Mr Kenneth Appel Borwick Bedfordshire and London Borough of Mr Robert Craig Hertfordshire Kensington and Chelsea Chief operating officer Mr Brian Waylett Mr Ray Puddifoot Professor Timothy Evans Rest of England and Wales London Borough of Medical director and deputy Hillingdon chief executive Public governors – part year Professor Mary Morrell Mr Richard Paterson Associate chief executive – Imperial College London finance Mr George Doughty North West London Staff governors Executive members – part year Mr Anthony Connerty Dr Ian Balfour-Lynn We have South of England Dr Caroline Shuldham OBE Dr Claire Hogg Director of nursing and around 11,000 Mr Philip Dodd clinical governance members with North West London Ms Anne McDermott Ms Joy Godden Patient and carer Dr Andrew Morley-Smith Interim director of nursing whom we governors – full year and clinical governance regularly Dr Alistair Lindsay Mrs Chhaya Rajpal Mr Nicholas Hunt North West London Director of service consult on Trust development “ strategy and Mr Guthrie McKie North West London Non-executive members service Sir Robert Finch planning. Mrs Brenda Davies Chairman Bedfordshire and Hertfordshire Non-executive directors – full year Mr Peter Kircher Bedfordshire and Mrs Lesley-Anne Alexander Hertfordshire CBE Mr Edward Waite Professor Kim Fox South of England
Mr Richard Hunting CBE Mr Stuart Baldock Elsewhere Mr Neil Lerner (deputy chairman) Dr Ejikeme Uzoalor Elsewhere Ms Kate Owen Dr Adrian Lepper Dr Andrew Vallance-Owen Representing patient carers MBE (senior independent ” director)
Mr Richard Jones
Non-executive directors – part year
Mr Philip Dodd
41 WE ARE RESPONSIBLE
A commitment to making our hospitals environmentally sustainable
he Trust is committed to patients with heart rhythm reducing carbon problems cared for at Temissions in line with Harefield Hospital. The the Department of Health’s service also began to supply NHS Carbon Reduction cellular implantable Strategy 2009. A carbon cardioverter defibrillator (ICD) management plan, updated in remote monitors, which can spring 2014, sets out how usually operate without a progress will be made telephone landline or wi-fi. towards achieving the targets set out in the strategy. Before remote monitoring was introduced, patients A carbon management group, were asked to attend an chaired by the Trust’s head of outpatient appointment every estates and facilities, meets three months. By making four times each year and remote monitoring a basic works with departments element of continuing care, throughout the organisation to hospital appointments are implement the plan. reduced, and monitoring is Membership of the group improved. Cellular monitors includes representation from also offer worldwide access. the estates, nursing, transport, I&T, and human Consultant cardiologist, resources teams. A project Dr Mark Mason, and his register identifies where team, who lead the cardiac savings can be achieved and remote monitoring service, what progress has been are pioneers in ICDs. ICDs made. There are currently 58 are used for patients who projects listed. have abnormal heart rhythms (arrhythmias), such as The Trust continues to potentially dangerous fast participate in the Carbon heart rhythms known as Reduction Commitment ventricular tachycardia or Energy Efficiency Scheme ventricular fibrillation. An ICD and reports annually in July of is implanted under the skin in each year as required. the left upper chest area to Claire Parker, chief cardiac physiologist, demonstrates a remote monitor monitor the rate and rhythm to a patient CRC emissions for 2014/15 of the heart. are currently projected to be 14,635 tCO2. This represents The remote monitor, which is a 5% fall on the previous year. generally kept at a patient’s home, performs daily patient’s heart to a normal over the device to allow the Reducing the carbon measurements using rate and rhythm. All alerts are data to be extracted. Newer footprint through remote information from the ICD. The transmitted directly to the monitors work wirelessly and monitoring monitor checks the device for cardiac remote monitoring the header sits on the base alerts (such as an abnormal team for analysis. of the monitor rather like a Developments in technology measurement) on a daily and home telephone, allowing provide significant weekly basis. Alerts are also Claire Parker, chief cardiac automatic transmission of opportunities for hospitals to triggered when arrhythmias physiologist at Harefield data from the header to the reduce their carbon footprint (when the heart beats too Hospital, explains: “Patient base. The base then by limiting the number of fast, too slow, or with an remote monitors are very user transmits the data to the team journeys patients are required irregular rhythm) are detected. friendly; some models simply to analyse. The whole to make. In 2014, remote If required, the ICD can require pressing a button on process takes less than five monitoring became standard deliver an electrical shock or the monitor. Others require minutes and saves the hours for all new and existing pacing therapy to return the putting a header (handset) of travel time and costs
42 Royal Brompton & Harefield Annual Review 2014/15
patients would incur if they anywhere in the world to had to attend a clinic Royal Brompton for analysis. appointment.” The devices are particularly Monitoring by mobile useful for patients who have infrequent symptoms as they AliveCor heart devices can keep the device for long were introduced at Royal periods to capture symptoms. Brompton Hospital in They can be used with both 2014/15 for recording children and adults. arrhythmias. AliveCor uses technology specific to a They are cost effective as the patient's iPhone model and devices themselves cost less supplements rhythm than other heart monitors and diagnosis. savings are made on consumables i.e. ECG The monitors attach to most electrodes. smart devices and can record a real-time, accurate The carbon footprint for the ECG. If patients have any Trust is reduced as these symptoms, they can record devices are returned by post an ECG within the app and are re-usable for other anywhere, anytime. patients.
There is no need for traditional At present, the team at Royal ECG electrodes (stickers), Brompton is undertaking a which is a significant more formal pilot trial for all advantage for patients who patients using two versatile have sensitive skin or are monitors: a 'Plate', which can irritated by electrodes. be attached to any smart device i.e. tablets, iPods, The devices can record an iPhones; and a pre- ECG from 30 seconds up to configured iPod for patients five minutes, which is then who do not own a smart AliveCor uses technology specific to a patient's iPhone model and remotely transmitted from device. supplements rhythm diagnosis
43 WE DISCOVER
44 Royal Brompton & Harefield Annual Review 2014/15
we discover We believe it is our duty to find and develop new treatments for heart and lung disease, both for today’s patients and for future generations.
esearch into across the breadth of our equipment, share core • Promote and increase cardiovascular and clinical practice. facilities such as biobanks, engagement in Trust Rrespiratory medicine is implement important patient research. central to the Trust’s mission Over the years we have and public involvement and our starting point is the nurtured strong partnerships programmes, and are key to • Provide research facilities, needs of the patients we with institutions such as educating the next generation effective research treat every day. By Imperial College London and of researchers. resources and investigating the causes of the National Institute of Health administrative support. their conditions and testing Research (NIHR) to provide We work with other new ways of diagnosing and our clinical teams with the universities, including the treating them, we have been necessary academic and University of Nottingham, and responsible for many financial support to advance numerous NHS organisations, significant medical advances their research programmes. such as Liverpool Heart and that have been taken up Our cardiovascular and Chest, and Chelsea and across the NHS and beyond. respiratory biomedical Westminster hospitals, so that research units (BRUs), we all benefit from access to The Trust’s portfolio of operated jointly with Imperial larger clinical populations, cardiovascular and respiratory College and funded by the data banks, and knowledge research encompasses NIHR and the Trust, are vital to sharing. numerous active studies enabling our best health researchers and clinicians to Trust researchers also continue pioneering research recognise the importance of into complex heart and working with industry partners lung conditions. to run clinical trials, to conduct The BRUs sponsored research, and to 2014/15 house offer patients opportunities to specialist, participate in cutting-edge research state-of- research. We collaborate with the-art a variety of companies – large highlights and small pharmaceuticals, and medical device, Supported a diagnostic and biotechnology companies – on investigator- research led, commercial research partnerships. portfolio of more than £17m, Our research supports the four goals of the 2012-2015 including £12m research strategy: of charitable and • Support and develop research-active staff. public sector
• Exploit opportunities to funding. attract and retain research funding.
45 WE DISCOVER
Hopes for clearer International recognition for prognosis from Trust research major study
In March 2015, Dr Toby healthy people. Some of the Maher, consultant respiratory biomarkers were associated physician at Royal Brompton with worsening disease and Hospital and head of the outcomes. Changes in Fibrosis Research Group at concentration levels after Imperial College London, with three months appeared to Anne-Marie Russell, senior predict the progression of IPF research nurse at Royal earlier than the physiological Brompton and Dr Gisli measurements generally Jenkins from the University of used. Nottingham, developed a blood test to give patients “Conducting clinical trials in with idiopathic pulmonary IPF is extremely important as Professor John Pepper OBE, consultant cardiac surgeon fibrosis (IPF) a clearer idea of part of the process for their prognosis and a better getting newly developed understanding of whether or medicines into the clinic,” he results of a study is pumping blood, allowing not current treatments to said Dr Maher. “For example, into ischaemic mitral blood to leak backwards from slow down progression of the until two years ago, there Tregurgitation conducted the left ventricle into the left disease will be effective. weren’t any treatments in the by Professor John Pepper atrium as the ventricle UK. But clinical trials have OBE, consultant cardiac contracts. This puts extra The condition, thought to resulted in two drugs being surgeon at Royal Brompton strain on the heart, which can affect up to 20,000 people in made available – pirfenidone Hospital, were incorporated lead to heart failure. MR the UK, causes progressive and nintedanib. These drugs into the 2014 American Heart occurs in 30 to 40 per cent scarring of the lungs (fibrosis) have been seen to slow the Association (AHA) / American of patients following a and is often fatal. The term progression of the disease.” College of Cardiology (ACC) myocardial infarction (heart idiopathic means that the Guidelines. The findings, from attack). Trust clinicians treat cause of the disease is a randomised multicentre around 560 patients with this unknown, but risk factors controlled study known as condition each year. include smoking, exposure to the RIME (randomised wood, metal and mineral ischaemic mitral evaluation) Professor Pepper’s results dusts, and previous viral trial, were published in the suggested that CABG plus infections. journal Circulation. valve repair does improve outcomes for patients The study, known as the The trial compared two compared with CABG alone. PRospective Observation of 2014/15 treatments for patients The AHA / ACC guidelines Fibrosis in the Lung clinical suffering moderate ischaemic now recommend that surgical Endpoints (PROFILE), is the research mitral regurgitation (leakage), intervention to treat MR by largest and most detailed who were undergoing heart repair or replacement of the observational IPF study of its highlights bypass surgery: standard mitral valve is justified in kind, and involves more coronary artery bypass graft patients with chronic than 200 newly diagnosed Identified as a (CABG) or CABG plus mitral secondary MR, but may also IPF patients. best performing valve repair. The aim was to be considered for patients determine if the combined with moderate secondary Blood samples were NHS trust for procedure would improve the MR, who are undergoing analysed throughout a six- heart’s functional capacity other cardiac surgery. month period to record the meeting national more significantly than the Professor Pepper said: concentrations of several CABG alone. “Being included in this neoepitopes (types of benchmarks for international level guidance protein). Results showed that Ischaemic mitral regurgitation highlights the direct impact neoepitope levels were study set-up (MR) occurs when the mitral that these kinds of trials higher in those with the valve of the heart fails to can have on improving condition compared with close properly while the heart patient care.”
46 Royal Brompton & Harefield Annual Review 2014/15
Discovery of genetic mutation will help early 2014/15 diagnosis and management of heart condition research highlights One of the scientific themes This new discovery helps to comprehensive list to interpret of the NIHR Royal Brompton determine which mutations of patients’ DNA sequences. Cardiovascular Biomedical the Titin gene are harmful and The research team is hopeful Catalogued Research Unit (BRU) is which are not, providing that this information could donated tissue genetics and genomics. information that will help also help to develop screen high-risk patients. For therapies to prevent or treat from 2,227 The Trust’s genetics and many people, variations in the heart disease caused by titin genomics lab was genetic code are completely mutations. Professor Stuart patients in the established to provide harmless and do not damage Cook said: “These results expertise at national and the heart. Professor Dudley give us a detailed Trust’s research international level, about the Pennell said: “This research understanding of the genes involved in reveals which genetic molecular basis for dilated biobanks cardiovascular disease and mutations are bad and which cardiomyopathy. We can use their use in diagnostic and are there purely as this information to screen therapeutic strategies. bystanders. It will benefit patients’ relatives to identify patients with cardiomyopathy those at risk of developing Inherited cardiac conditions and enable us to reassure the disease, and help (ICCs) are the most common relatives who do not have the them to manage their cause of sudden cardiac disease, allowing them to be condition early.” death in the young and a discharged from clinic major cause of death and and preventing needless The research was funded by disability across all age anxiety and unnecessary the MRC, the British Heart groups. Families affected by expensive tests.” Foundation, Fondation sudden cardiac death often Leducq, the Wellcome Trust, undergo tests over several The new study, published in the NIHR cardiovascular BRU Professor Dudley Pennell, director of the cardiovascular years and suffer great anxiety, Science Translational and the NIHR Imperial BRU and the CMR unit at after the unexpected death Medicine, gives doctors a Biomedical Research Centre. the Trust of a relative from inherited heart disease.
In January 2015, Professor Dudley Pennell, director of the cardiovascular BRU and the cardiovascular magnetic resonance (CMR) unit at the Trust, with Professor Stuart Cook, from Imperial College London, announced a breakthrough in understanding the significance of gene mutations in dilated cardiomyopathy (DCM). DCM is an inherited condition where weakening of the heart muscle prevents it from pumping efficiently, leading to heart failure. It is estimated that around one in 250 people has DCM.
Their research identified genetic mutations that cause DCM, paving the way for more accurate diagnosis.
47 WE DISCOVER
RESEARCH IN NURSING
Research nurses play a pivotal role in the successful delivery of research studies. To support those involved in research, a research group steering committee holds quarterly forums that feature guest speakers, regulatory updates, relevant training and discussion of professional development opportunities. The group was established to:
• Develop a well motivated, competent and proficient group of research nurses who collaborate actively with one another.
• Provide training to ensure strict codes of governance and regulatory compliance relating to clinical research are adhered to.
Findings presented at RCN research symposium
taff take pride in sharing with support from the King’s second EBCD project was been very successful in their research findings Fund, Oxford University and undertaken with lung cancer helping us make significant Snationally and King’s College London. patients at Harefield Hospital. changes that have direct internationally, for the benefit This also had a number of benefits for patients. It was of patients everywhere. The study used video positive outcomes for both testament to the hard work of recordings of patients patients and staff members, all involved that the team led In spring 2014, nursing staff describing their own personal such as creating new patient this symposium at the presented at the Royal experience of healthcare, as a information about going home prestigious 2014 RCN College of Nursing (RCN) trigger for in-depth and with a chest drain, and research conference.” International Research structured discussion around establishing an enhanced Conference in Glasgow. improving services through recovery programme for lung partnership working. A staff cancer patients. The Head of research in nursing, group and a patient group programme includes pre- Sharon Fleming, chaired the from Harefield Hospital’s admission clinics for all symposium session on intensive therapy unit, and a thoracic surgery patients at “Experience-based co-design patient group from Royal both hospitals. (EBCD): stories from clinical Brompton Hospital’s lung practice”. cancer unit, collaborated and John Pearcey, cancer made a number of services manager, who The session was drawn from improvements as a result. co-presented at the a collaborative research study Following this success, a symposium, said: “EBCD has
48 Royal Brompton & Harefield Annual Review 2014/15
2014/15 Patient collaboration helps develop research teaching toolkit highlights The respiratory medicine techniques that complement • Guided relaxation – can Recruited 3,149 nursing team at Royal medical treatment, and for be used to reduce Brompton Hospital cares for the patients to learn muscle tension. As the patients into patients with the following techniques they could use in muscles relax, patients respiratory diseases: everyday life, wherever they may find it easier to more than 175 are. Often, patients feel breathe. Guided imagery • Cystic fibrosis helpless and reliant on can calm anxious studies (2,384 medical treatment to reduce thoughts and help ease • Lung failure (receiving total their breathlessness.” breathlessness. patients for and part-time ventilation NIHR portfolio therapy at home) After researching an The nursing team used an extensive range of literature, EBCD approach for the studies) • Immune system issues the team organised a patient project. EBCD involves and staff event where those working with patients as • Interstitial lung disease attending selected their equal partners to improve preferred top five techniques: their experience of services. • Complex asthma and For this project, each nurse allergy. • Positioning – adopting a partnered with a team of number of positions best patients to co-design Many patients need lifelong suited for individual teaching and relevant care with regular admissions patients in order to information for a toolkit, which to hospital to manage maximise breathing and can be used to teach the deteriorations and changes reduce breathlessness. preferred breathing to treatments. Team techniques. members wanted to research • Using a handheld fan – a number of techniques to held by the patient and enable patients to manage directed around the lower the distressing symptoms of part of their face, around breathlessness, which is the nose and mouth. The often associated with fan cools the air passing complex lung conditions. over some receptors in the nose, which sends a In April 2014, the respiratory signal to the central part team was funded by the of the brain reducing Foundation of Nursing the sensation of Studies (FoNS) Practise breathlessness. Based Development and Research Programme, to • Abdominal breathing – explore non-medical this includes the effective management of focused use of the breathlessness to breathing muscles, complement traditional particularly the pharmacological methods. diaphragm. Paul Lidgate, charge nurse and member of the research • Pursed lip breathing – project steering group, said: in certain lung conditions “The idea underpinning our this technique can help research was to give patients reduce the work of some degree of self- breathing, reducing management of their breathlessness and breathlessness through helping relaxation.
49 WE DISCOVER
PATIENT EXPERIENCE
Michael Tubbs, aged 27, benefits from the new Organ Care System
Michael, from London, was diagnosed with cystic fibrosis as a baby. He was referred to Royal Brompton, aged four, by his GP and local children’s hospital.
“My condition didn’t affect me as a young boy but when I was 10 I started to get chest infections about twice a year. From then onwards I went to Royal Brompton every three months for a two-week course of IVs (intravenous antibiotics) to keep me Michael after his double lung transplant at Harefield Hospital healthy. I still wasn’t affected by my cystic fibrosis much and played football with my friends.” “I ended up staying in “Transplant surgeon, Mr “It was a relief to know that By the age of 17 Michael hospital for nearly a year,” André Simon, visited me on would soon be over, but it was having more frequent Michael remembers. “The Foulis ward to tell me more was also scary thinking chest infections and doctors said my lung wasn’t about the operation about the surgery. The staff needed to stay at Royal healing because all my because I was too ill to go to at Harefield explained Brompton more often. previous infections had Harefield Hospital where the exactly what was happening damaged the lining of my transplant team is based. He to me and I was involved in “Each time I would get a lung, making it weak. was confident about doing it every step. That was really productive cough, a tight and told me not to worry, good because it would have chest, difficulty breathing, “It was horrible not being which was reassuring and been more nerve-wracking fever and I had no energy. able to see my friends, made me feel better.” not knowing what was The care from all of the missing family birthdays and going on. doctors and nurses at Royal doing the things I used to Two weeks later a suitable Brompton was very good do, but I knew that, as a pair of donor lungs became “I was told that my new and all my tests and specialist lung hospital, available and Michael was lungs had been put inside a treatment were always done Royal Brompton was the transferred from Royal machine, called the Organ on time.” best place for me to get the Brompton to Harefield by Care System (OCS), which care I needed.” ambulance. recreates the conditions in His condition deteriorated the body and makes lungs two years ago, when part of The cystic fibrosis team “I wasn’t living a good life at ‘breathe’ to see how well his right lung collapsed. asked Michael if he wanted that stage. I was so ill that I they are working. It meant While chest drains helped to join the lung transplant list couldn’t even get out of bed the transplant team could initially, his lung kept and he had general health to have a shower – I would assess whether or not the collapsing and would not checks to see if he was cough so much that I would lungs were suitable for heal. suitable. end up being sick. transplantation. The staff
50 Royal Brompton & Harefield Annual Review 2014/15
The Organ Care System uses cutting-edge technology to recreate conditions in the body explained the machine was a piece of cutting-edge technology and that I was one of the first lung transplant patients to benefit from it at Harefield – previously it was only used for heart transplants.
“Everyone made me feel as at ease as possible in the hours before the operation and kept me updated on when I was going into theatre.
“I woke up on the intensive care unit about 36 hours later and stayed there for another three days, before being taken to the ward. I was told that everything had gone really well and I started to go on the exercise bike for short periods of time and walk around the ward.
“The nurses on the ward were friendly and helpful, the food was good and I enjoyed having my own room with a TV. The physiotherapists were also very nice – it was a really good hospital to stay in.
“I was discharged after about three weeks, which was less time than I thought I’d need to be there for.
“Now I’m doing really well and taking my dogs for walks again. The transplant has changed my life. Even though I was slightly nervous to be one of the first lung transplant patients to receive my donor lungs from the OCS, now I’m really pleased that I was able to benefit from the new technology.”
51 WE DISCOVER
PATIENT EXPERIENCE “Gradually I became so medicine, who told him breathless that I could no more about the research Phil Havell, aged 68, longer go upstairs and had and he was eventually took part in a clinical to convert my garage into a recruited onto the trial. trial for an innovative bedroom. I needed portable emphysema treatment oxygen, nebulisers and “The care at Royal at Royal Brompton inhalers all the time and took Brompton has always been last year numerous pills daily, which very good and the doctors sometimes made me so talk in my language, rather Fifteen years ago Phil tired that I slept all day. I than using technical terms. I Havell, from Wisbech, was breathless all the time, usually saw Dr Will McNulty, Cambridgeshire, decided to even when I was talking, my clinical research fellow in stop smoking. As is often chest felt very tight and I respiratory medicine, who the case when people first had a bad cough. was brilliant and very good stop smoking, he started to at explaining things in a way get colds and chest “I couldn’t go out alone and I could understand.” infections. I was in and out of hospital nearly every month. It Phil had the coils placed I was told that my lung “My doctors gave me affected me very badly into his right lung during a function had improved, and steroids and antibiotics to because I used to be really 30-minute procedure now I only need to come treat the infections, but they active, and it had a huge performed by Dr Shah at back once a year. I was kept coming back, and I impact on my wife, Jane, Chelsea and Westminster very lucky to benefit from was getting worse over too. I felt that my life wasn’t Hospital in August 2014, such new technology, I time,” explains Phil. “I also worth living the way it was.” and then his left lung was believe I’d be dead without started to feel breathless.” treated in late September. it – my heart couldn’t take all In November 2012, Phil’s He continued coming to of the bad episodes I used Ten years ago Phil’s GP consultant at The Queen Royal Brompton for follow- to have. diagnosed him with chronic Elizabeth told him about an up over the next year. obstructive pulmonary exciting new trial at Royal “Everyone at Royal disease (COPD), an Brompton that he had heard “I had no reservations about Brompton does such a umbrella term for a about at a conference being a guinea pig – I good job and they are so collection of conditions overseas. Patients with couldn’t go on the way I was. friendly. They know I travel causing lung damage, severe emphysema were far for each appointment including chronic bronchitis being offered a treatment “My life has improved a lot and make sure all the tests I and emphysema (in which that involved wires being since having the treatment. need follow on from each the tiny air sacs in the lungs placed in areas of damaged I’ve only had one bad other so I’m not waiting are damaged). lung through a episode in the last year, around. I can’t praise the bronchoscope (a tube-like which resulted in a hospital team enough.” “I was given inhalers and device normally used to see stay, compared with one nebulisers. But I still had the inside of the airways every month. I no longer run frequent chest infections and and lungs). Once in place, out of breath talking, my a couple of years later things the wires coiled up, acting colour has improved and I got so bad that I was like springs to keep the don’t need to use oxygen admitted to my local hospital, airways apart and restore during the day like I used to. The Queen Elizabeth the tension that patients’ Hospital in King’s Lynn.” lungs had lost. “Now I can go out by myself in the car, so socially things As time went on Phil’s Within two weeks of Phil’s are much improved, and I admissions to hospital consultant recommending can do more everyday tasks became more frequent and him for the trial, he was that I couldn’t before, such he was put under the care given an appointment at as cook dinner. of a respiratory consultant at Royal Brompton. Phil met Dr The Queen Elizabeth Pallav Shah, consultant “At my last appointment at Hospital. physician in respiratory Royal Brompton in August,
52 Royal Brompton & Harefield Annual Review 2014/15
53 WE DISCOVER
Claire Nolan, specialist pulmonary rehabilitation physiotherapist
STAFF PROFILE hospital admission in IPF has no cure and an average patients. life expectancy of three Claire Nolan is a years after diagnosis. specialist pulmonary This will be compared with rehabilitation currently used surrogate Claire’s supervisor, Dr Will physiotherapist at markers, such as baseline Man, consultant chest Harefield. and change in the total physician, said: “Should amount of air a patient can 4MGS prove to be a valid Claire received a £250,000 exhale during a forced surrogate endpoint in IPF, it NIHR doctoral research breath test, gas transfer will allow clinicians in the fellowship in September (TLCO) – used to determine NHS to provide more 2014. the gas-transfer function of information about prognosis the lungs, six-minute walk to patients with IPF and Her fellowship aims to tests (6MWT) and features their carers, who currently determine how reliable, identified on high resolution face a highly uncertain and valid and responsive usual computed tomography unpredictable future.” walking speed is in patients (HRCT) scanning. with idiopathic pulmonary The team supporting fibrosis (IPF) through a four- If the research validates Claire’s fellowship include metre gait speed (4MGS) 4MGS as a feasible Dr Man, Dr Toby Maher, test. In particular, the surrogate marker, it has the consultant respiratory research will analyse potential to change the physician, Professor Paul baseline speed at the point future design of therapeutic Cullinan, consultant in of diagnosis and changes trials in IPF, and provide respiratory medicine, and Dr over time, to determine further impetus to the NHS Matthew Maddocks, whether or not walking and industry to develop and lecturer and specialist speed is able to predict test therapies for patients physiotherapist from King's mortality and non-elective with the condition, which College London.
54 Royal Brompton & Harefield Annual Review 2014/15
PATIENT EXPERIENCE SureScan, has special led to delays in diagnosis software to protect it from and treatment.” New devices allow the scan’s magnetic field patients to have MRI and safeguards it against Penelope said: “I feel I could scans any interference. Patients live forever now! My new fitted with one can have MRI pacemaker has given me Heart rhythm patients at scans on any part of their complete peace of mind. Harefield Hospital were body, including the heart. Before, I was scared of among the first in the UK to taking any exercise or even benefit from a new Doctors can reprogram the picking something up – implantable device which ICD wirelessly on a laptop I couldn’t live my life to was designed to allow them before an MRI scan, so that the full. to undergo vital MRI health the device is shielded from checks. detecting abnormal heart “But this is like having my rhythms during the time it is own personal paramedic, People with traditional carried out. The matchbox- which will respond faster Penelope Wybrow was one of pacemakers and ICDs, sized device costs than an ambulance and Harefield’s first patients to have which send electrical pulses £20,000, twice as much as restart my heart.” the new ICD fitted to the heart to change a traditional implants. dangerous rhythm into a normal one, are unable to One of Harefield’s first benefit from MRI technology patients to have the new because of a risk that the ICD fitted was Penelope scans could make their Wybrow, 42, from Pinner in heart devices malfunction. north-west London. Dr Mark Mason, consultant cardiologist
The imaging technique uses Penelope has a powerful magnetic field cardiomyopathy, an which can stop the metal inherited disease that leads in the devices working causes the heart muscle to properly, so patients cannot thicken and weaken over have this type of scan. time, making it less able to maintain a normal rhythm MRIs allow doctors to view and putting it at risk of detailed images of internal stopping suddenly. organs and blood vessels and are a crucial tool when Dr Mark Mason, consultant it comes to diagnosing cardiologist, implanted her many conditions, including device in April 2014 during heart problems and cancer. a 45-minute procedure that Patients with conventional was carried out under local pacemakers and ICDs have anaesthetic. traditionally undergone alternative forms of Dr Mason said: “This device screening instead, such as means patients can X-rays and ultrasounds, undergo MRI scans, which which could lead to a are the now the gold delayed diagnosis. Harefield standard for diagnosing was one of the first life-threatening or disabling hospitals in the UK to offer a conditions such as new life-saving device. spinal problems.
The battery-operated ICD, “Thousands were denied called the Evera MRI these scans before, which
55 WE SHARE OUR KNOWLEDGE
we share our knowledge We believe in sharing what we know through teaching, so that what we learn can help patients everywhere.
he Trust’s commitment Over recent years investment Also at Royal Brompton, the to sharing knowledge in our facilities has enabled Simulated interPRofessional Tand expertise spans teams at both sites to expand Team Training (SPRinT) local, national and their teaching provision. programme has been based international initiatives. The Students from around the on the paediatric intensive high priority that is placed globe are attracted to care unit since 2008. on education and training Harefield Hospital’s STaR Internationally renowned and The high priority reflects a very real Centre. The centre promotes award-winning, SPRinT uses responsibility to invest in the expert patient care by inviting in-situ simulation to provide that is placed on next generation of students to train with Royal the multidisciplinary team cardiovascular and Brompton’s and Harefield’s involved in patient care with education and respiratory clinicians, and cardiovascular clinicians to insight into human factors the Trust continues to enjoy develop professional that influence personal training reflects a a sound reputation for the capabilities, such as the performance, emphasising very real provision of postgraduate management of medical team performance while programmes. emergencies, proficiency in rehearsing the management “responsibility to invasive procedures and of rarely occurring critical Our clinical teams share their surgery, and effective events. invest in the next knowledge at conferences communication and team and training events around work, in a safe, learning The team is actively involved generation of the world, and clinicians environment. in educational committees of wishing to specialise in heart the Royal College of cardiovascular or lung conditions are invited Royal Brompton Hospital’s Paediatrics and Child Health, and respiratory to take up fellowships to state-of-the-art Clinical Skills the Paediatric Intensive Care work alongside established and Simulation Centre is a Society, and the International clinicians. experts at the Trust. More collaboration between Royal Pediatric Simulation Society. recently, digital technology Brompton and The Royal has provided a valuable new Marsden Hospital which First paediatric teaching platform to reach a focuses on clinical skills cardiology study day global audience. training for staff and other healthcare professionals. In spring 2014, Trust As a specialist Trust, our Clinical teams receive training consultants led by Dr Salim experts also have an in complex procedures and Jivanji, paediatric cardiology important role to play in crisis management in the specialist registrar, held a well helping to establish complex simulation suite, and learn attended paediatric procedures within new surgical techniques in cardiology study day, which mainstream clinical practice. the wet lab. covered a range of topics 56 ” Royal Brompton & Harefield Annual Review 2014/15
including Great Ormond Street Hospital for Children, Papworth Hospital and Nottingham University Hospitals. The sessions focused on human factors, in particular clinical leadership and teamwork, in the context of acute cardiac care, and explored how patient safety in healthcare could translate advances made both in the military and the aviation industry. Military personnel with experience at Camp Bastion discussed how the NHS might adopt and adapt approaches used by the armed forces to manage risk in high pressure environments, and similar examples were discussed from the airline industry. The symposium, the first of its kind internationally, dovetails with a major initiative at the Trust to build capacity and capability in understanding human factors in healthcare. A multidisciplinary faculty has been developed to offer A GP tries out a spirometry test, supervised by respiratory physiologist, Peter Dickel monthly courses at both sites, to better understand the complexities of safe care delivery.
Professor Lord Darzi, Paul including fetal cardiology, Trust is praised for Chest Hospital NHS Hamlyn Chair of Surgery at inherited cardiac conditions, making patient safety Foundation Trust and funded Imperial College London and and paediatric cardiac a priority by the Health Foundation. Honorary Consultant surgery. The theme of the Surgeon at Imperial College day was “the future”, and The Trust has a strong record Over 100 delegates attended Hospital NHS Trust (who led delegates were given a in patient safety. Performance the event from organisations a national review of the NHS valuable insight into new is monitored continuously, developments in the and openness and A packed auditorium for Lord Darzi’s keynote address specialty. transparency is encouraged from all staff. A highlight of the day was the keynote lecture on “50 years The Trust is committed to of cardiac surgery”, given by “Sign up to Safety”, a national Professor Jane Somerville, initiative hosted by NHS former consultant cardiologist England with the aim of at Royal Brompton and delivering harm-free care to recognised expert in every patient and halving congenital heart disease. avoidable harm over the next Dr Jivanji commented: “It was three years. a really well attended day and we had some excellent In April 2014, an inaugural feedback from those symposium “Improving Quality attending. We hope to and Safety in Acute Cardiac establish the conference as Care” was held in conjunction an annual event.” with Liverpool Heart and
57 WE SHARE OUR KNOWLEDGE
and is author of the report: “High quality care for all”), gave the keynote address. In his speech he praised the Trust for hosting the first symposium focusing specifically on acute cardiac care and stressed patient safety must remain a priority.
GPs attend respiratory study day
A GP study day to discuss common respiratory conditions was held at Harefield Hospital as part of a regular programme of events for primary care teams. Several consultants and other healthcare professionals gave presentations on their specialist area, and provided Professor Mike Polkey (fourth from left) on his visit to the COPD clinic in Guangzhou, China updates on recent advances in the diagnosis and management of common lung conditions and lung cancer. Trust staff share undiagnosed or untreated support nursing development expertise on visit and currently, neither in the region. Delegates took part in a to China pulmonary rehabilitation nor practical spirometry session Tai Chi are used to treat it. In 2015, two experienced to measure lung function. In January 2015, respiratory Although pulmonary cardiac paediatric nurses Peter Dickel, respiratory consultant, Professor Mike rehabilitation has proven joined the multidisciplinary physiologist, explained: Polkey, and physiotherapist, benefits, the study may show team on Royal Brompton’s “Most GP surgeries will have Bhavin Mehta, travelled to Tai Chi to be just as effective, children’s unit and paediatric spirometers but they may not China to help set up a new and if so, potentially a more intensive care unit (PICU). be used very often. This study to compare pulmonary accepted form of treatment to session was a bit of a rehabilitation with Tai Chi in develop in the country.” Their remit was to: trouble-shooting exercise to helping to improve the quality help make the GPs aware of of life for patients with lung Professor Polkey will return to • Garner new knowledge in what they should be looking disease (Tai Chi is a traditional China at the end of the study surgical and clinical for in the results.” Chinese form of exercise, to assess the results. paediatric cardiac care. originally developed as a Dr Will Man, consultant in martial art, which combines Paediatric nurses from • Understand the patient respiratory medicine, who deep breathing with slow and Hong Kong visit Royal pathway for paediatric discussed pulmonary gentle movements). The Brompton for heart surgery and cardiac rehabilitation at the event, Chinese study is observational training catheter services. said: “The aim of the day was co-ordinated at the key state to discuss common laboratory in Guangzhou, In July 2014, the Trust • Acquire information on the respiratory conditions that South China, and involves responded to a request made design and delivery of the GPs may see and to give 120 patients with COPD, a by representatives of a nurse preceptorship them some guidance about term used to describe a Hospital Authority in Hong programme (whereby referrals to a specialist centre number of respiratory Kong, to share good practice newly qualified nurses like Harefield. Those conditions, including and develop an annual receive support and attending were really emphysema and chronic overseas scholarship development during their engaged in the presentations bronchitis. programme for clinical leaders first 12 months). and discussions and very in paediatric cardiothoracic positive about the services Professor Polkey said: “We nursing. A new children’s • Observe the and facilities we offer. We were surprised to find that a hospital is currently under multidisciplinary approach hope to repeat the study day large number of patients in construction and the of congenital heart next year.” China with COPD go scholarship programme will disease care.
58 Royal Brompton & Harefield Annual Review 2014/15
• Understand the role of the regarded grand round Mr Lim said: “We are Clinical teams from more community nursing meetings, commonly held by delighted to be spearheading than 20 referring trusts service for children with international teaching hospitals this initiative by partnering attended the first meeting, heart problems. as part of their educational with the leading scientific which focused on severe programmes. Featuring a journal in the field. It asthma in children. The nurses also observed the fictional case study, it poses a underscores the reputation of Dysfunctional breathing and award-winning work of the series of questions about the the Trust as an internationally advances in research were simulated paediatric diagnosis and treatment of a recognised centre of two of the topics discussed. resuscitation team (SPRinT). complex case. excellence for managing respiratory diseases.” A second study day for Transforming the The first interactive grand occupational health advisors education of doctors round was led by Mr Eric Lim, Jo Szram, director of medical covered assessment and around the world consultant thoracic surgeon, education, added: "The management of with contributions from Lancet's digital platform offers occupational asthma. During In April 2015, experts at the Professor Andrew Nicholson, us a valuable and highly the day delegates were Trust published an interactive consultant histopathologist, efficient channel to reach shown how inhalation grand round in collaboration Dr Simon Padley, consultant clinicians and medical challenge tests are with The Lancet Respiratory radiologist, and Dr Sanjay students worldwide, conducted (recreating a Medicine. This was the first in Popat, consultant medical expanding our influence work environment and a series and the collaboration oncologist from The Royal around the globe." monitoring patients’ will see several cases about Marsden Hospital, who all reactions to allergens). different respiratory diseases provided audio interviews, and Asthma service shares highlighted. appropriate X-rays and knowledge Feedback from both days photographs. was extremely positive, with The interactive educational The Trust’s asthma teams the quality of information tool, available on The Lancet’s Commenting on the hosted two study days in rated as good or excellent website, mimics the highly- partnership with the Lancet, spring 2015. by all those attending.
A view of the interactive educational tool, available on The Lancet’s website
We are delighted to be spearheading this initiative by partnering with “the leading scientific journal in the field.
”59 WE SHARE OUR KNOWLEDGE
Mateusz Kolecki (second from right), a medical student visiting from Poland, observes Dr Jo Szram (left), consultant physician and director of medical education, in a clinic
Dr Szram said: “We treat Dr Prasad discussed the asked to return to develop Harefield was the most more children and adults with effects of exercise on the acute pain services at Kigali represented centre at the severe asthma than heart and the importance of Military Hospital. It was such event, which was attended anywhere else in the country, cardiac screening, while a valuable experience. Even by delegates from around the and lead Europe in the Dr Babu-Narayan and Dr though we went to teach, we world. The team had seven assessment of work-related Keegan considered future certainly learnt a lot too. abstracts and one poster asthma, so these study days careers in the health sector. We’re hoping that, with the accepted, four of which were offer a valuable opportunity to help of SPIN, we’ll be able to by allied health professionals raise awareness of our First pain team in return to Kigali and have attending the congress for services.” Rwanda some of their specialists over the first time. to visit us.” Researchers inspire the In November 2014, Dr Sian Dr Melissa Sanchez, clinical next generation Jaggar, consultant “Pain champions” were psychologist and one of the anaesthetist, and Rachel identified within the nursing presenters, said: “The Researchers from the Anderson, clinical nurse team at the hospital in Kigali presentations were a great cardiovascular BRU were specialist in pain and were taught how to success and this was the first invited to share their management, visited Kigali, assess and treat pain, using time we have had so much expertise and career advice Rwanda, to help establish the the drugs available locally. representation from allied with young visitors at the country’s first pain team. The The pain champions then health professionals science, technology and visit was part of a project cascaded their learning to alongside medical and innovation festival, organised by the charity SPIN other clinical teams. surgical colleagues.” Technopop, at the end of (Specialists in Pain October 2014. International Network) to help Success at transplant clinicians and paramedics in congress Consultant cardiologists, developing countries improve Dr Sanjay Prasad and Dr their pain management A multidisciplinary team from Sonya Babu-Narayan, and techniques. Harefield Hospital was invited principal physicist, Dr to present at the 11th Jennifer Keegan, took part in Dr Jaggar explained: “Rachel International Congress on sessions on sports science and I presented at Lung Transplantation in Paris and the human body during conferences in Kigali and at the end of September the four-week festival. Nairobi in 2013 and were 2014.
60 Royal Brompton & Harefield Annual Review 2014/15
Allan Seraj, practice educator, with student nurses
61 THE TRUST
awards and recognition
any Trust experts rofessor Andrew hold key positions in Bush, consultant Mprofessional Ppaediatric chest associations, colleges and physician, was awarded the societies and act as advisors 2014 Lifetime Achievement to government departments Award by the European and arms-length bodies. Respiratory Society’s (ERS) They travel widely, giving Paediatric Assembly at the lectures and presenting at 24th International Congress national and international of the ERS in Munich, conferences. Every year, a Germany. Professor Bush number of them gain also received an Honorary particular recognition for Lifetime Fellowship from the their work. Some South African Thoracic noteworthy achievements Society in June 2014. The during 2014/15 include: fellowship was in recognition Mr Babulal Sethia of his contribution to rofessor of cardiology r Babulal Sethia, respiratory medicine in and director of the NIHR consultant congenital South Africa. PRoyal Brompton Mheart surgeon, was Cardiovascular Biomedical appointed president of The Research Unit, Dudley Royal Society of Medicine Pennell, was elected to the (RSM) in July 2014. During Fellowship of the Academy of his three-year presidency, Mr Medical Sciences (a) in April Sethia aims to build on the 2014. The prestigious RSM’s cross-disciplinary fellowship is given in work and focus on recognition of exceptional developing partnerships with contributions to the other healthcare and advancement of medical educational organisations. Mr science. Professor Pennell is Sethia, who has been a a world-leading expert in consultant cardiac surgeon at cardiac magnetic resonance Royal Brompton since 1999, (CMR) imaging and has been is widely published as an influential in promoting the international expert on use of CMR in the clinical congenital heart disease in diagnosis and management children and adults, and of cardiac disease, both in regularly lectures to clinicians the UK and across the world. Professor Dudley Pennell all over the world. Professor Andrew Bush
62 Royal Brompton & Harefield Annual Review 2014/15
r Amelia Shoemark, senior clinical scientist r Isabel Skypala, challenge for patients whom Din primary ciliary consultant dietitian and allergy history and tests are dyskinesia (PCD), was Dclinical lead for food inconclusive. The clinics were awarded an NIHR healthcare allergy, was honoured with the first of their kind in the UK. science post-doctoral the prestigious William fellowship for her work Frankland award from the investigating “New diagnostic British Society of Allergy and tools for PCD”. PCD is an Clinical Immunology (BSACI) inherited condition where cilia, for her outstanding service in which are tiny moving the field of clinical allergy. She structures that line the is the first non-medical airways, ears and sinuses, recipient of this award. Dr are unable to function. Skypala set up the dedicated Dr Amelia Shoemark adult food allergy clinics at Royal Brompton in 2007. The clinics are a one-stop shop for food allergy diagnosis, with a gold standard oral food Dr Isabel Skypala n March 2015, the Health Service Journal (HSJ) Irecognised chief executive, Robert Bell, as one of the most influential figures within n April 2015, Royal Year at a ceremony in UK healthcare. Noting his 10 Brompton consultant November 2014. years’ service at the Trust, the IDr Gillian Halley, was nomination recognised some named National Innovator of of the challenges he has the Year at the National NHS faced, whilst celebrating his Leadership Recognition many achievements, making awards. Dr Halley, who has particular reference to the pioneered the Trust’s unique sense of community he instils web-based Hospital to Home in staff. Mr Robert Bell pathway, was presented with the award for her work on developing the service, which is designed to enable children he Trust’s pain management team was among five who need long-term nominees recognised at pharmaceutical company ventilation to be safely Grunenthal’s national pain awards in Glasgow in April discharged from hospital. She T 2015. The team was awarded a £5,000 grant to continue its had previously been named research into managing the pain associated with cardiac London NHS Innovator of the Dr Gillian Halley device implantation. The grant has been put towards developing local and national protocols to help clinical teams manage the pain that patients experience after having cardiac devices such as pacemakers, defibrillators and cardiac resynchronisation therapy (CRT), fitted. r Nicholas Simmonds, Dconsultant respiratory physician, won an award at an NIHR event in February 2015 for first European / global recruitment of a patient into an international study. Dr Simmonds’ research is looking at a new drug treatment for cystic fibrosis.
Dr Nicholas Simmonds
The award-winning pain management team
63 THE TRUST
our profile in the media
A strong and positive quiet confidence, that transplants at Harefield extensively on Channel 4 presence in the media can everything was going to be Hospital. During transit News, with presenter make a valuable contribution all right.” between donor and recipient, Krishnan Guru-Murthy to increasing awareness of the new Organ Care System visiting the little girl and our services and expertise. JUNE 2014 adopted by Harefield interviewing surgeon, The Trust’s communications clinicians, simulates Professor Francois Lacour- team works with many rofessor Martin Cowie, conditions of the human Gayet, about her successful diverse publications and consultant cardiologist body, pumping oxygenated procedure. In an ITV News media outlets each year, Pat Royal Brompton, blood inside the donor heart. London follow-up report, reaching millions of people shared his expertise on This increases the time the Professor Lacour-Gayet around the world. Here is a implantable cardioverter heart can be maintained in a explained that Hala should small selection of recent defibrillators (ICDs) on BBC1’s suitable state for transplant be able to live a normal life coverage. Breakfast programme in June. compared with the following the correction of Professor Cowie explained conventional method of ice her heart defect. MAY 2014 that ICDs can be lifesaving for preservation, meaning donor patients at risk of dangerously hearts can be retrieved from NOVEMBER 2014 feature in the Daily Mail abnormal heart rhythms. He further afield than previously. focused on the work of was also featured on BBC Mr André Simon, director of n innovative and life- AHarefield Hospital’s London News about the transplantation, said the changing treatment for senior echo cardiology Trust’s contribution to new technology had become the Aemphysema, carried co-ordinator, Julie Donovan, National Institute for Health “gold standard” for organ out as part of a clinical trial at after she was nominated for a and Care Excellence (NICE) retrieval at Harefield. Royal Brompton Hospital, was national “Health Hero” award guidelines, which showcased on BBC1’s The by a transplant patient. The recommended that ICDs rime Minister David One Show. Dr Pallav Shah, story included a range of should be available to more Cameron praised the: consultant physician in examples of Julie going the NHS patients. The BBC P“world-class care” at respiratory medicine, extra mile for patients and report described the Trust as Royal Brompton, describing explained that inserting coils she was described in the “the leading NHS centre for the expertise of doctors and into the lungs through a piece as a “hospital fairy cardiorespiratory research” nurses as “second to none” bronchoscope can improve godmother”. Patients and and included an interview with in a front-page story in the lung capacity by restoring the relatives explained how Julie a Harefield patient whose life Sun on Sunday. The Prime spring-like tension in damaged gave them emotional support had been saved by an ICD. Minister was referring to airways. A film of Dr Shah and comfort, while also three-year-old Hala al carrying out the procedure making them feel less alone. AUGUST 2014 Massri’s journey from Gaza was included in the piece. The mother of one patient for life-saving heart surgery described how Julie had he Mail on Sunday at Royal Brompton, which JANUARY 2015 provided reassurance whilst reported that the Trust’s was organised by the her teenage son was having Tuse of revolutionary charity Chain of Hope. he world’s first implant of heart surgery, saying: “Julie technology had enabled Hala’s story was widely a new replacement heart made us feel, through her more patients to have heart reported and featured Tvalve at Royal Brompton
64 Royal Brompton & Harefield Annual Review 2014/15
was featured in the Daily Mail Scoble “owed his life to the Hospital”, by double-lung in January. Mrs Margaret care he received at Royal transplant patient, Sharon Mann had the minimally- Brompton” after undergoing Brennan, described the invasive procedure to replace complex surgery to replace “everyday miracles” that a leaking mitral valve after she leaking heart valves. happen at Harefield. Mr Fabio was not deemed suitable for De Robertis, transplant conventional surgery. Mrs MARCH 2015 surgeon, spoke of the Mann described the new groundbreaking work at lease of life that the Tendyne BC political editor Nick Harefield, and colleagues transcatheter mitral valve had Robinson’s praise for explained how the hospital’s given her. Consultant cardiac Bthe care he received at clinical teams have pioneered surgeon, Mr Neil Moat, Royal Brompton after the use of new treatments provided an expert clinical undergoing surgery for lung and technology over the view and explained that if cancer, was widely covered years. clinical trials were successful, in the media. Mr Robinson the new valve could be explained that his operation, he wife of England and approved for more carried out by consultant Arsenal footballer, Theo widespread use. thoracic surgeon, Mr Eric Lim, TWalcott, described the had been a success, and on couple’s gratitude to Royal FEBRUARY 2015 BBC Radio 2 described Mr Brompton staff after their Lim as his “excellent surgeon newborn son was treated for he Trust’s specialist at Royal Brompton”. a heart complaint. In an expertise was illustrated interview in Hello! magazine Tin The Mail on Sunday n its centenary year, that was widely reported in in February by the case of Harefield Hospital’s several other national stroke patient, Paul Scoble, Ireputation as one of the newspapers including the who was transferred to Royal world’s leading transplant Daily Mail and Daily Mirror, Brompton after doctors at his centres was celebrated Melanie Walcott described local hospital had told across a number of media her son’s surgery as ”the relatives nothing more could channels. In The longest two and a half hours be done for him. The Independent, “A century of of our lives but the staff newspaper stated that Mr saving lives at Harefield were fantastic.”
arefield Hospital BBC1 Breakfast, discussing mechanical heart pumps transplant surgeon, Mr Harefield’s expertise in fitting primarily used to extend HFabio De Robertis, left ventricular assist devices patients’ lives while they wait described his “unexpected (LVADs). LVADs are for a transplant. honour” after heart transplant patient, Andrew Britton, Mr Fabio De Robertis, transplant surgeon (left), with Andrew Britton named his firstborn after him and his wife, Lauren, who named their firstborn child after Fabio in a story published by several national newspapers in November. ITV’s Good Morning Britain interviewed Mr De Robertis via a studio link to Harefield. Andrew and his wife, Lauren, explained they had named their son “after the surgeon who saved Andrew’s life”. The coverage included numerous references to how grateful the Britton family was to the transplant team. Andrew and Lauren also appeared on
65 OUR CHARITY AND THE ARTS
our charity Royal Brompton & Harefield Hospitals Charity raises money to support the Trust’s pioneering work in heart and lung diagnosis, treatment and research in areas that lie outside NHS budgets.
What the Charity funds
ince April 2012, the Harefield Heart and rb&hArts Fundraising activities Charity has operated Lung Appeal Sindependently of the Now in its 12th year, rb&hArts The Charity raises funds NHS to help realise In April 2014, the Charity re- engages with approximately through a diverse range of ambitious projects for both launched its Harefield Heart over 3,500 people annually activities. As well as deriving hospitals. It is overseen by a and Lung Appeal to raise and relies on Charity funding income from a property board of trustees, under the funds for seven Organ Care to help deliver a variety of portfolio, individuals and chairmanship of Richard System kits, which are used creative activities. In 2014/15, corporate donations are Hunting CBE, with day-to- to transport donated organs, rb&hArts’ work focused on encouraged, applications are day operations managed and to build a new exhibitions, site-specific made to charitable trusts, by chief executive, Gill echocardiography room. commissions, a musician-in- foundations and grant-making Raikes MBE. residence, and a range of bodies and a programme of By April of this year, the participatory workshops and fundraising events is Every year, the Charity runs Charity had beaten its performances in public organised throughout the two main appeals to support fundraising target, allowing spaces and wards. year. Supporters are also the work of Royal Brompton Harefield to buy 11 life- encouraged to organise their and Harefield hospitals: saving OCS kits and Celebrating a very own events and to take on enabling work to start on a special year sponsored challenges. Royal Brompton new scanning facility. Hybrid Theatre Appeal In 2015, the Charity, in For more information, visit Patient Amenities collaboration with the Trust, www.rbhcharity.org Fundraising continued Fund developed a programme of towards the Charity’s goal of exciting events to celebrate the raising £4.5m for the £6.3m Every year, the charity 100th anniversary of Harefield hybrid theatre project at Royal allocates £100,000 to Hospital. From its origins as an Brompton Hospital. The improve how patients ANZAC military hospital during hybrid theatre will make it experience care in our the First World War, the possible to carry out a hospitals. Staff are hospital has grown into a By April the combination of medical encouraged to put forward world-renowned specialist procedures such as a CT suggestions as to how the centre for the treatment of Charity had scan, a non-invasive money can be best heart and lung diseases. procedure and heart surgery invested. Examples of beaten its target, in the same space, at the recent projects are: As a fitting legacy, the Charity same time, rather than with refurbishing a waiting room, is launching a new centenary allowing Harefield multiple admissions to either buying new high-spec appeal in 2015/16 to raise catheter labs or theatres. wheelchairs and providing funds towards an extended to buy 11 life- Treating patients less patients with iPads so they intensive therapy unit, which saving OCS kits invasively and in a shorter time can keep in touch with means experts at the hospital means recovery is quicker friends and relatives during will be able to treat a greater “ and scarring is reduced. their stay. number of seriously ill patients.
66 ” Royal Brompton & Harefield Annual Review 2014/15
With thanks to:
• Kathryn Dixon, and Rosie and Philip Pope for organising “100 Hearts” to raise £154,000 for Harefield’s transplant unit • Team Macy, who have tirelessly fundraised for the Charity since 2012 and raised awareness of congenital heart disease • The Knights of St. Columba who raised £6,772 through a Charity of the Year agreement in 2014 An example of a hybrid theatre • Tara Smith, who was born (Manchester Royal Infirmary) with cystic fibrosis and had a double lung The Charity has purchased 11 Organ Care transplant at Harefield; Systems for Harefield Hospital just six months later she raised money for the Charity by climbing Mount Snowdon • Lewis Silkin LLP for raising £15,000 in memory of their staff member, James Levy, who was treated at Royal Brompton Hospital throughout his life • Hitachi Capital for donations and Double lung sponsorship amounting to transplant £30,000 in recognition of patient, Tara the treatment given to Smith, raised their staff member, over £8,000 Vanessa Bradley, at climbing Mount Snowdon Harefield Hospital • The Fidelity Foundation and The Geoff & Fiona Squire Foundation for their generous gifts towards the Hybrid Theatre Appeal • Heritage Lottery Fund for supporting Harefield’s centenary celebrations • Crescent Building Supplies for their sponsorship and ongoing support of Harefield Hospital Rob Brydon, Angus Deayton and a host • The Royal Brompton and of other celebrities joined transplant Harefield fundraising patient, Will Pope, to raise funds for Organ Care Systems (pictured) and to committees support Harefield’s transplant programme
67 OUR CHARITY AND THE ARTS
rb&hArts rb&hArts, with the support of Royal Brompton & Harefield Hospitals Charity, brings all forms of the arts to Royal Brompton & Harefield NHS Foundation Trust.
Arts in health
ver the past 12 years of our participants experience example ceiling art, flooring Brompton and Harefield we have established arts for the first time while and wall vinyls) and also found that 70 per cent of Oa world-class and they are in one of our manage an art collection (of them felt markedly physically highly innovative hospital hospitals. over 1,000 pieces), which are better after taking part. For arts programme, designed displayed for the benefit of example, one participant to improve the wellbeing of Our year-round creative patients, their visitors and said: "My whole body feels patients, staff and the programme is funded by staff. so different just in one single diverse communities Royal Brompton & Harefield session, from tension to we serve. Hospitals Charity and a Singing for Breathing relaxation. Something that variety of charitable trusts and continues to provide two medical intervention won't Supporting patients from all donations. It offers a wide weekly singing workshops for achieve!" over the country with heart range of participatory patients living with COPD. and lung disease, we have a activities, performances in The workshops involve 35 rb&hArts is committed to national reach, and work with public areas and wards, as people per week and increasing opportunities for over 3,500 people annually. well as temporary exhibitions approximately 650 in- and more patients to benefit from We know that people who across the hospitals. We outpatients over the course of Singing for Breathing take part in our activities tend support the Trust’s capital a year. A survey of 500 workshops. It is our ambition not to engage with the arts projects team to implement patients attending the singing to introduce additional locally – and that the majority integrated artworks (for workshops at Royal workshops next year.
Breath-etched copper plates by Jayne Wilton 68 Royal Brompton & Harefield Annual Review 2014/15
Singing for Breathing 100 years of Harefield
hroughout 2015, from a patient, staff and local Harefield centenary is community perspective, Tbeing marked by a culminating in an exhibition in series of events and activities the Concert Hall, in autumn supported by the Heritage 2015. Lottery Fund (HLF) and the Trust to celebrate the A new quilt, retelling our orking alongside a Arts Council England and hospital’s history over the last 100-year story, has also been composer, curator, culminated in an exhibition of 100 years. An oral history commissioned for permanent clinical research Jayne’s work at Royal W project is capturing memories display on site. physiotherapist and three Brompton throughout respiratory groups at Royal autumn 2014. As part of the Brompton and Harefield project, the Singing for hospitals, visual artist, Jayne Breathing groups worked Wilton, created new artworks with facilitator, Joanna to capture the usually Foster, to create a new unseen human breath. composition, Did We Sing, which premiered during The project was funded by Jayne’s exhibition.
The human breath captured in art by Jayne Wilton
Harefield Hospital in the early 20th century
Adrian Garratt, musician in residence ITU, HDU and transplant drian Garratt, comedy violinist, has been in Aresidency at Harefield Hospital, playing in the intensive therapy unit, high dependency unit and transplant unit for 12 months. His particular style, a mix of chat, comedy, improvisation hospitals over the years. He is and playing music has had a not just a talented violinist, but significant and positive impact someone who fully in these wards. understands the role that the arts can play in stressful As an experienced artist, environments. familiar with working in complex healthcare Music in hospitals transforms situations, Adrian is unique the patient experience, among the many musicians providing distraction, we have chosen to play in the amusement and joy.
69 Photography by Alex Orrow Photography – www.alexorrow.co.uk Designed and produced by Eureka Marketing Solutions – www.eureka-marketing.co.uk
70 Royal Brompton & Harefield Annual Review 2014/15
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