THE

Issue Number 13 PulseMay 2004

Race for life The lifesaving injections that can save patients’ lives

Paul Jenkins Why we’re flying the flag for acute and general medicine

The male disease Developments in the fight against prostate cancer

Viewpoint Work-life Why the NHS is not balance free for all Childcare schemes that Improve Working Lives Students on the move Unveiled: plans for a new school of nursing at NNUH NEWS ROUND Putting a value on diversity

AS A TRUST, we are committed to building Staff numbers by ethnic group (%) The Race & Cultural Awareness Group a valued workforce whose diversity reflects provides a forum to discuss and promote that of the local community. It is also an diversity issues, as well as an opportunity to IWL standard that every health service socialise with colleagues. A cultural employee should be able to challenge awareness day is planned for NNUH and discriminatory behaviour based on other projects include a calendar of cultural differences in language, ethnic origin, events and a welcome pack for overseas staff. culture, religion, gender, sexual orientation, age and disability. White British 82.9 Asian other 1.68 Career Enhancement training is available Other ethnic groups 8.32 Black African 0.37 for black and minority ethnic (BME) staff at NNUH and at other sites across , The Disability Advisory Group was Undeclared 6.26 Black Caribbean 0.15 established in 2000 to work towards White other 2.52 Suffolk and Cambridgeshire, to increase ensuring equality for disabled people. confidence, overcome limitations to career opportunity. Our Race Equality Scheme and progress and improve job satisfaction. Action Plan is available on the Trust intranet. Race Equality Following an audit in March 2004 the Norfolk Race Equality • We are looking for individuals to become Council reported that we had made good Staff numbers by gender (%) IWL Equality & Diversity Champions. progress towards fulfilling the requirements Female: 80.41 Male: 19.51 If you would like to get involved or to of the Race Relations Amendment Act 2000. Staff numbers by age (%) nominate a colleague, or if you would like to However, there is still much to be done to Under 30: 18.69 know more about any of the issues mentioned promote good race relations, tackle Under 50: 76.04 Over 50: 23.96 here, contact Hasan Cagirtgan in HR, either discrimination and promote equality of on ext. 5049 or by email.

LETTERS WRITE TO SUE JONES, EDITOR, COMMUNICATIONS TEAM, NNUH Hissing airlines, tinitus white noise Enjoyable visit At the age of 79, I am grateful to be fit Gaseous explosions erupt from ‘the boys’ The Queen has and active and I take every opportunity Bleeps and rings from the nurses station asked me to pass to speak up for the NHS. More A concerned relation, or some aggravation? on her thanks and personally, I am deeply grateful to the A rattling cough, a sound of spew best wishes to all overworked and (almost) unanimously A ‘varicose’ man needs a ride to the loo those – including efficient, cheerful and friendly staff at The special night wheelchair is brought from management, NNUH. its store staff, volunteers Incidentally, the new system of The one with square tyres that clatter the and patients – telephoning to confirm appointments is floor who took so much trouble to make her far more efficient than sending letters. I Heartbeat tick of the ward wall clock recent visit such a happy and heartily approve of this change 2.10am and time has stopped memorable occasion. William Etherington, Only another four hours to go Her Majesty was pleased to see some The lights will come on and its all systems go of the impressive facilities at the Excellent care Another long day of drugs and ‘obs’ hospital. She particularly enjoyed being As a patient at both the old N&N and From people who care, and are good at their able to meet so many of those involved the new hospital, my husband received jobs in the project and to see something of the best of care over many years until But a plea from the patients as night time the running of the hospital. he sadly died in December 2003. draws near Christopher Geidt, Assistant Private In particular I would like to thank the Give us some ear plugs! We don't want to Secretary to The Queen staff on Coltishall, Brundall and hear! Gunthorpe Wards, in Plastics Night-time symphony Richard Batson, EDP Cromer Outpatients, the Arthur South Day Heartbeat tick of the ward wall clock Procedure Unit and the Colney Centre. 2am and time has stopped Grateful to be healthy I don’t think anyone should have any Trying to sleep, groggy and sore I have just undergone my 19th minor complaints about this wonderful But there's so much noise, and it's not just surgery treatment – the second by laser hospital. snores – for transitional cell carcinoma. Mrs S. Francis, Whissonsett,

2 NEWS FROM THE NORFOLK AND NORWICH UNIVERSITY HOSPITAL NHS TRUST - MAY 2004 WELCOME

Training programme We need to work targets general skills smarter, not harder THE LAST year has been tough. Through THE NNUH has introduced a specialist four-year training programme for registrars your hard work and in acute and general medicine. dedication, we The four-year programme has the achieved the key backing of the Royal College of Physicians targets for inpatient, and aims to give qualified doctors the day case and specialist skills they need to diagnose outpatient waiting times, apart from a acutely ill patients when they enter the small number of patients awaiting bone hospital as an emergency. or tissue. Remarkably we did so while The trainees join a rotational programme managing a sustained and exceptional which takes in the James Paget Hospital, the 10 per cent increase in emergency Queen Elizabeth Hospital in King’s Lynn admissions. and Peterborough General Hospital as well Thank you for all you did and continue as NNUH. Keeping up with to do, in whatever capacity, be it directly • Has generalism taken a back seat in hospital with patients or, like me, supporting those medicine? Read Paul Jenkins’ Viewpoint, P11 the Canaries on the frontline. But the pressures on you and on the LIFELONG Norwich City fan George Townshend, from Blofield, is the 500th hospital are not sustainable. We cannot patient to take part in the 'Canaries in the keep on increasing the occupancy. We Community' project to bring football action must find ways of working smarter, not to patients in hospital. harder. George needs regular kidney dialysis but I know that under the pressure we are keeps up with the club with the help of experiencing this phrase has a hollow volunteer Duncan MacInnes, who shows ring. That is why we have just launched him the goals on a laptop computer. “I the Transformation Strategy for Central listen to the match commentaries on the Norfolk, ‘Better Care for Central Norfolk’, radio but it’s not the same as being there,” in partnership with all the other local says George. “Watching the goals on screen health and social care organisations. is the next best thing.” The central objective of the strategy is Theatres in action A former merchant banker, Duncan is to enable patients to take greater Ever wondered what goes on behind the delighted with the success of the scheme: responsibility for their own health and scenes in an operating theatre? The National “It started with children on Buxton Ward decisions about their care, and to shift Association of Theatre Nurses is celebrating but now I spend five hours a week visiting care closer to patients’ homes. This is its 40th aniversary on Wednesday 2 June with patients all over the hospital. As a fan particularly relevant to those with long- a theatre awareness day in the East Atrium. myself, I can appreciate how much they term chronic illnesses and is intended to There will be hands-on activities and fun for miss seeing their team in action.” reduce the need for so many emergency all ages, including a chance to take a close George is pictured with Duncan (left) admissions. look at equipment and surgical instruments. and former Norwich City goalkeeper Bryan Other initiatives include improving the For more information visit www.natn.org.uk Gunn, who presented him with a book flow of elective work, maximising or contact Adrian Jones on bleep 1004 about the club. opportunities for day surgery, reducing infections and complications and making the best use of the many health facilities across Central Norfolk. THE DUKE OF KENT took time out to talk to patients The outcomes we need to deliver are a when he visited the NNUH sustainable way forward and improved stroke unit in March. The unit services for patients. Please look out for has been praised by the Stroke ways to get involved. Association for providing prompt treatment and excellent care. Among those who met the Duke was Phyllis Starland, who is pictured with STEPHEN DAY sister Julia Chapman-Wright Chief Executive, Norfolk and Norwich on Dunston Ward University Hospital NHS Trust

NEWS FROM THE NORFOLK AND NORWICH UNIVERSITY HOSPITAL NHS TRUST - MAY 2004 3 INFO NEWS ROUND

Norfolk and Norwich University Hospital School of nursing plans unveiled Colney Lane, Norwich, Norfolk NR4 7UY Tel: 01603 286286 Website: www.nnuh.nhs.uk Restaurant West Atrium Level 1, open daily 7am-2.30am Coffee bars Outpatients West and Outpatients East, open Mon-Fri, 9am-5pm Plaza (East) open Mon-Fri, 8am-6pm Saturday 10-4pm WRVS shops School of Nursing and smart-board technology. The building will East Atrium, open 8am-8pm Mon-Fri, THE UEA’S Midwifery is to move from Hellesdon also incorporate energy-efficient design 10am-6pm weekends Plaza (West) open 7am-8pm Mon-Fri Hospital to a brand new building close to principles developed on the main UEA 8am-6pm Saturday and Sunday the roundabout at NNUH. Work on the campus. Serco (for housekeeping, porters, catering £6m complex is set to start in September, Margaret Coomber, Director of Nursing and maintenance). Call ext. 3333 aiming for completion in December 2005. and Education, commented: “We’re IT helpdesk (for tel./ computer faults): Refer Among the state-of-the-art facilities will delighted that the schol of Nursing and to Intranet homepage or call ext. 5555 Security Call ext. 5156 or 5656 be a skills laboratory that replicates health Midwifery will soon be on our doorstep. Reception care facilities on the hospital wards, a It will save a great deal of travelling East Atrium Level 1: ext. 5457 or 5458, 200-seat lecture theatre, seminar rooms between the two sites for both students West Atrium Level 1: ext. 5462 or 5463 and teaching spaces that benefit from and staff.” Outpatients East Level 2: ext. 5474 or 5475, Outpatients West Level 2: ext. 5472 East Atrium Level 2: ext. 5461 Car parking For information about permits, call Site Services on ext. 5789 Bus services Enquiries/ complaints: 01603 620146 [email protected] Cycle sheds West (near staff entrance) and East (near A&E). Keys available from Patient Services Bank Cash dispenser in East Atrium Level 1 Chapel Open to all. For details of services and to contact the Chaplains, call ext. 3470 Sir Thomas Browne Library Mon, Wed, Thurs: 9am - 5.30pm, Tues: 9am - 8pm, Fri: 9am - 5pm Playscheme At Blackdale Middle School during school holidays for the children of Trust staff. Contact Debbie Sutherland on ext. 2202 Cromer Hospital WELCOME RACE FOR LIFE Mill Road, Cromer NR27 OBQ ...to the following consultants who Latest figures from the DOH show that Tel: 01263 513571 have joined the Trust since 1 March: NNUH is one of the country's top performers Restaurant for giving lifesaving injections to heart attack 7.30am-1.30pm, 2-3.45pm, 5.30-7pm Dr Vipan Datta paediatrician, Dr Crawford Jamieson victims within a crucial half- hour period. • The following departments are based at gastroenterologist, Correct diagnosis is important as patients Norwich Community Hospital, Mr Richard Wharton, colorectal who have not suffered a heart attack could be Bowthorpe Road, Norwich NR2 3TU, harmed by these powerful thrombolysis drugs. Tel: 01603 776776: Breast screening, surgeon So to save vital seconds, paramedics are now Health records library, Diabetes Research, Pain Management FAREWELL able to beam electrocardiographs (ECGs) from the ambulance to our coronary specialists at ...to the following staff who have left • The following departments are based at NNUH, and nurses are trained to deal quickly Aldwych House, Bethel Street, Norwich, the Trust since 1 March 2004: with patients needing thrombolysis. NR2 1NR. Occupational Health (ext.3035), Caroline Blowers, auxiliary nurse on Outpatient Appointments, Clinical Governance, “Our door-to-needle times have improved Ward, after 30 years’ Training and some of Nursing Practice dramatically, thanks to the co-operation and service, Angela Lockwood, staff enthusiasm of all the teams involved,” says Dr • The Norwich Central Family Planning nurse in neonatal intensive care, after Clinic is based at Grove Road, Norwich Tony Page, clinical director for Cardiology. NR1 3RH. Tel: 01603 287345. 29 years, Audrey Carr, staff nurse on Easton Ward, after 25 years.

4 NEWS FROM THE NORFOLK AND NORWICH UNIVERSITY HOSPITAL NHS TRUST - MAY 2004 Teamwork in a class of its own SINCE 2002, the UEA’s Centre for Inter-Professional Practice has been working with staff at the NNUH to develop team-working skills. Five teams have successfully completed the eight- month programme, tackling issues such as communication, information-sharing, decision-making and managing conflict. The NNUH Child Protection Team is currently working alongside Police, social services and education in Norfolk to co-ordinate efforts to safeguard children, while another team is addressing issues of patient safety in an increasingly complex healthcare environment. The teams include physiotherapists, pharmacy staff, nurses, admin staff, Happy to be home: Virginia Geere with daughter Helena and surgeon Simon Wemyss-Holden occupational therapists, doctors, catering staff and dieticians. Each is encouraged to set goals that would lead to positive or Keyhole surgery brings fast results innovative changes in the way they work. least a week in hospital and even more time The sessions are facilitated by the SPECIALIST LIVER surgeon Simon Wemyss-Holden has performed a new type of recovering at home,” says Virginia. “With centre’s director, Professor Shirley laparoscopic (keyhole) surgery at NNUH to this technique, I was up and about very Pearce, along with Margaret Coomber, remove tumours of the liver and pancreas. quickly even went house-hunting the the Trust’s director of nursing and One of the first patients to benefit from the following day!” education, centre co-ordinator Fiona technique is Virginia Geere, from Mr Wemyss-Holden, who recently joined Watts and research associate Alison Wymondham, who was able to return home the Trust from Leicester, says the procedure Watkin. two days after having a benign tumour would not have been possible without the An important aspect of the Centre’s removed from her liver in March. ability to ‘map’ blood vessels using work is to foster team-working among “I’d been suffering pain and discomfort sophisticated radiology equipment. healthcare students, who meet in from the tumour for some time but I knew a Only certain types of tumour are suitable ‘buddy-groups’ to resolve problems in a conventional operation would involve at for this type of surgery. variety of healthcare scenarios. There are now plans to expand the work into primary care and across Protecting adults Friendly face of security secondary and primary care. If you would like to take part in the Patient Safety programme, contact Fiona ABUSE CAN take many forms, from The security team at NNUH has been named physical and sexual to psychological, ‘Best Team’ in the Midlands round of the or Alison on 591237 or 591273, or visit financial, neglect and discrimination. Annual Security Officer Awards, organised by www.med.uea.ac.uk/research/cipp_home New guidelines on protecting vulnerable the British Security Industry Association. The .htm. adults have now been prepared and are 21-strong Chubb team available on the Trust intranet (under won the award for Guidelines with General Applicability). their willingness to ‘go For information, advice and support on the extra mile’ in this issue, contact Specialist Health Visitor providing assistance Gill Lee on ext. 5786. and a caring approach to patients, visitors and staff. Last year EPILEPSY AWARENESS WEEK From May 16th-23rd there will be a stand in they dealt with 1,397 the West Atrium with details of local and security issues at national support organisations, plus a NNUH, including 153 chance to talk to our epilepsy specialist incidents involving nurses about this little understood condition. aggression.

NEWS FROM THE NORFOLK AND NORWICH UNIVERSITY HOSPITAL NHS TRUST - MAY 2004 5 IMPROVING WORKING LIVES

As work starts on a new on-site nursery at NNUH, The Pulse looks at childcare arrangements available for staff who work at the hospital CHILD’S PLANS HAVE now been unveiled for a new 1600 staff in 54 nurseries all over the on-site nursery which is due to open later country, and all our children have been this year. Situated next to the doctors’ through the system.” residences at NNUH, the nursery will have places for 100 children aged from three months to five years. • A RECIPROCAL arrangement with Busy Bees It will be run by Busy Bees, a private means that Trust staff can childcare company with 54 nurseries make financial savings by throughout the UK, including three at NHS AIMING HIGH swapping part of their salary Childcare co-ordinator Margaret hospitals in Plymouth, Preston and Chorley. for childcare vouchers. For Dewsbury (pictured left) says enquiries Hospital staff will be given priority and information on the scheme from staff show a need for more childcare there will be limited number of places for and to register an interest in the nursery, provision for older children. To those who need to drop children off at contact Busy Bees on Freefone 08000 430860. this end, she has negotiated 6.30am. Normal opening hours will be from discounts for NHS staff at 7.30am to 6.30pm, Monday to Friday. Camp Beaumont, a multi- Busy Bees was started 20 years ago activity centre for children up by three couples – all teachers – who to 16, with a coach to take pooled their resources to buy a large them from NNUH to the day camp in property in Lichfield and open their . Staff are also offered first nursery. discounts at the multi-sports courses run David Thackray, one of the six by Norwich City Football Club during founding directors, recalls: “Two of school holidays. the families sold their homes to live ‘above the shop’. “It was a gamble, but we felt there A NEW PARENT and toddler group for NHS staff now meets on the second was a need for a professionally run Thursday of every month at the Earlham nursery that we would want our Excellence Centre, Clarkson Road, children to go to. Now we employ between 10am and 12. The aim is to share information THE TRUST’S OWN PLAYSCHEME meets during on issues such as flexible school holidays at Blackdale Middle School. Play working, childcare options, leader Sue Guy (pictured right with admin assistant speech development and Christine McKenzie) was delighted when sleep problems, while Ofsted praised the scheme’s high quality of making new friends and care. For details, contact HR on ext. 2202. having fun. THE JIC AFTER-SCHOOL CLUB provides • For more information on transport from a number of local schools to childcare issues contact the John Innes Centre in Colney Lane. The the childcare team on excellent facilities include a sports hall and 01603 622292 swimming pool. For details contact Sarah Webb on 01603 450345.

6 NEWS FROM THE NORFOLK AND NORWICH UNIVERSITY HOSPITAL NHS TRUST - MAY 2004 VIEWPOINT WHY THE NHS IS NOT FREE FOR ALL As the Government promises to crack down on 'health tourism', our Overseas Visitors Manager Veronica Pryke explains why this is such a contentious issue

qualify for free treatment – even if they LAST YEAR we reclaimed more than £300,000 from patients, PCTs and the are pensioners who have paid UK taxes Department of Health towards the cost all their working lives. of treating visitors from overseas. But in Each case is considered on its own my experience this is only the tip of the merits and often involves careful iceberg – the true cost to this Trust is detective work, with the help of PLAY probably nearer £1m. organisations such as the immigration As Overseas Visitors Manager, my job service, the NHS Fraud Squad and is to interview these patients and find international embassies. We all have the out whether they are eligible for free same interest at heart – we are treatment. If not, we are obliged to claim accountable to the public purse. back our I am sometimes accused of being medical costs. “Questions about This is an residency can stir up extremely contentious strong emotions. issue, but However, if staff have concerns any issues they should about ‘health leave them at home ” tourism’ are nothing new – there have racist but the Trust has a clear policy been guidelines in place since 1988 to against racial discrimination and I help tackle the problem. The only always respect other customs and CONSULTANT NEUROLOGIST Jeff Cochius and his wife Ann (above), a staff difference is that the Government has cultures. nurse in A&E, have been juggling work and now updated its guidance, pledging to Feelings can run high so I always ask a family life ever since Ann embarked on a make the NHS available “to those who senior member of staff to witness my return to practice course live here, not to those who don't”. interviews, and I involve our translation “The holiday four years ago. Their four So how do we decide who is eligible? service, INTRAN, to avoid playscheme children, Tim, Sarah, All patients who are treated by this Trust misunderstandings. I also get a lot of Rebecca and Nick, all should be asked: ‘Have you lived in the support from Overseas Visitors Support is a lifesaver” attend the Trust holiday UK for the last 12 months?’ If the answer Action Groups in the Eastern region playscheme at Blackdale Middle School, is no, they could be liable for medical and in , and from colleagues at which Ann describes as ‘a lifesaver’. expenses. the UEA. “Both our families are in Australia so we There are some exceptions. For I’m aware that questions about can’t rely on them to help out in the instance, patients who are here to work residency can stir up strong emotions in holidays,” says Ann. “I have to be very or study may be covered, as are those staff as well as patients. However, if staff organised but it’s worth it because I love my whose countries have reciprocal have any issues they should leave them job and miss it when I’m not there! healthcare agreements with the UK at home – to do otherwise is to face “I’m lucky because Jeff is a (provided the need for treatment arises possible dismissal for racial big help and the shift patterns while they are visiting the UK). And discrimination. in A&E are very flexible. asylum seekers who have applied to the “The Trust has always been Home Office for refuge are entitled to The Viewpoint column is written from supportive – even the return to full residency rights, including free a personal perspective and does not practice course was organised treatment, while their application is necessarily reflect the views of the Trust. around school hours and being processed. If there is a subject you feel strongly about, colleagues never seemed to At the same time, British citizens who please send your contribution to Sue Jones, resent my flexible working live abroad for some of the year may not Editor, Communications dept, NNUH. arrangements.”

NEWS FROM THE NORFOLK AND NORWICH UNIVERSITY HOSPITAL NHS TRUST - MAY 2004 7 INSIDE STORY The MALE As the first support group for prostate cancer patients meets at NNUH, consultant urologist Krishna Sethia explains how local research is contributing to the global fight against the disease

PROSTATE CANCER is more common tumours are the most likely to kill patients than breast cancer, affecting around 35 per and we also need to find out what 'turns cent of men over the age of 70. But fewer on' the cancer cells to make them able to patients will die from it - around 9,000 a spread.” year in the UK compared to 30,000 women In a collaborative research project with with breast cancer. the UEA, urologists, pathologists and “The disease is on the increase and we are research scientists are pooling their now seeing more men in their 40s and 50s resources to look more closely at cancerous who are affected,” says consultant urologist cells and identify the triggers that cause the Krishna Sethia. “But this could be because disease to progress. men are more aware about health issues and In time it is hoped this work will lead to are less embarrassed about discussing their new tests and perhaps even drugs that will symptoms with a doctor. target these tumours more effectively. In the “We know there is a genetic link and that mean time, patients have a number of men who have a member of the family with treatment options, including radiotherapy, Urology specialist nurse Sallie Jermy, prostate cancer are more likely to get it. surgery or drug therapy to reduce the male “All treatments have side effects, However at the moment we have no way of hormone testosterone, which is known to sometimes causing incontinence and knowing which tumours are likely to grow make prostate cells grow. impotence, which can be very distressing. slowly and which may need clinical “A lot depends on whether the disease is We try to patients all the information they intervention at an early stage. early or advanced, the man’s general health require in order to make a decision they are “We need better tests to determine which and age, and his personal preference,” says comfortable with.” Banking on a future cure we are collaborating with the UEA and the PATIENTS IN NORFOLK are helping to create a tissue bank of samples to be used James Paget Hospital, drawing on the for vital research into prostate and other experience of histopathologists, urologists cancers. and research scientists in this country and So far more than 300 men have agreed to beyond. donate prostate tissue samples after a biopsy “The research is refining our knowledge of or more radical surgery. The samples are individual tumours and may eventually lead carefully dissected, labelled and stored at to new drug treatments that will target the NNUH in temperatures below minus 80 tumours more accurately.” degrees. The ‘Partners in Cancer Research Human “We are extremely grateful to the patients Tissue Bank’ already contains 2,500 samples who give their consent,” says consultant from both benign and malignant tumours, pathologist Professor Richard Ball (pictured including breast tissue and head and neck right), who set up the tissue bank at NNUH cancers and lymphomas, as well as prostate in 1999. “It really is a teamwork approach as samples. Chief biomedical scientist Iain Sheriffs prepares a sample for the tissue bank

8 NEWS FROM THE NORFOLK AND NORWICH UNIVERSITY HOSPITAL NHS TRUST - MAY 2004 PROFILE Prostate cancer: the facts

• At NNUH there are 400 new cases each year. Nationally, the figure is 21,000 and expected to rise to 30,000 by the end of the decade. • Around 15 per cent of patients disease have an aggressive form of the disease, DAVE COLE, 62, from • The first signs are usually Dunwich, (pictured left with problems with urinating but often specialist nurse Sallie Jermy) there are no symptoms and the was one of more than 50 disease can only be detected by a patients who attended the first blood test prostate cancer support group • The average age of patients is 72 at NNUH in April. He opted to but more younger men in their have his prostate removed two 40s and 50s are now coming years ago after a biopsy forward, perhaps because of revealed a malignant tumour. greater awareness. “I’d asked my GP for for a • 15 years ago, only 20 per cent of blood test, even though I had people knew where the prostate no symptoms, after reading an gland was – the figure is now article about the disease,” he thought to be close to 70 per cent. recalled. “I could have had radiotherapy instead but I have no regrets about the operation - I’m just glad the cancer was caught at an early stage.” Research at the cutting edge A NEW laser microscope which can forefront of research to study the literally ‘lift’ cancer cells from a tissue function of genes in relation to cancer. sample is attracting scientists from all "In particular we are looking at the role over the world to take part in of protein-digesting enzymes in the collaborative projects with the UEA's progression of the disease," says School of Biological Sciences. Professor Dylan Edwards (the school’s The £80,000 microscope was bought chair of cancer studies, pictured below last October with the help of charitable with CJ Shukla and Krishna Sethia, right). donations, research grants, the Royal "The new laser equipment means we can College of Surgeons and Trust funds. study individual cancer cells to learn more Using samples from the NNUH tissue about what makes some tumours more bank, the UEA scientists are at the malignant than others."

NEWS FROM THE NORFOLK AND NORWICH UNIVERSITY HOSPITAL NHS TRUST - MAY 2004 9 PROFILE A test for the TESTERS Barbara Marriage started testing for cervical cancer long before the national screening programme was introduced. Here she tells Sue Jones why she decided to put her scientific skills to the test

BARBARA MARRIAGE will be Advanced Practitioner post in the celebrating her 60th birthday in department so she can further develop her June. But she has no intention of career and release consultant time.” taking life easy. On the contrary, she is Barbara insists this latest qualification is preparing to blaze a trail as one of the just a continuation of her professional first advanced practitioners in cervical development. “Most of what I do is down to cytology in the country. common sense, mixed with a natural Her achievement is not to be curiosity and lots of experience,” she says. underestimated – only a quarter of the “You can’t rest on your laurels because things biomedical scientists who entered for this are changing all the time and you need to new qualification were successful first time keep up with new scientific developments.” around. It means she is now able to examine Indeed, Barbara has been ‘keeping up and report on abnormal cervical smears, a with scientific developments’ and taking role previously reserved for medical staff. formal examinations ever since she joined Pathologist Ray Lonsdale is delighted the health service as a junior lab technician with Barbara’s success, which he says is “a in London 1961. “At that time there was no credit to her hard work, enthusiasm and national screening programme so the ability. We now hope the Trust will fund an service was pretty patchy,” she recalls. “Most

PICTURE BY LIN WYMER smear tests were carried out in family planning clinics and there was no formal system in place for following up patients. Cervical cancer: the facts “In those early days I would ring colleagues in other departments to check on • Cervical cancer is the most common abnormalities and the women are the condition of patients whose smears form of cancer in women under 35. asked to repeat the test or referred seemed ‘abnormal’. Then I would make a If caught at an early stage, it is for further investigation. note of the results in a book so I could see nearly always curable by surgery or • Death rates from cervical cancer have how successful our screening had been. radiotherapy fallen by around 42 per cent in the “Of course, some women would slip • A cervical smear test is offered to all last ten years. The national screening through the net because they were not women over 25 every three years programme is thought to prevent up screened at all, but at least I would have the and every five years for those aged to 3,900 cases each year. satisfaction of knowing we were helping to 49 to 64. This involves removing a • More than 90 per cent of new cases save some people’s lives.” small sample of cells from the neck are due to the sexually transmitted After national screening was introduced of the womb for investigation in human papilloma virus (HPV). in 1988, Barbara was asked to take the lead the lab. However, there are many different in quality assurance for the Trust’s Cytology • Some 34,000 samples are examined strains of the virus and more team – a ground-breaking appointment at NNUH each year. Approximately research is needed to discover how designed to help patients receive the best- eight per cent of these show it develops. possible service.

10 NEWS FROM THE NORFOLK AND NORWICH UNIVERSITY HOSPITAL NHS TRUST - MAY 2004 VIEWPOINT TURNED ON BY TEAMWORK Paul Jenkins explains why he is still excited by hands-on Three years ago, the Trust took the lead once again when it was chosen by the medicine after 22 years as a consultant in acute and DOH to pilot LBC (liquid-based general medicine cytology), whereby smear test samples are preserved in pots of liquid and the slides To me this is a mystery. There’s great WHEN I did my medical training 30 prepared in a special machine. years ago, it was usual for doctors to work variety and excitement every day and the “LBC screening has been a great success long hours tending to patients with a job satisfaction is instant. because it gives a more representative diverse range of clinical problems. This If you are ‘turned on’ by medicine, sample,” Barbara explains. “It also means was ‘general medicine’. Learning from turned on by being part of a team, turned the sample can be used for further testing, senior role models, we were able to hone on by seeing patients benefit from your so we can go on to find out more about our skills in a very supportive and intervention, it’s the perfect job. cancer of the cervix. practical environment. As the son of a South Wales “Of course, when screening involves the Since then, the hours junior doctors are steelworker, I come from a community human eye it is bound to be subjective. In expected to work have, quite rightly, been where parents were desperate for their reduced to more “We can’t afford to be sensible levels, while the growth of “There is no greater complacent – we are technology has privilege than to be always aware that the meant that doctors are learning to able to help patients samples come from become specialists as at a time when they real women with busy soon as their basic medical training is need us most ” lives and families” complete. As a result, generalism has tended to take a back seat. children to gain higher education and this Trust we’re extremely lucky to have an Here in the Emergency Assessment leave the working class environment. experienced team of screeners. However, Unit, we are trying to redress that balance My mother wanted me to be a preacher, we can’t afford to be complacent - we are by creating a new specialty in acute and teacher or doctor – in that order of always aware that the samples come from general medicine. With the backing of the preference! Now I get a great deal of real women with busy lives and families to Royal College of Physicians and the Royal satisfaction from passing on skills to look after. College of Anaesthetists, we are providing enthusiastic young doctors. The joy is “Not so long ago a woman would a four-year training programme to help being able to show them the clues that routinely be advised to have immediate doctors gain the specialist skills needed to help them to arrive at a diagnosis – and surgery if her cervix showed early signs of diagnose and treat acutely ill patients to explain how they can learn from disease. Now we consider the impact this when they come through the front doors mistakes I have made in the past. would have on fertility and pregnancy, of this hospital. It is pleasing that we’ve had a steady and we involve the whole The training scheme recognises the stream of visitors from other Trusts multidisciplinary team to help her decide importance of good teamwork and the wishing to learn about our training on the best course of action.” need to treat patients holistically, rather scheme. But the key to it all is teamwork. As a mother herself, Barbara welcomes than concentrating on a specific range of At times, it may seem as though we are this ‘common sense’ approach. Married to problems or symptoms. wading through treacle, but we’re doing it a graphic designer, she has two sons who For instance, a patient may be admitted together as a team – and there is no greater have both pursued scientific careers. with heart failure but may also be privilege than being able to help patients Her enthusiasm for life extends beyond suffering from pneumonia and diabetes at a time when they need us most. work - she is a lively contributor to the too. With more than 2200 admissions to East Anglian Cellular Pathology the Emergency Assessment Unit (surgical The Viewpoint column is written from Discussion Group and she loves exploring and medical) every month, our medical a personal perspective and does not archaeology, having recently studied for a teams need access to senior opinion necessarily reflect the views of the Trust. GCSE in pre-history. around the clock. If there is a subject you feel strongly about, “There’s always something new to So why are doctors so keen to specialise please send your contribution to Sue Jones, learn” she says, “which is why, for me, life and leave general medicine behind them? Editor, Communications dept, NNUH. is never ever dull.”

NEWS FROM THE NORFOLK AND NORWICH UNIVERSITY HOSPITAL NHS TRUST - MAY 2004 11 FOCUS ONMY CROMER MOVE A sound investment You can hear a pin drop in Cromer’s new Audiology rooms. The Pulse explains how the improved facilities for hearing tests are creating a ‘quiet’ revolution in patient care

CROMER’S NEW state-of the art “It's a huge improvement – we Audiology facilities are proving very now have facilities and equipment popular with both patients and staff. that meets the latest international The three new state-of-the-art audiology standards,” says Dr John FitzGerald, rooms include a new super-silent testing the Trusts head of Audiology. “We are room which is, in fact, a room-within-a- extremely grateful for Sagle room, mounted on top of anti-vibration Bernstein's legacy for making this support structures and made from material possible.” that absorbs sound. Even the air Months of preparation went into conditioning is designed to be soundless. the refurbishment, including digging deep travelled to Norwich for appointments can It’s all a far cry from the old department underground to make room for the now be seen in Cromer. Clinics are now in the pathology lab, where up to three support structures. Staff also had to be held four days a week at Cromer compared patients would be seen simultaneously – trained to operate the new testing to only two days before the new facilities and hearing testing was sometimes equipment, which has been installed as a were in place, and the number of patients accompanied by the sound of oxygen tanks result of the national modernisation using the Audiology services at the hospital being delivered outside. project. (see box, below) is expected to rise significantly from The new £83,000 facilities mean that the 3,500 who were seen at the hospital Assistant many more patients who would once have last year. technical officer Jackie Garner checks a Making room for baby screening hearing aid for sound quality ALL NEWBORN babies in Norfolk will reason. But from early 2005, the Trust will and (above soon be routinely screened for hearing join a national programme to screen all right) Maureen problems. At the moment, tests are only newborn babies. Chapman tests carried out on those who are thought to be Research shows that babies with hearing a patient’s at risk, either because of a family history, loss who are fitted with hearing aids during hearing low birth weight or some other medical their first year are much more likely to follow normal speech and social development. The new facilities at Cromer will enable Digital revolution triggers new demand babies from North Norfolk to be seen as outpatients nearer their own homes. This “If patients are really struggling with will also take some of the pressure off our IMPROVEMENTS in Audiology services have led to a surge in enquiries from their existing hearing aid, we ask them to services in Norwich when routine screening patients, both at Cromer and NNUH. In attend the drop-in clinic for an informal is introduced next year. March a total of 200 patients attended the assessment,” says Dr John FitzGerald, the weekly drop-in repair clinics at Cromer, Trust’s head of Audiology. “Many people compared 120 in February, while at imagine that the new aids are smaller and THE PULSE NNUH the figures rose from 550 to 720. will fit inside the ear, but that is not the Head of Communications Much of this increase is due to a case at all. The new digital hearing aids Andrew Stronach (ext.3200) national programme to replace old-style look very similar but the sound processing Editor Sue Jones (ext.5944) analogue hearing aids with digital is much better. " Pictures Medical Illustration alternatives. However, patients who have “It is natural that patients want to make (ext. 3245) and Sue Jones received hearing aids within the last three the most of the new facilities at Cromer Communications Assistant years are often disappointed to learn that and we are doing our best to cope with Hayley Gerrard (ext. 5821) they not yet eligible for digital aids as the the increased demand. However, we are Please send your contributions for newer type of analogue aid should, in asking people to be patient while this new the July issue by 9 June. most cases, meet their hearing needs. service is being introduced.” • The Pulse is funded from donations and not from NHS funds.

NEWS FROM THE NORFOLK AND NORWICH UNIVERSITY HOSPITAL NHS TRUST - MAY 2004 12