Health Secretary Encouraged by Signs of Progress at Medway

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JULY/AUGUST 2016 In this edition Page 3 Pages 4&5 Pages 8&9 Emergency A snapshot of Celebrating Excellence Department update 2015/16 Awards Health Secretary encouraged by signs of progress at Medway

The Secretary of State for Health, Jeremy Hunt, paid a visit to Medway Maritime Hospital last month. The Secretary of State is keen to visit trusts in special measures that are showing signs of improvement – Medway NHS Foundation Trust being a good case in point. The Chief Inspector of Hospitals, Sir Mike Richards, published a letter in April to the Health Secretary setting out his latest assessment of Medway NHS Foundation Trust. His assessment was based on fieldwork carried out by the Care Quality Commission (CQC) at Medway Maritime Hospital on 29-30 March.

It was a really positive acknowledgment of the progress we are currently making. He was really pleased to witness the changes we are making at first-hand, and was very complimentary about our staff and the obvious hard work that has gone into the progress we have made so far. MP for Gillingham and Rainham, Rehman Chishti, Margaret Dalziel, Clare Hughes, Cliff Evans, Jeremy Hunt, Amanda Gibson and John Ferguson pictured in the Emergency Department. Lesley Dwyer Chief Executive a tour to highlight the significant changes that The Secretary of State also met with Amanda people of Medway can be very proud of the have been made recently, including the new Gibson, Senior Matron, about the Home First progress the hospital has made.” The CQC found signs of considerable minors unit. initiative – a recently introduced programme Chief Executive of Medway NHS Foundation improvement since their last inspection of the Mr Hunt was offered an overview of the next that is helping to facilitate early discharge Trust, Lesley Dwyer, said: We were absolutely hospital in August 2015. Specifically, they found phase of the exciting redevelopment programme and ongoing treatment and care at home for delighted to welcome the Secretary of State for that: for the Emergency Department, which will medically fit patients. Health, Jeremy Hunt to Medway. ■■ The hospital was safer for patients help Medway Maritime Hospital cope more Speaking at the visit, Jeremy Hunt said: “I am “It was a really positive acknowledgment ■■ Leadership had improved effectively with the 100,000 patients who visit very impressed by the progress that has been of the progress we are currently making. He ■■ Staff engagement among senior and middle the department each year. The Emergency made. Change always takes time, but I feel that was really pleased to witness the changes managers had improved although low Department was built to cope with 45,000 things are really turning a corner at Medway. We we are making at first-hand, and was very staffing levels are impacting on the morale people. now see a really good partnership with Guy’s complimentary about our staff and the obvious of frontline staff Mr Hunt visited Lister Ward to meet staff and St Thomas’s hospitals and an almost entirely hard work that has gone into the progress As part of the visit, Mr Hunt met with senior and patients and discuss the Trust’s newly new management team. Talking to doctors and we have made so far. He is now seeing a very leadership and clinicians, as well as visiting the implemented Medical Model, with the two nurses on the frontline, a clear sense of purpose different Medway to the one he saw on his Emergency Department, where he was given leads, Dr Sandip Banerjee and Dr Richard Leach. emerges – and while there is more to do, the previous visit.” Puzzle page: brainteasers, mind benders and more P11 Find your way around: hospital map P12 2 Medway NHS Foundation Trust | JULY/AUGUST 2016

Medway educates on risks of stillbirth Medway stages pregnancy

Medway Maritime Hospital recently held a special day as part of the Kicks Count clinical research day campaign to increase awareness of the risk of stillbirth pregnancy. Every year, 6,500 babies are stillborn or Medway Maritime die soon after birth. A stillbirth is defined as a baby born dead after 24 completed Hospital held its annual weeks of pregnancy. If the baby dies before 24 completed weeks, it is known as clinical research day at a miscarriage or late foetal loss. the start of June. For many women, changes in their baby’s movements throughout pregnancy There were talks at the event from pioneering are perfectly natural. Between 23 and 30 research clinicians about the key work they weeks, expectant mothers can notice the are undertaking to improve patient care and movement become more vigorous and can quality of life. The day showcased the steps distinguish a kick from a roll. being taken to treat children who are diagnosed Midwives, Julie Spencer and Paula Turner, with Attention Deficit Hyperactivity Disorder held a stand in the main entrance of the (ADHD), improvements in catheter removal and hospital and in the waiting area of the how iPhone technology can be used for patients antenatal unit to offer new families advice at home to detect chronic hearing problems, and mums-to-be information on what to reducing unnecessary hospital visits and look out for during pregnancy. increasing independence. Karen McIntyre Deputy Director of Diana Hamilton-Fairley, Medical Director at Nursing (Women and Children’s Directorate) Medway NHS Foundation Trust, said: “We’re said: “We want women to understand very proud of all the excellent research that is their baby’s movements, recognise their taking place at Medway, and have had many pattern and to trust their instincts if they are great success stories. Patients taking part in concerned. In the past, we focused on the research are vital to its success; they have paved number of kicks per day. This isn’t relevant the way not only for themselves, but also for now; we want to know if your baby future generations. changes the pattern they normally have for “A big part of the day was to demonstrate kicking.” how research can help to improve patient care Work on a new bereavement suite and safety, as well as highlighting what research started in April. The bereavement suite opportunities are currently taking place here at Leading the way: Medway at the forefront of pioneering research is being funded by local charity, Abigail’s Medway Maritime Hospital.” Footsteps and will be used by families who experience a stillbirth or lose a child shortly after birth.

For further information and advice on antenatal care, please visit your local Katie and Cookie’s owners GP. For information and resources on antenatal care, please visit www.kickscount.org.uk scoop prestigious award Help us to make a Bob and Janet Clarke, owners of Medway’s difference therapy dogs, Katie & Cookie, were recently presented with a special award for their As part of our recovery plans, we are incredible dedication to changing lives with their putting in place some ‘quick wins’. These help of their local companions. are things that make a real difference to our The Good Citizen Dog Scheme Awards, staff in helping to care for our patients. We hosted by the Kennel Club, celebrates some of have already received a fantastic response the greatest people and organisations working from staff, with lots of great ideas being with dogs. suggested. For example, after a suggestion from a member of staff, we have provided a quiet private office to enable upset relatives to speak to our concierge away from the bustle of the main reception. We have also installed nappy changing units in our toilets next to the restaurant and introduced new barriers for the outpatients department booking area that are safer and more hygienic.

If you have any suggestions on ways we can improve care for our patients, please contact Michael Addley on [email protected] Bob, Janet and their two chocolate Labradors, Katie and Cookie, are frequent visitors at Medway Maritime Hospital where the canine Bob Clarke; Gerald King, Kennel Club Board Member; Janet Clarke and Simon Luxmoore, I would like to thank pair act as therapy dogs for patients and their Kennel Club Chairman the sister and staff of families. When visiting the hospital with their Sunderland Day Care Centre dogs, Bob and his wife Janet take extra leads for my care. I was treated for patients to help walk Katie and Cookie and and Cookie, and a young boy befriended Cookie difference to the lives of many others, we are so with professionalism and award younger patients rosettes for their bravery when his treatment meant he could not interact proud of them.” kindness at all times. They during treatment. with other people. protected my dignity and Katie and Cookie have made a positive Bob commented on their wonderful To find out more about Katie and Cookie, privacy and made me feel difference to patients’ lives. A three year old achievement: “It feels so nice for the dogs to be including how to book a visit on a ward, that my care really mattered. girl who had suffered a stroke learned to walk recognised. They do incredible things everyday please contact [email protected] again with the help of her new friends, Katie with children and adults and make such a or 01634 374 416 JULY/AUGUST 2016 | Medway NHS Foundation Trust 3

Medway stages latest recruitment open day

Medway Maritime Hospital hosted the latest in its series of open days for nurses and midwives in May. Candidates were provided with a tour of the hospital, including the children’s ward and the neo-natal unit – an area of the hospital that was reported as delivering “good” with areas of “outstanding” practice in the latest CQC report. Rebecca Bradd, Acting Director of Workforce said: “We’re really pleased with how our latest recruitment day went. We met candidates of a really high calibre – some of whom have exceptional nursing and midwifery experience already. We’re confident some of these candidates will now take the next step and come and join Medway for an exciting and rewarding Medway Maritime Hospital set to become a smoke-free site career.” The Trust is recruiting more permanent staff than ever as it moves increasingly away Medway announces plans to from its reliance on agency staff. For further information on the range of career opportunities currently available at Medway NHS Foundation Trust, become smoke-free by October please visit jobs.medway.nhs.uk From 17 October 2016, Medway Maritime Hospital will become a smoke-free site. This Our role is to care for Trusts marks first means that from this date, all patients, visitors people at their most year of Sign up to vulnerable, in a safe Safety and staff will not be able to smoke in the environment. By not buildings, hospital grounds and car parks. allowing smoking on Staff at Medway Maritime Hospital held The purpose of going smoke-free is to provider it is important that we lead by our site we are helping a special event to mark the one year protect and improve the health and wellbeing example; that’s why I and the vast majority to protect our patients, anniversary of its participation in the of all patients, visitors and staff who use the of our staff believe that going smoke-free national Sign up to Safety initiative. hospital. The move is in keeping with many is absolutely the right way forward for the visitors and staff from At the event that was attended by hospitals and public spaces where smoking is hospital. the harmful effects of nearly 80 people, there were key external now no longer permitted. “Our role is to care for people at their most speakers, experts who have led the way in As part of plans to go smoke-free the Trust is vulnerable, in a safe environment. By not smoking. patient safety and risk management and working closely with Medway Council to offer allowing smoking on our site we are helping to Lesley Dwyer presentations from Medway’s clinical staff. smoking cessation support to patients, visitors protect our patients, visitors and staff from the Chief Executive Speaking at the event, Chief Executive, and staff. This will include providing free nicotine harmful effects of smoking. Lesley Dwyer, said: “It was wonderful to see replacement therapy to patients on wards, on- “I do appreciate that hospitals by their very teams across departments and disciplines site support for staff and advice for visitors from nature can be stressful places and that people coming together to share knowledge and Medway Council’s Stop Smoking Service. may experience emotions that make them feel If you are a smoker and are interested expertise on the clinical practices which are Lesley Dwyer, Chief Executive of Medway the need to smoke when on-site. However, I in stopping, you can get free specialist improving patient safety NHS Foundation Trust comments: hope that the public will support this initiative support from the Medway Stop Smoking “Safety is an absolute priority at Medway “There can be no doubt that smoking has a and help to make the hospital a better, Service. To contact them call 0800 234 6805 Maritime Hospital, so it was inspiring to see negative impact on health and as a healthcare healthier place for all” or 01634 994800 or text QUIT to 81025. the amazing work that has taken place over the last 12 months and what is planned for the future. It was fantastic to see so many come together to share their passion for improving the Medway experience for our Emergency Department redevelopment update patients.” A programme of essential construction works have taken place at Medway Maritime Hospital to help pave the way for the next exciting phase of plans Orthopaedics hold to redevelop the Emergency Department. study day

The bulk of the works involved the The Trauma and Orthopaedics department realignment of the main access road that runs recently held a special study event for staff directly outside the Emergency Department to at Medway Maritime Hospital. improve access for emergency ambulance crews. This brought together staff from Medway This has also involved the excavation of a and the community, including nurses, large section of the grass bank situated next to doctors, physiotherapists and occupational the Postgraduate Centre, the construction of a therapists. As part of the day, staff specially designed lay-by for ambulances and the participated in special talks and workshops. removal of the main canopy outside the Majors Holly Smith, Practice Development Sister Sections of the Emergency Department. in Trauma and Orthopaedics, said: “The Medway NHS Foundation Trust has submitted event was a resounding success, with some a planning application to Medway Council really good feedback from the staff who for the next phase of redevelopment. Subject attended. I think everyone benefited from to approval, the redeveloped Emergency having a day that was solely dedicated Department is planned to consist of 24 bays in to improving knowledge and care of majors, 7 bays in resuscitation, and 10 bays in orthopaedic trauma patients.” the Clinical Decisions Unit (CDU). 4 Medway NHS Foundation Trust | JULY/AUGUST 2016 A snapshot of 2015/16 – a year of challenge and change for Medway NHS Foundation Trust

Without question, 2015/16 was a year of challenge for Medway NHS Foundation Trust.

The Care Quality Commission’s inspection improvements in performance. of the hospital in August 2015, and the There is still a huge amount to do and we are report it published in January 2016, in which very clear that we are not nearly where we need we were again rated as inadequate, were to be. But we are optimistic that we are moving watershed moments for the Trust. in the right direction, and that our patients and While there were already a range of community can have confidence in us in the improvement plans in place, it was clear we years to come. needed to accelerate our drive to improve the As we enter into 2016/17, we would like to quality and safety of patient care throughout thank all of those who work in the hospital for the hospital. the service they provide to our patients and We were given a period of three months our community. In addition, we would like say from January to demonstrate sustainable a huge thank you to our local partners and improvement. Our staff responded in a stakeholders for their unyielding support during fantastic way, showing huge commitment and 2015/16. determination to turning the Trust around. We hope you find this special feature a useful In March, we were subject to a short and candid overview of the 2015/16 financial targeted inspection by the Care Quality year. Commission in March 2016. The report from Shena Winning, Chairman Shena Winning, Chairman Lesley Dwyer, Chief Executive this inspection acknowledged a number of Lesley Dwyer, Chief Executive

Improvements to the Emergency Department

The Trust put in place a number of improvements to the Emergency Department during the year:

■■ In November 2015, a new, separate manage its emergency flow effectively minor injuries area was opened, with its ■■ The opening of the new waiting room own entrance, waiting room and seven ensures any patients, who are assessed as treatment rooms needing treatment in the majors unit, will ■■ This was followed in February 2016 by now be situated in an area, where they the opening of a new dedicated waiting can be closely monitored by doctors and area for patients visiting our ‘majors’ unit, nurses, should their condition change or where patients can be better monitored worsen by doctors and nurses, should their ■■ As part of a new revised clinical condition deteriorate assessment, patients are now seen by ■■ The refurbishment will continue in a senior clinician, who will make an New Medical Model 2016/17. This will give the Emergency informed decision on what the most Department the capacity and layout to suitable treatment and discharge plan is. The most significant element of the recovery plan was the introduction of a new “Medical Model” in March 2016. Benefits include:

■■ A single, named consultant taking and a subsequent specialist. This helps to responsibility for a patient’s care, from the speed up diagnosis and treatment time a decision has been made to admit ■■ Quicker initial assessments, ideally within them until they are discharged or their care 15 minutes of a patient’s arrival in the is taken over by a specialist. Ideally, patients Emergency Department should have just those two doctors ■■ Shorter stays for patients, both in the managing their care during their time in Emergency Department, and in the the hospital; the initial admitting consultant hospital generally.

Recruitment

Like many NHS organisations, Medway NHS Foundation Trust has a shortage in a number of different staffing groups, in particular, permanent nursing staff.

The following initiatives were put in place: European Union which resulted in the ■■ A number of nursing and midwifery open recruitment of approximately 15 nurses days for potential new recruits were held, from Spain, Italy and Greece. Some of each of which attracted up to 50 people the Trust’s nursing accommodation was considering a career at the Trust refurbished to house the new nurses ■■ Various communications campaigns to ■■ Work with key stakeholders and local promote careers at the Trust among health partners to think of innovative people living in the local area ways to boost recruitment and retention ■■ Recruitment drives elsewhere in the rates in 2015/16. JULY/AUGUST 2016 | Medway NHS Foundation Trust 5 A snapshot of 2015/16 – a year of challenge and change for Medway NHS Foundation Trust Recovery Plan: The Trust is determined to improve the hospital. Our Recovery Plan has six key objectives:

Modernising Improving Accelerating Continuing Improving care Working 1 the Emergency 2 patient safety 3 the Trust’s 4 to improve 5 for patients 6 closely with Department, and care by recruitment corporate and with cancer, healthcare reducing the time it minimising the number drive to bring in the clinical governance, reducing waiting times, partners to ensure takes for patients to be of different doctors right people with which will support replacing scanners and patients receive the seen and assessed. that patients see during the right skills. This both safe and high providing additional right care in the their stay in hospital. will ensure consistent quality patient care and capacity for patients to community, when high quality care by a productive working see specialists. they are ready to reducing dependency culture for staff. leave hospital. This on interims and agency will free up beds for staff. people coming into the hospital.

Women and Children’s Health Leadership Financial

The Women and Children’s Directorate is one of the best performing areas of the hospital and was rated as “Good” in the 2016 Care Quality Commission report, with the neonatal intensive and Clinical Performance care unit found to be continuing to provide components of outstanding care. The 2015/16 financial year proved Governance extremely challenging for the Trust with a Over the year, the directorate saw a number can lead to miscarriage year-end deficit of £52.5m. The deficit has of achievements: ■■ “Baby cooling” research has been A number of improvements to leadership continued to grow because, in response ■■ A new Maternity Enhanced Care Unit undertaken – this is a technique to and clinical governance were introduced to the CQC’s findings over the last few was opened in August 2015, allowing increase the chances of survival and during 2015/16. months, we took the decision to invest in mothers who require acute medical reduce the risk of brain damage in babies initiatives to improve the quality of patient attention to stay close to their new born who have been born with a lack of blood These included: care. baby, reducing both psychological and and oxygen ■■ The replacement of the old four We are determined to stabilise our emotional trauma ■■ Work started on a new bereavement divisions and chief operating officer financial position. The next phase of ■■ Pioneering research has been developed suite, to allow parents to spend precious role with three new directorates, our recovery plan will focus in delivering to screen babies for Down’s syndrome time and grieve with their babies who are each overseen by a director of clinical greater efficiency and cost reduction, safely, through a blood test, preventing sadly stillborn or die in infancy. operations while not compromising on patient safety the need for invasive needle testing which ■■ The appointment of 12 new clinical and quality. directors, mainly promoted from within the organisation, to take responsibility for the different areas of patient care within the hospital. Each clinical director is supported by a Next steps senior nurse and general manager. We will continue the hard work on all of these initiatives in the months to come. We anticipate that the CQC will return for a full Performance inspection in November. To view the full Annual Report and Emergency Department Four Hour Accounts for 2015/16 please visit Target: www.medway.nhs.uk ■■ 84.79% of patients were diagnosed, treated and diagnosed from our Medway Trust Foundation NHS Medway NHS Foundation Trust Emergency Department within four Medway NHS Foundation Trust hours of arrival Annual Report and Accounts 2015/16

Cancer Waiting Times Target:

■■ 85.53% of patients were seen withinMedway NHS Foundation Trust

Medway Maritime Hospital Annual Report and Accounts 2015/16 Accounts and Report Annual the statutory two week waiting target Windmill Road Gillingham Kent ME7 5NY Tel: 01634 830000 Hospital Standardised Mortality RatioEmail: [email protected] (HSMR):

■■ The Trust’s updated HSMR position www.medway.nhs.uk (March 2015 – February 2016) is 102.92, continuing the reduction that has been seen over the last year and www.medway.nhs.uk reflects the persistent focus on this Medway area in recent months. NHS Foundation Trust 6 Medway NHS Foundation Trust | JULY/AUGUST 2016

Get connected at Medway Maritime Best of care, Best of people Hospital! You may have noticed our new Trust vision ‘Best of Care, Best of People’ on the front cover and we are delighted to say that we have now launched our new vision and values for the Trust.

They have been shaped by feedback from more than 600 staff and demonstrate our aspiration to provide Our vision the highest quality care for our patients, through highly skilled staff. It is really vital We are pleased to now offer free wi-fi that all staff in the organisation live these access to our patients, visitors and staff. This values every day so it is great that so means you will never have to miss an email, many have been involved in their creation. score update or breaking news story, while you are at Medway Maritime Hospital. You are free to use your own devices, but please use your device considerately and note that we do not allow any recording, Our values Lots of work has been carried out in we can be better, now we must aspire to be photos, video or audio to protect the privacy recent months as part of our recovery plan to the best. and dignity of staff and patients alike. Our new values are bold, every person make improvements to the way we care for A key part of making our vision a reality It’s really easy to get connected: counts, sharing and open and together. I’m patients, and this is beginning to bear fruit, will be through our values, making sure we 1. Connect to MFT-Public-Wi-Fi sure you have noticed that these spell out despite there still being much more to do. As think about them in everything we do. 2. Open the internet which will display the BEST! an organisation, we have demonstrated that login page 3. Enter your details 4. Press the complete registration button While you are online, why not take the opportunity to follow our Facebook and Twitter pages for the latest news on the Bold hospital? We are inspiring and ambitious Keep up with We can be BOLD by striving to be Medway online: the best, having a “can do” attitude and welcoming and learning from new opportunities. Our website medway.nhs.uk

Our Twitter feed Medway_NHS_FT

Our Facebook page Medway NHS Foundation Trust Sharing and Every Person Open Annual summer ball Counts We are open and The Medway Mess Committee is hosting its annual Summer Ball on Saturday, 30 We are respectful speak up July in the Command of the Oceans, Historic Dockyard Chatham. The Medway and supportive We can be SHARING AND OPEN Mess committee is made up of junior by speaking up when we see issues that doctors who organise socials events and We can make sure EVERY PERSON affect the safety and well-being of others, functions. COUNTS by looking for ways to create a by questioning, challenging and embracing This year’s ball is a black tie event with positive experience for others, treating others innovation, and by reflecting and sharing tickets priced at £45 for Mess members with kindness and challenging behaviour that what we learn. and £55 for all other members of staff. is not in line with our values.

To book your place, please email [email protected] with your name, seating preference and any dietary requirements. Together

My son had an accident and We are inclusive and had to visit the children’s responsible Emergency Department. He was seen very quickly and We can ensure we are TOGETHER the staff were amazing. The nurse that we saw was very by being accountable and responsible for good with him. everything we do, working in partnership to They explained what they deliver the best care and making a positive were doing and why they contribution to the success of the Trust. were doing it. They were able The launch of our vision and values marks to calm my son down and a really important new chapter for the Trust treat him. We cannot thank and we look forward to working with our you enough for the care and staff, patients and stakeholders as we aim to the treatment that you gave provide the best of care for our community. my son. JULY/AUGUST 2016 | Medway NHS Foundation Trust 7 MediLead programme empowers junior doctors to lead the way Medway Maritime Hospital has launched a new programme to support and develop our top talent.

Developed by a team at Medway Maritime Hospital, the MediLead programme was originally proposed by Consultant Anaesthetist, My ambition is for Medway Dr Sarah Hare. to provide a World-class Dr Hare explains: “My ambition is for level of care to every Medway to provide a World-class level of care to every patient. MediLead is part of patient. MediLead is part of this ambition. “If we are equipped with the this ambition. right tools, our junior doctors can help us to drive continuous improvement across the Sarah Hare organisation.” Consultant Anaesthetist “Junior doctors bring a fresh perspective to the organisation, and many of them have new ideas to offer,” said Anum Pervez, Foundation Year 2. The MediLead programme is a way Projects have included: of empowering doctors who are new to the ■■ Improving the training and quality of ECGs Trust to talk about their ideas with colleagues. performed by nurses and junior doctors so Sharing insights and new approaches helps benefiting patients in smoother diagnostics create a professional culture where robust ■■ Creation of bespoke paediatric equipment challenge and open discussion is valued, so trolleys to ensure smooth and outstanding that every idea aimed at improving care for our care for our sickest babies and children who Great minds think alike: junior doctors gather as part of the Medilead programme patients is welcomed and explored.” need transfer to London children’s intensive As part of their application to the MediLead care units programme, each junior doctor identifies a ■■ Development of an app for all staff to access Those enrolled in the programme are a range of areas including negotiation and project that they will work on with the support Medway Maritime Hospital policies and given an understanding of the organisational communication, self-awareness and the of senior doctors, senior nurses and managers procedures structure of the Hospital, the NHS and the importance of staff engagement. They are also as part of their leadership development. ■■ Developing communication aides for safe Department of Health. They learn about encouraged to submit their work to national Projects are focused on patient safety and the handover of patient care between staff different approaches, leadership and conferences and meetings to share learning delivery of efficient services. members develop personal and professional skills in with other NHS organisations.

Junior doctors help develop pocket guidebook to deliver faster, better care Medway Maritime Hospital is launching a guidebook to help junior doctors provide faster, safer treatment Baby charity launches for patients with acute illness. bereavement counselling Developed over five months by four junior doctors working at the Trust, the publication, Making Miracles has launched a professional known as The Green Book, aims to provide junior doctors with easy access to up to counselling service supporting families of high date advice in acute clinical situations. Plans Claire Henderson, Oliver Sohan, David are in place to adapt The Green Book into Jonathan Jones and Dheeraj Khiatani risk pregnancies, premature babies and baby a smartphone application by autumn 2016, loss at Medway Maritime Hospital. making it even more accessible. Jones, Dr Oliver Sohan, Dr Dheeraj Khiatani Dr David Jones, who collaborated on the and Dr Claire Henderson – are also enrolled in Between 1,200 and 1,400 women in Gynaecology at Medway Maritime Hospital project, was inspired to develop The Green the Trust’s MediLead programme, which helps Medway alone go through a high risk said, “In situations where pregnancies end Book after using a similar guidebook at junior doctors to develop wider leadership pregnancy each year, signifying just how crucial traumatically, it is vital that parents are offered another Trust. The idea was to give doctors skills as part of their role. it is to provide a counselling service within the bereavement counselling to ensure they are ready access to clinical guidance in a concise Asked if he had any words of advice Trust. fully supported. We are committed to looking format, available in any setting in the hospital, for someone considering starting a similar The charity is also working with professional at all the ways we can better support mothers with or without access to a computer project, Dr Jones said: “The most challenging counsellor, Alison Hopkins, to deliver the and families, and we are exceptionally proud to terminal. This is particularly important when aspect of starting any project in a large, service and ensure that patients receive the achieve this important milestone together with doctors are on call, caring for patients with complex organisation is figuring out how emotional and psychological support they Making Miracles”. acute symptoms. The Green Book allows the to put it in motion. A good place to begin require during this very difficult time. The Women and Children’s Directorate was doctor to provide fast, safe diagnosis and is finding out if your organisation has a Founder of Making Miracles, Kelly Wells, rated at ‘good’ with areas of ‘outstanding’ treatment, using the best clinical guidance leadership programme, and joining it. Being explains, “We are now putting extra support practice in its last inspection from the Care available, minimising the risk of their part of MediLead (the Trust’s leadership services into the Trust, which will complement Quality Commission (CQC). The Trust has also condition deteriorating any further. programme for junior doctors) was key. the great work the medical team do here. We begun works on a new Bereavement Suite, The Green Book is arranged in ten themes MediLead gave each of us the confidence have worked closely with Medway Maritime which gives parents the opportunity to stay covering over 40 acute clinical conditions and training to put the project plan together. Hospital for two years now and understand the with their child, whilst they go through the from cardiology and gastroenterology to It also gave us access to senior consultants trauma parents face when given very sad news process of grieving in a safe and compassionate oncology and cardiovascular. and managers in the Trust, whose support is about their pregnancy. Nobody is prepared environment. The Green Book is an example of how our essential in bringing projects like this to life.” for such news and it is our job as a charity to junior doctors are bringing fresh approaches support families during such a difficult and For further information on Making and ideas to high quality, safe patient care. For further information on the Green often heart-breaking time.” Miracles and the services they offer, The four authors of the publication – Dr David Book, visit [email protected] Dot Smith, Head of Midwifery and please visit www.makingmiracles.org.uk 8 Medway NHS Foundation Trust | JULY/AUGUST 2016 Celebrating our amazing staff!

The tireless work of doctors, nurses and support staff was recognised during an annual awards evening hosted by Medway NHS Foundation Trust on Friday, 20 May at Priestfield Stadium, Gillingham.

The Celebrating Excellence Awards are now nurses and support staff perform a brilliant job in their 14th year, and organised by the Trust’s day-in-day-out throughout the entire year. It Improving Working Lives team. The event was so pleasing to recognise and celebrate their welcomed more than 400 members of staff efforts on what was wonderful evening tinged from Medway Maritime Hospital to celebrate with emotion and stories of true heroism. On a their achievements and dedication. The awards personal level, I would like to say a huge thank recognise staff members who go the extra mile you to our staff who have all worked so hard in to improve the experience that patients have what has undoubtedly been a tough year. when they visit the hospital. Despite this, they continue to carry out their The annual event not only showcased the jobs with the utmost professionalism and always great work carried out by teams and individuals, with a smile on their faces. I’ve been at Medway but was also an opportunity to celebrate staff now for just over a year and I couldn’t think receiving long service commendations. of a better way to mark my first anniversary. Lesley Dwyer, Chief Executive of Medway I’ll certainly remember this occasion for some NHS Foundation Trust said: “Our doctors, time.”

Employee of the Year Award – Margaret Salmon

“Margaret has worked for the Trust within tirelessly with the children and families on her the Learning Disability Service since 1989. clinical caseload. She is a great advocate for She has been instrumental in developing and them and her main focus is to empower and evolving not only our team but the entire enable families to support their children to learning disability service. Maggie works reach their full and individual potential.”

Behind The Scenes WOW Individual Award – Endoscopy Award – Grace Rose Waiting List Schedulers This award is given to the person who has received the most WOW! award Patient Safety Award – James Hatfield and Haley “The team have shown their resilience, nominations throughout the year. Wow! Wawrzewska with Ewan Carmichael, under intense change, requiring awards are nominated by members of the commitment, tenacity, leadership and public. Non-Executive Director have achieved an enormous amount of “Grace was really brilliant, helpful she change in 6-7 weeks...the team have answered all my questions. Gave me loads been inspirational through very difficult of information. Made me feel relaxed and “James and Haley, as a combined team, safety has improved and which is calm and circumstances. It shows a true Medway most importantly made me laugh, thank turned around Sapphire Ward from a chaotic welcoming...both laugh and smile every spirit and despite all challenges to you Grace. I must say all staff were kind, ward where good standards of nursing care day, are wonderful role models and great overcome the difficulties and problems helpful and put me at ease. were not being achieved, to a ward where professionals. They care and that’s why they faced in a very short period of time, they Thank you.” patients are well cared for, where patient make a difference.” have achieved.” JULY/AUGUST 2016 | Medway NHS Foundation Trust 9 Celebrating our amazing staff!

Volunteer of the Year Award: Adam Dicketts alongside Amanda Gibson (left) and Alison Streatfield

“Adam comes to Will Adams ward every doctors, cleaners – everyone! His comic week. He always makes the patients smile drawings for staff are amazing. No one is safe and has a wonderful rapport with the nurses, from his wit and genius.”

Hospital Hero Award – Ann McKinnon

“When my son was in hospital when he are seriously ill through for their dream trip, broke his leg, nothing was ever too much sometimes even filling out paperwork etc so for Ann, and she quite often goes out of her the families have less stress...she always goes way for anyone that wants/needs anything above and beyond and I’m sure she is an unusual. Ann is always putting children who angel in disguise.”

Innovation Award – The Birth Place Team

“Since January 2015, the Birth Place found positive responses from women. By staff have pioneered using sterile water adding the training to the midwives essential for injection to alleviate chronic back in skills mandatory training programme, this pain labour.. .The method was first rolled treatment is now offered by all staff across out amongst the Core Team and quickly the Maternity Unit.”

Team of the Year Fair and Diverse Award – Matrons – Award – Ruth Goodey Acute and Continuing Care “Ruth has developed this new role with WOW Team Award – passion and great care. Her role as Carer Support Worker (for carers of people with Emergency Department “The matrons within acute and dementia) has seen her build excellent, continuing care are a supportive and lasting relationships with the families of hardworking team going above and our patients (often regular attenders in This award is given to the team who have nominated by members of the public. beyond the call of duty on a daily basis to hospital ) with dementia.” received the most WOW! award nominations “Very quick to attend to myself, very polite ensure patient safety and to support staff”. throughout the year. Wow! awards are and helpful and very professional.” 10 Medway NHS Foundation Trust | JULY/AUGUST 2016

Schwartz Rounds Meet our staff governors A Schwartz Round is a multi-disciplinary forum where staff discuss emotional and News@Medway spoke social dilemmas that arise in caring for patients. to Ann Bushnell and The Rounds are held every month in Seminar 2 between 12.30pm–1.30pm and Tim Cowell to find out have attracted a full cross section of staff more about the role of members including consultants, middle grade and junior/foundation doctors staff governors. and general practitioners; ward sisters, nurses and student nurses, pathology, What made you want to become a staff chaplain, pharmacists, admin and clerical, governor? HCAs, AHPs, ODP, housekeepers and AB: I became a staff governor because I resuscitation and managers. wanted to make a difference to the working Previous topics covered are numerous lives of non-clinical staff. and have included areas such as the TC: I would absolutely echo that. When people personal impact of a memorable patient, talk about the NHS, they most often talk about the impact of working with a patient and the doctors and nurses, but there are many their family during a difficult time, a case other staff, often behind the scenes, who work of self harm, working in the lonely hours hard to improve things for patients and for Ann Bushnell and Tim Cowell and being protective and detective. other staff.

Future dates are as follows: You mentioned non-clinical staff, is there AB: We also play a role in helping our public to ensure that any issues they have are resolved vv Thursday, 14 July also a staff governor who looks after the governors to understand how the Trust as quickly as possible. vv Thursday, 15 September interests of clinical staff? operates. As staff governors, we are in an vv Friday, 14 October AB: Yes, there is. In fact, we have recently held advantageous position as we know the What do you think makes you a good staff elections for this role. operational workings and the business of the governor? Trust. This means we can use our knowledge AB: I would like to think that I have developed Further information can be found on Can you tell me more about the role of the and experience to advise the public governors a real understanding of the issues that matter the Intranet site or by contacting Kane staff governors? on a wide range of issues. to staff and how I can support them to meet Willsea on TC: I would say that our main role is to their needs and expectations. [email protected] represent the views and interests of staff Can you give us an example of how you TC: As Head of Security & Traffic Management, throughout the organisation. We ensure that support staff? I spend a lot of my time moving around the their voices are heard when discussions are TC: Both Ann and I are incredibly passionate organisation and talking to staff. I would like to taking place about important issues. Of course, about ensuring staff are happy and motivated think that I am approachable to everyone and patient care is central to everything we are at work. We have zero tolerance for bullying provide good advice when it is needed. Where you can trying to achieve as an organisation and staff here at the organisation, but sadly this is governors also have a role to play in ensuring something that can sometimes still occur. We If you would like to contact Ann and Tim, find your copy of our patients receive high quality care at all are available for staff if they have any concerns please email [email protected] news@Medway times. or worries and can provide support and advice or [email protected]

Medway NHS Foundation Trust | MAY/JUNE 2016 Improving how we detect unwell patients at Medway

As part of the Trust Recovery Plan, last month saw the introduction of the Deteriorating Patients Programme to help us better detect and treat THE DETERIORATING Members’ Corner patients of concern whilst they are in hospital. PATIENTS PROGRAMME

Nurses and doctors here at Medway are The programme, led by Medical Director Diana Hamilton-Fairley, Director collaborating to improve ways of identifying of Nursing Karen Rule and supported by Consultant Anaesthetist Dr Priya these patients early so that we can give them By understanding our Krishnan and Assistant Director of Nursing Alison Hendron, comprises three more effective clinical care within a set time- improvement work streams. frame. deteriorating patients and The programme also seeks to understand implementing a team that some of the underlying factors that may RECOGNITION be causing this to happen. Getting a better can respond to them, we Medway Our Twitter feed rust Recognition of the acutely ill patient through focussed training, understanding of this group of patients will will be better able to care promoting electronic solutions for recognising and escalating Welcome to Members’ Corner, a ownership of their NHS foundation trust. As help us to improve how we care and treat them Medway_NHS_FTfor these patientsNHS in a Foundation T care. We have introduced safety briefs and board rounds on the Our Facebookwhilst they arepage here at Medway. wards by senior nurses to support hospital staff at night. Under the Deteriorating Patients programme, timely, consistent and Dates for your diary Medwaywe are NHS developing Foundation an Acute Response Trust Team Our website effective way. to be able to deliver timely care to patients 24 RESPONSE medway.nhs.uk hours a day, seven days a week. This will allow Dr Priya Krishnan We are expanding the number of nurses on duty to allow a more co-ordinated approach to care and Consultant Anaesthetist us to respond effectively to all patients earlier and escalate dedicated section for members of membership numbers increase, links between response by the right person with the right skills care to the most appropriate doctor. We are also developing at the right time. professional clinical standards for identifying and responding to “For the patient whose condition is getting “We are studying the root causes of why our patients whose conditions worsens. worse, this approach will allow a highly- sickest patients suffer cardiac arrests, peri- skilled team of nurses and doctors to respond arrests (the period recognised as just before to them more quickly, with access to senior a cardiac arrest), or get transferred to critical REPORTING medical support,” explains Catherine Plowright, care (intensive care or high dependency care) Medway NHS Foundation Trust. the hospital and the local community will Trust Board meetings To improve staff engagement with the work we carry out Consultant Nurse for Critical Care and one of the unexpectedly,” she said. as a programme, we are developing an Acute Deterioration programme’s clinical champions. “We will then share that learning amongst Dashboard. The dashboard will allow us to track specifi c “The result will be that the patient will then clinicians so that we can improve awareness monthly quality metrics that relate to patients of concern such get the care they need quickly and safely.” and reduce the occurrence of this in future. By as compliance with sepsis bundles, and delays in transfer to the It is Dr Krishnan’s ambition that clinicians learn understanding our deteriorating patients and intensive care unit. This will help patients and staff understand MAY/JUNE 2016 more about this group of patients from this way implementing a team that can respond to them, the current issues facing deteriorating patients, and improve Medway Maritime Hospital is part of a strengthen. The Board meetings are held in of working. we willPage be better able to7 care for these patients our care of acutely ill patients at Medway. in a timely, consistent and effective way.” In this edition Page 3 Trust set to stamp Page 2 CQC – signifi cant out smoking ‘Home First’ Frailimprovements elderly service now available seven foundation trust, which means that you can public every month and we welcome partnership launcheddays a week become a member and get involved with If you become a member, you can: people to come along and observe A service to help improve emergency care for frail elderly patients, and reduce their stay in Medwayhospital, hospital is now available seven days to a week take at model Medway Maritime Hospital. some of the hospital’s work. Membership is ■■ have the opportunity to learn how both proceedings. approachThe Acute Frailty Service wastowards originally patient care introduced last year to run Monday to Friday, This is a strong example of how Medway NHS between 8.00am and 5.00pm. Following the Foundation Trust is taking proactive steps to success of the pilot project, the service has now improve patient care by minimising the number An exciting new been extended to cover Saturday and Sunday. of different doctors that patients see during their The service ensures frail elderly patients are stay at hospital– one of the key issues raised free and you can get involved as much or as the hospital and the wider NHS work vv Thursday 28 July 2016, 1.30pm approach to help seen by a specialist team, including a geriatric in the recent Care Quality Commission (CQC) dramatically improveconsultant and specialist nurse, upon their report. arrival in the Emergency Department or medical Margaret Dalziel, Director of Clinical patient care and assessment unit. The patients seen by the Acute Operations (Acute & Continuing Care experience has beenFrailty Service are typically over 80 years of age, Directorate) at Medway NHS Foundation Trust live in nursing or residential homes. It is also said: “We’re delighted to announce the service ■■ help us improve patient care, including J launched by Medwaylikely they will have dementia, delirium and a is now available seven days a week to frail and little as you like. J Trafalgar Conference Suite, history of falls. elderly patients. NHS FoundationAs Trust. part of the service, treatment and “It’s no secret that Emergency Departments discharge planning now starts the minute are often not the best place for frail people, The Trust has unveiled its new Medicalpatients Model,are seen by staff in the Emergency especially those with dementia. If patients are which will apply to patients whoDepartment, are admitted where they receive a seen more quickly upon arrival, we can move on an emergency basis into Medwaycomprehensive Hospital geriatric assessment. It is then them swiftly to the older people’s care ward or cleanliness and safety by feeding in your – a patient with acute respiratory problems for Through our members and the governors, Level 3, Green Zone. decided what treatment they need, whether the dementia unit, which are more appropriate example. they need to be admitted, and for what period places. Most importantly; this is also helping lead As part of the new model,of patients time. will now to reductions in the amount of time our elderly undergo a comprehensive clinical assessment frail patients spend in hospital.” ideally within 15 minutes of arriving in the hospital’s Emergency Department. This will help views and ideas to ensure that only those patients, who really we are in a better position to listen and need to be admitted, are admitted, and others are referred to care elsewhere, such as the onsite GP practice, Medway on Call Care (MedOCC). ■ This new approach will respond to the views of local people, patients ■ become involved in plans for future The start time and venue are subject prove hugely benefi cial in providing better patient care, reducing pressure on our Emergency development Department. Margaret Dalziel, and our staff. As a foundation trust, we remain to change, so please check our website inspection, one of them being to reduce the Director of Clinical Operations number of different doctors that patients see during their stay in hospital. Model care: Patients are now seen by no more thanconsultants two consultants within our departments. This does not contribute to a good experience and in some The Medical Model has also seen the introduction of board and ward rounds ■ said: “The major sea change is that we are now cases it meant a patient could stay in hospital a ■ you can vote to elect the Council of If a clinical decision is taken to admit the patient throughout the hospital. Board rounds provide onto a ward, they will come under the care ensuring our patients are being given the right lot longer than they probably should have. firmly part of the NHS, but have greater before attending “This new approach will prove hugely an opportunity for doctors, nurses and allied of a single named consultant who will take care plan, and are being seen by the right people health professionals to come together and responsibility for their care until they can be seen from the outset. benefi cial in providing better patient care, determine how best to use the resources by a specialist or discharged. “Patients who need to be admitted will reducing pressure on our Emergency available that day to progress each patient’s In simple terms, this now means patients will now come under the care of a single named Department, freeing up vital bed space and journey through hospital. This also means have no more than two consultants managing consultant. ensuring patients have a structured discharge Governors and stand for election as a identifying patients at an early stage who are their care; the initial admitting consultant and a “Not only will this offer the patient a safer care plan the moment they are admitted.” The Medical Model is a vital milestone in ready for discharge. ¬ care plan; it also means they don’t have to relay freedom from central government control. We subsequent specialist. ¬ www.medway.nhs.uk/about- Patients will be given an expected date of the same information time and time again to the Trust’s Recovery Plan and fi rmly addresses discharge when they are admitted, enabling different clinical staff. several key points raised by the CQC in its recent both patients and their families to better plan, “In the past, it would not be uncommon and to get back home sooner. for patients to be seen by several doctors and governor yourself. Margaret Dalziel, Director of Clinical Operations at Medway NHS Foundation Trust believe that foundation trust status will help the-trust/publications/board- Puzzle page: brainteasers, mind benders and more P11 Find your way around: hospital map P12 the hospital thrive in the future – becoming papers: a stronger part of the community and being It’s easy to become a member. You The newsletters are free and accountable to local people. can apply online by completing the If you are interested in observing any membership form available on our of the meetings, please book a place distributed throughout the How to become a member website, under the membership tab, or with the membership office hospital. Residents and patients in areas served by by contacting the membership office. ƀƀ [email protected] They can be found in: Medway Maritime Hospital, as well as staff, ¬¬ www.medway.nhs.uk 01634 825292 can register as members of the organisation. ƀƀ [email protected] ■■ Magpie Children’s area Membership allows local communities to have 01634 825292 ■■ Macmillan Cancer Care Unit ■■ GUM clinic What is the Council of Governors? ■ ■ Postgraduate Centre The Council of Governors works closely with the Board of Directors, representing the views of local people and ■■ Education Centre organisations to ensure the hospital provides the best possible services for patients. The Trust’s Board of Directors will ■■ Diabetes Centre continue to provide overall direction and leadership and ensure that it fulfils its legal obligations. ■■ The Atrium ■■ Restaurant Governors’ roles and responsibilities ■■ Coffee shop The key role for governors, whilst representing the interests of their constituency, is to ensure the Board fulfils ■■ Outpatient areas 1 to 7 the requirements of Monitor (the Trust’s independent regulator) and acts in accordance with the Trust’s identified objectives. The Council of Governors acts in an advisory capacity and by doing so, contribute to the strategic direction ■■ Emergency Department of the Trust. The operational management and decision-making however remains with the Trust Board. ■■ Sunderland Day Case Centre JULY/AUGUST 2016 | Medway NHS Foundation Trust 11

No. 3600 Your monthly puzzle challenge

CROSS CODE CRYPTIC CROSSWORD 1 15 26 7 11 14 17 4 14 1 15 7 Quiz Challenge 1 2 3 4 5 7 15 6 20 23 10 6 11 1. In which fi eld event did athlete 6. Singer Frankie Sandford is a 6 25 11 8 17 15 8 2 25 10 21 14 8 Bob Beamon set a world member of which popular girl record that held for 23 years? group? 7 8 1 19 6 19 11 10 22 2. Which Australian city is capital 7. Which country’s fl ag design is 10 11 of the Northern Territory? thought to be the oldest still in 7 1 11 26 26 11 6 8 6 17 13 11 use? 9 10 11 12 3. Which Berkshire village was 8. Easter-ledge pudding is made 11 14 11 21 5 1 14 associated with the CND with the young leaves of which 13 12 protest marches from 1958 to plant? 24 6 9 8 10 17 5111684 1963? 13 15 14 9. What was the novelist and 4. Which colour is between blue 8 5 13 6 7 26 7 critic Mrs Cicily Isabel 15 15 16 and violet in a rainbow? Andrews better known as? 9 26 14 7 7 14 25 16 11 12 11 26 5. Which constellation of the 10. In which golf competition did 16 17 18 19 26 15 4 14 14 13 6 zodiac lies between Aries and England and Ireland beat the Aquarius? USA in 1999? 20 20 6 21 21 14 2 15 21 18 21 14 12 21 NONAGRAM WORD PYRAMID 21 22 3 17 26 21 11 7 11 SPELL out a 15-letter word 11 26 11 25 11 21 4 8 11 11 5 7 or phrase by moving from R E V 24 23 23 one chamber to another O within the pyramid. You ABCDEFGHIJKLMNOPQRSTUVWXYZ G C E may only enter each of ACROSS DOWN the chambers once L E 1234567891011 12 13 1. Deposit for purchase of 1. Complete evening service (6,3) P E and may only feathers? (4,7) I A N proceed through D H E 2. Fishy girl at the cinema (5) 14 15 16 17 18 19 20 21 22 23 24 25 26 C openings in the 7. Algernon sensed some of it HOW many words of four walls. The first S O T I was drivel (8) 3. One entitled to look closely (4) letters or more can you letter may EACH number in our Cross Code grid represents a different letter make from this 8. Restraint at edge of 4. Agreeable toadies (3-3) of the alphabet. You have three letters in the control grid to start appear in any Nonagram? Each word chamber. C H O L T pavement, say (4) you off. Enter them in the appropriate squares in the main grid, must use the central letter, 5. Again a cur is removed from then use your knowledge of words to work out which letters and each letter may be 9. Test was in the morning (4) the country (9) should go in the missing squares. used only once. At least FIVE ALIVE 11. Made comments about old As you get the letters, fill in other squares with the same number 6. Reef knot to release (4) one word using all nine HERE are two German money in the plant (8) in the main grid and control grid. Check off the alphabetical list of letters can be found. SG WL IA BT SZ miniature five- letters as you identify them. 10. Worthless crew spotted! (6,3) Guidelines: square 13. Sucker for a drink (5) 24 Good; 28 Very Good; crosswords 12. Do not tear round for an RA ML IT 14. One man who acts on behalf MAGIC SQUARE 33 Excellent. using the same of another (5) explosive device (9) Any word found in the Concise grid – but the Oxford Dictionary (Tenth Edition) is letters have 16. Furnished with clothes fi tted 15. My language in this side of NOTATION VARIES SO eligible with the following AT EG AP EI EN exceptions: proper nouns; plural been mixed up. to requirements (8) Liverpool (6) USING all 16 letters of the phrase above, form nouns, pronouns and possessives; You have to four words each of four letters which will fit in the third person singular verbs; AC HG GW 18. Related to a knight at home (4) 17. Bath water (4) hyphenated words; contractions work out which grid to form a magic square in which the words letters belong and abbreviations; vulgar slang 21. Deceive the jester (4) 19. Kelvin, going over the small can be read both horizontally and vertically. words; variant spellings of the to which same word (where another variant EN NE AE MR SY crossword. 22. David the bookmaker! (8) stream, found some shrimp- is also eligible). like creatures (5) 23. He acquaints people with his SUDOKU EQUALISER relations (11) 20. Sticky go-between? (4) Easy Hard EACH row and each column must contain the numbers 1 to 9, and so must each 3 x 3 box. 3 6 QUICK CROSSWORD 5 618 2 3 1 1 1 2 3 4 5 6 7 815 4 8 951 4 1 1 5 1 3 8 9 426 9 9365 0 3 PLACE the four signs (add, 10 11 12 13 13 14 15 16 7 9 6 3 1 subtract, multiply, divide) one in each circle so that 17 17 12 437 842 the total of each across and down line is the same. 18 19 Perform the first calculation in each 47 25 281 3 line first and ignore the mathematical law which says you should always 20 21 20 21 perform division and multiplication before addition and subtraction. 4 8 8 5 22 23 24 25 26 27 All puzzles on this page are supplied by Sirius Media Services. 29 3 49 8 To try more of our puzzles 28 29 interactively 3 2 3 1 online go to www.puzzledrome.com PZ1P3600 © Sirius Media Services Ltd PREVIOUS SOLUTIONS 30 31 FIVE ALIVE: QUIZ CHALLENGE: 1 Ravel’s Bolero; 2 A dog; 3 Chris Boardman; 4 The Salvation Army; 5 Pygmalion; 6 European Free Trade Association; 7 ACROSS 22. Chatter (7) 7. Bronze coin (5) The gums; 8 The Rolling Stones; 9 Ulysses S. Grant; 10 Heroes. (1) Across – Goods; Yodel; Lardy. 11. Bury (5) CROSS CODE CRYPTIC CROSSWORD: Down – Ghyll; Order; Silly. 1. Shrub of the rhus 25. Social class (5) genus (5) 1 2 3 4 5 6 7 8 9 10 11 12 13 Across – 1 On the alert; 7 Raged; 8 Granada; 10 Tenement; 11 Mini; (2) Across – Payee; Truss; Highs. 28. Pastoral poem (5) 12. Thin expanse (5) D R L T W J E H F G C U X 13 Newark; 15 Length; 17 Apse; 18 Amphorae; 21 Dirtier; 22 Radii; 23 Down – Patch; Young; Eases. 4. Mollusc (7) 29. Messenger (7) 14. Apportion (4) 14 15 16 17 18 19 20 21 22 23 24 25 26 Blue cheese. 8. Allay (7) 15. Main artery (5) M S V A Y K O B P I Q Z N NONAGRAM: 30. Core (7) Down – 1 Organ; 2 Tidemark; 3 Engine; 4 Lead; 5 Reading; 6 Writing abate; abbé; abelia; abet; ablate; able; 9. Memorise (5) 16. Swallow-like bird (5) EASY SUDOKU HARD SUDOKU MAGIC SQUARE: 31. Toss (5) and; 9 Arithmetic; 12 Recharge; 14 Wastrel; 16 Smirch; 19 Ridge; 20 alba; albeit; albite; baba; babe; babel; 10. Initial (5) 17. Graven image (4) 315247968 923468175 drip; rare; iris; pest. Hive. baht; bail; bait; bale; balti; bate; bath; DOWN 13. Diplomatic 21. Free from harm (6) 947816235 578192643 QUICK CROSSWORD: bathe; beat; belt; beta; bile; bite; blab; 1. Muffler (5) 826395471 614357928 WORD PYRAMID: Across – 1 Sweater; 8 Outrage; 9 Madeira; 10 Mankind; 11 Treadle; 14 blah; blat; bleat; bleb; blithe; habit; building (7) 22. Self-possession (5) 2. Stingy person (5) 6 3 8 5 2 9 1 4 7 4 6 1 8 2 3 5 9 7 District council. Odd; 16 Beef; 18 Clef; 19 Ajar; 20 Sloe; 21 Tot; 23 Renegue; 26 HABITABLE; hatable; labiate; tabi; 17. Anger (3) 23. Chasm (5) tabla; table. 792134856 752941386 EQUALISER: Tingled; 28 Ebbtide; 29 Corsair; 30 Stellar. 18. Be present (6) 3. Intone (5) 24. Hooked claw (5) 154678329 389576412 Clockwise from top 19. Cloudy, stirred 4. Meat pin (6) 25. Compact mass (5) 2 7 3 9 5 1 6 8 4 1 4 7 6 8 5 2 3 9 Down – 1 Symptoms; 2 Endue; 3 Triad; 4 Roamed; 5 Stun; 6 Mariner; left – divide; add; up (6) 5. Impromptu (2,3) 26. Holy person (5) 561483792 896234751 subtract; multiply. 7 Need; 12 Able; 13 Loft; 15 Date; 16 Bare; 17 Forebear; 18 Country; 489762513 235719864 Total: 9. 22 Orders; 24 Noble; 25 Grill; 26 Tick; 27 Loan. 20. Mineral (3) 6. Springs (5) 27. Soil (5)

To visit our website scan listening to you this QR code with the Contact the Editor: Michael Addley, news@Medway, Communications Office, Medway NHS Foundation Trust, Gillingham, Kent, ME7 5NY reader on your smartphone. To download a free QR code Email: [email protected] Designed by [email protected] reader, visit the app store. 12 Medway NHS Foundation Trust | JULY/AUGUST 2016 Locations Department Finding your way around Key: Colour shown denotes Zone Colour, number relates to Level all levels and exit Ramp access to to rear car park. De li very Sui te Day Su r g C .T. De p Car diolog y ( Ou t p Car di ac C h C h Ce d Car P Car dio res pi rat o Café Byr on W ard Br on te W B lood T ests Breast Ca n C o C o C h A udiolog y ( Ou t p at i Aret hu sa W A ppoin tme n A d Ac u A n Am bul at o Acc id e n Acc id e n Sunderland Day Care a pl in cy a p r on ary ffee Loung e r i m i te n Centre Entrance ar cer te st in a & Shop e l / P rayer ss ion ark Enqui r i ata l Me di ca l R oo m (Level 1). Care Care T t t Cat h artme n ery P ar d / H igh De p & E & E ry R o Care De p Out Patients & ard & Spi r i ts Care U ni t sett i ( Phl e bo t o my) Area 7 eter Sui te mer g mer g ( D i L artme n eam r o Desk U ni t / Li ster W ard ea gu e U ni t t sc h ry R oo m ce du re Sui te es at i Department Day U ni t e n e n ( E Antenatal t u e n (R i ar g (Ma in En tra n Dolphin e n C G (Ma in En tra n cy cy a l Ward o t ts c h H o ts e Loung f PP Care F ) (C hild re n e nd n Area ar d W atts A&E Area s pi tal De p r i e H nd s Green Zone t. 6) 7) cy , Atrium Ma in En tra n ce) U ni t s) ce) U ni t) A&E (HDU) Ocelot Ward ce ) Department Emergency Out Patients (Blood tests) (A&E) Eliot W Ward Area 6 Eliot Purple 3 Purple 1 Brown 1 Brown 1 Brown 2 Brown 2 Green 4 Green 3 Green 2 Green 2 Green 2 Green 2 Blue 2 Blue 2 Blue 2 Blue 2 Blue 2 Red 2 Red 2 Red 4 Red 3 Red 2 Red 2 Red 3 Emergency Childrens (A&E) ard Eliot Ward Entrance D i Dermat olog y E D olphin W ard E Elio t W ar d G E E Endo sc op y G F F K ing f i Ke n Keats W Hear ing Harvey W G In te n I G Gundulph W ard Ma in Ma gpi es L Macm ill a n Li ster W ma ging ract u eta l a w ar l ye NT mer g e n a l e ni t o y n cke n t on y P t W era l O ff i aec olog y re n U ni t s i Rece p Me di c in e s h re e n -Ur in ary ve s W re gn a n ard Day Red Zone ce W ard ard er W A id s Rec o cy G C lini c ( Oph t h a l Ce n ar d Care Red Zone

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Version: 1, Issued: 13.08.15