September 2024

Board to Ward - September 2024

In September’s Board to Ward we share three key highlights to demonstrate key progress, decisions made and share in an open and transparent way some developments and learning:

• A family of a patient with learning disability, Sarah, talk about her and their experience of care – giving praise and rich learning for how we can do better  
• Reduced patient waits and ambulance delays in emergency care
• Major Trauma Ward announced

And more developments around our new South West Liver Unit and plans for a new Urgent and Emergency Care Centre.

1.  The experience of a patient with learning disability and her family

This is Sarah. Her parents Penny and Steve came along to talk to our Board about Sarah’s experience of care. Penny and Steve were supported by the Learning Disabilities and Autism Team and our Patient Experience lead to share their story. This story is shared with their permission, both as positive feedback and as a learning opportunity, and this is what they said. 

"Sarah is 35 years old, she was born with quadriplegic cerebral palsy. She’s non verbal and has lived with a dislocated hip all her life. Through all this she’s remained happy and always had a smile for everyone. She loves fashion and clothes shopping. She loves music and going to the theatre. Probably her greatest love was her food and eating which luckily she can still enjoy. Sarah was admitted to Derriford Hospital in May. She was very poorly and was treated on the sepsis pathway. Sarah was assessed quickly put on IV fluids and antibiotics and within hours was on Tavy ward where she stayed for a few days before being transferred to Burrator ward. The person admitted to Derriford was unrecognisable from our daughter. She was screaming in obvious pain without a clear reason. We were worried that the doctors wouldn’t know if Sarah’s behaviour was normal or perhaps due to hip pain. So we chose to stay with Sarah during her stay. And brought in the picture of the Sarah we knew. We soon realised she was having spasms and cramps because she was unable to swallow her medication. It was very distressing for ourselves, staff and carers to observe and probably our lowest point during our stay.  We honestly thought she might die. The disability team supported us all through this. They approached us on the ward when Sarah arrived and arranged free parking for us which was in available as we were travelling from Dawlish every day for 60 days. They visited us on the ward daily.  Listening to our concerns and chasing and even organised best of interests meetings and attending a safeguarding meeting. They had a good understanding of Sarah’s disability. Sarah was on Burrator ward which is a challenging ward we saw a lot of patients with learning disabilities come and go and they all received the same help and support we did from the team. They were really hard working and a credit to the hospital. We can’t thank them enough. Sometimes you just need someone to talk to and someone who will listen. We’d also like to thank the consultants, doctors and nurses on the ward. The nurses all came to love Sarah and after a difficult start all interacted with her. They are all now professionally trained in hoisting.  Special mentions for ward sister Thara who was always checking on Sarah progress., doctor Dele and doctor Reyan. The dietitians Zak and Richard were also a great help. We did find some doctors had old fashioned attitudes towards the disabled. Namely that Sarah would pull out her peg. Sarah has no voluntary movement. He even asked us has she pulled it out yet. When we said no . He replied “she will.” The comment was unwarranted. I’d also like to thank the housekeeping staff too – Sarah enjoyed having the menus."

Chairman James Brent thanks Penny and Steve for coming and sharing Sarah’s story and apologised for the delays. Medical Director Dr Anthony Hemsley also apologised and added: “A really high number of the patients on our wards are vulnerable and that’s why it’s vital that the clinical staff are advocates for their patients. There are many patients without carers who can come and stay with them and it’s important that staff advocate for the right things to happen for their patients at the right time.”

Our Learning Disabilities and Autism Team also presented their Annual Report and here are just a few of the many highlights from that:

• There are 160 Link practitioners across the Trust and meetings were well attended. As a result, we can report that at end of year 2023-2024 on the Reasonable Adjustment Heat Map 59 areas have been awarded GOLD status, 16 GREEN and 6 remain YELLOW. There are no areas that are RED.
• Tier 1 Part 1 Oliver McGowan online Training (OMT) is available for all staff on their electronic staff record and at the end of March 2024 over 700 staff had completed this training. Tier 2 OMT 1 day face to face training has been available from March  with very high interest and uptake.
• Derriford User Group (DUG) have had much success in the delivery of their annual workplan for 2023/2024. The key highlight of the year was their mystery shop on communication and accessibility - which will help to further improve our hospital services.
• An excellent neurodiversity guide and toolkit for managers/staff has been created in collaboration with Occupational Health, HR, Derriford Autism Group members and the LD/AS team members. This is available on UHP online Staff Hub.

2.  Reduced patient waits and ambulance delays

We are making real improvements for patients – reducing the unacceptable times they are waiting for emergency and planned care. Our Chief Executive Mark Hackett said: “I would like to thank all the staff and teams for leading, implementing and sustaining this improvement. Their commitment is both humbling to see and remarkable alongside our wider changes in the One Plan for improvement. I want to continue to thank our teams at all levels for the extraordinary efforts they are making to improve the organisation and its central purpose around delivery of high-quality care, excellent research, education and training. We still have further to go for our patients but this is great progress.”

A big thank you to staff, including those offering Same Day Emergency Care (the team is pictured below) who are doing a stellar job of providing emergency care quickly

What have we done?

During August, we have opened two additional Rapid Assessment and Treatment Spaces; relocated and expanded our Same Day Emergency Care service and created a 22 bedded Medical Receiving Unit – all supporting a new model of caring for patients who arrive as emergencies. To support this, we have recruited a total of 5 new consultant Emergency Physicians who will be focusing on supporting the afternoon and evening rota in the Emergency Department.  In August we have:

• Reduced hours lost to ambulance handovers from consistently over 6,000 to 2,500 hours
• Achieved our 4-hour improvement trajectory at 67.8% meaning nearly 68% of patients are seen, treated and admitted or discharged within four hours
• Reduced the time to treatment for patients in the Emergency Department by an hour
• Reduced the time to admission for patients by three hours
•   Seen a 33% reduction in the number of patients waiting over 12 hours for admission
•   Seen an improvement in quality metrics within the Emergency Department. There has been a reduction in falls and hospital acquired pressure ulcers. Patient experience has also shown an improvement for the first time in several months with improved Friends and Family Test scores; an increase in compliments and a reduction in complaints
• Implemented changes for patients presenting with a fractured neck of femur (broken hip). In the summer months an average of 40 patients per month presented with this problem. We saw a reduction in ambulance waits from 3 hours to 1 hour; a reduction in time to surgery from 42 hours to 32 hours and a reduction in length of stay from 14 days to 8.8 days.

This is all despite continued increases in emergency demand (the number of patients arriving as emergency cases) of 5.8% year to date.

What difference has this made?

More patients arriving in our urgent and emergency areas are being seen, treated and admitted or discharged within 4 hours, as shown in the graph below:

3.  Major Trauma Ward announced

Our Major Trauma Team (pictured below) are delighted the business case for the creation of a major trauma ward which is part of the annual plan for this year has been approved. We have started recruiting staff with a plan to open in late November. Once open this means we meet a major shortfall in the current major trauma standards. This is a major service and quality improvement for our patients and important in our role as one of only 27 Major Trauma Centres in the country.

And a couple of other developments:

We’ve opened our South West Liver Unit. Patients with liver disease are being treated in a brand new state-of-the-art space following the refurbishment of the South West Liver Unit at University Hospitals Plymouth. We welcomed the Chief Executive of the British Liver Trust, Pamela Healy OBE (pictured below with staff), to cut the ribbon to the new unit last month. The unit has 23 beds and looks after patients before and after liver transplants. Staff in the unit have been involved in designing the new environment to make it feel less clinical. They have chosen colour themes to create a restful and mindful environment, been involved in the equipment used, and overhead lighting with nature themes have been installed. The unit has a new quiet room to facilitate a compassionate space for difficult conversations for patients and their families.

90% of liver disease is preventable with the main causes of liver disease being obesity, an undiagnosed hepatitis infection and alcohol misuse. You can reduce your risk of liver disease with some simple lifestyle changes such as trying to maintain a healthy weight and not drinking too much alcohol. Learn more about liver disease on the NHS website

The British Liver Trust’s Love Your Liver campaign focuses on three simple steps for liver health:

• Drink within recommended limits and have three consecutive days off alcohol every week
• Cut down on sugar, carbohydrates, and fat, and take more exercise
• Know the risk factors for viral hepatitis and get tested or vaccinated if at risk. You can find out if you are at risk and check your liver health online.  Take the liver disease online screening test

We are pushing ahead with building a much-needed new Urgent and Emergency Care Centre. This week the Government announced that our scheme is part of the New Hospitals Programme review. While this is in progress, we continue to work positively with the New Hospital Programme and local stakeholders to progress our development scheme, with enabling works well underway and preparations continuing for the demolition of our decommissioned children’s theatres ahead of the construction work to begin on the new building. Read about our response to the New Hospital Programme Review 

Every month our Board leaders meet in public to assess how we’re doing for the patients and communities we serve, how we’re doing for our staff, our achievements, our challenges with a big focus on what we’re doing to address them and what our plans are for the future.  Find out who makes up our Board at University Hospitals Plymouth.

Do you want to get involved?

• Did you want to ask the Board a general question? If you do, please let us know by emailing communications.phnt@nhs.net and we will put it to the leaders and get an answer at the next Board meeting.
• Would you like to attend and watch the Board meeting? View our board meeting dates, venue details and papers.

UHP volunteer honoured in 2024 NHS Parliamentary Awards

Last week, NHS staff across the South West celebrated the remarkable achievements of staff and volunteers who have won regional categories in this year's NHS Parliamentary Awards, after being nominated by their local MPs.

UHP volunteer Lyndsey Withers was nominated by Luke Pollard MP and was awarded The Volunteer Award. Lyndsey was nominated for her voluntary work across Plymouth. Aside from her work at UHP as a volunteer and Patient Safety Partner, it also includes her work at the Plymouth University Faculty of Health as a community research partner and Medical School student mentor, with Plymouth Soup Run and Shekinah’s drop-in centre for people affected by homelessness and other disadvantages, and past efforts with the Salvation Army where, among other wellbeing initiatives, she collaborated with GP and hospital staff to encourage hostel residents to test for hepatitis C.

The Parliamentary Awards comments on Lyndsey being chosen for the award, stating: “Lyndsey Withers has been chosen in recognition of her dedication and selfless contribution to improving the health and lives of some of the most-vulnerable people in Plymouth.

“She exemplifies the true spirit of volunteerism, dedicating her time to numerous projects that span a number of sectors - including the NHS, primary care, social care, academic and research sectors - to inspire and make positive change for citizens, patients and staff.

“Lyndsey acts locally but her impact has been far-reaching as she is willing to share knowledge and expertise that empower others to replicate initiatives and contribute to research projects, leading to lasting improvements in health outcomes and ensuring that a patient voice is heard at all times."

Lyndsey discussed her winning the regional category, saying: “It’s a privilege to receive the regional award. I care passionately about health equity and hope that the award will give further visibility to local efforts to support the most disadvantaged people in our community and advance our collective ambition for them to lead healthier purposeful lives.”

Elizabeth O’Mahony, Regional Director of NHS England in the South West, said: “Every year, I’m delighted to see our dedicated staff and volunteers across the South West receive this well-deserved recognition.

“I’d like to congratulate every one of the winners and thank all the MPs who have taken the time to acknowledge the exceptional work happening in their constituencies. 

All winners will now go on to represent the South West in the national awards ceremony, alongside those from other English regions, at the prestigious Queen Elizabeth II Centre in Westminster on Monday 14 October.

Response to New Hospital Programme Review Terms of Reference

Following the announcement of the New Hospital Programme Review, as outlined by the Chancellor of the Exchequer on 29 July 2024, the Terms of Reference for the review have now been agreed with the Chief Secretary of HM Treasury. The paper details which schemes will form part of the review and includes Derriford Hospital’s new Urgent and Emergency Care Facility.

In response, University Hospitals Plymouth’s Future Hospital Director Stuart Windsor said: “While the review is in progress, we continue to work positively with the New Hospital Programme and local stakeholders to progress our development scheme, with enabling works well underway and preparations continuing for the demolition of our decomissioned children’s theatres ahead of the construction work to begin on the new building.

“We are progressing at pace, with works having already started to make changes to the ambulatory entrance to our current Emergency Department, and a range of works to prepare for the handover of the site on which the building will be constructed. Our scheme is already at Full Business Case, and we are working to agree a final submission date and approvals process. Our target remains to start the construction of the new building in the spring of 2025.

“In addition, one of our first steps will be opening the new Dartmoor building, which will not only house the new Urgent Treatment Centre but also relocate the Fracture Clinic. This is an important enabling step to ensure that we can continue to deliver Emergency Services, and fulfil our role as a Major Trauma Centre for the Southwest peninsula, whilst construction work takes place.

“The much-needed new Urgent and Emergency Care Facility will be a great asset to the people of Plymouth, and we look forward to the clarity that the government review will bring in terms of seeing this move from planning to delivery.”

Enabling work underway for new Urgent and Emergency Care Facility as Plym Theatres close

University Hospitals Plymouth NHS Trust is creating space for the new Urgent and Emergency Care Facility as Plym Theatres close.

With new theatres, wards and buildings now open, the Trust closed Plym Theatres on 30 August.

This means contractors can prepare for the strip-out, structural surveys, and eventual demolition of the building which sits at the front of the site.

Nicki Collas, Associate Future Hospital Director at UHP, said: “Building works on a busy acute hospital site demand a huge amount of investment, preparation and planning.

“We have been creating new wards and buildings during the past few years with the ultimate goal of creating space on site for the much needed new Urgent and Emergency Care Facility.

“Project teams and contractors have been working very hard to move clinical activity into a range of new theatres and clinical areas and we want to thank staff who have fully engaged in this activity throughout, as well as patients and visitors for their understanding as we move into this next phase.”

Visitors to the hospital site will see the hoardings around the site extend to a bigger area, and robust noise attenuation plans will be in place to keep the impact on the surrounding environment, patients and staff, to a minimum.

From September to November 2024 the teams involved in the strip-out of the spaces will be conducting surveys and structural investigations before taking down internal walls in preparation for the full demolition, leaving the building as an empty shell.

Subject to approval to proceed, the exterior building shell demolition will then take place in the new year.

UHP formally opens new orthopaedic theatres

University Hospitals Plymouth NHS Trust (UHP) is pleased to announce the opening of the new Bigbury Orthopaedic Surgical Suite. The new surgical suite is now fully operational and saw its first patients go through the three dedicated elective orthopaedic theatres in June.

Located on level 2 of Derriford Hospital, the theatre facility will support complex and non-complex orthopaedic operations and provide an excellent teaching environment for orthopaedic trainees.

The commencement of the new theatres has substantially increased the number of orthopaedic cases being treated. In the 6 months since April, outputs of hip and knee operations have increased by 250% compared to the same time period as last year.

Rathan Yarlagadda, Consultant Orthopaedic Surgeon and Clinical lead for Elective Orthopaedic Recovery, said: "The introduction of the Bigbury Orthopaedic Surgical Suite has greatly enhanced our capacity for orthopaedic surgery, including hip and knee replacements. This state-of-the-art surgical unit, combined with our improved patient pathways, will allow us to perform a higher volume of procedures each day, thereby reducing waiting times and significantly improving access to essential orthopaedic care for our patients."

Patient Michael Duckett who cut the ribbon at the official opening of the unit said: “I have just had my hip replaced. My operation went well, and I am slowly recovering. All the staff have been really helpful and professional. Once I am fit and well and mobile again, I am looking forward to doing simple things like take a shower and go for a walk, which I haven't been able to do.

“I was honoured to be asked to cut the ribbon for today's opening ceremony”.