Barts and The London NHS Trust has once again achieved the highest possible rating for its quality of services in a major national survey.
In its ‘annual health check ratings’ published on Thursday 18 October, independent health watchdog, the Healthcare Commission, rated the services at the Trust’s three hospitals – Barts in the City, The Royal London in Whitechapel and The London Chest in Bethnal Green – as “excellent” for the second successive year. Barts and The London is the only major teaching hospital in the capital to achieve the “excellent” rating two years running and the only hospital trust in East London to be awarded the top rating. The Trust also maintained its ‘good’ rating for the efficiency with which it uses NHS resources.
The Healthcare Commission believe this year’s health check ratings are the most comprehensive assessment of the NHS ever to take place. It examined every hospital in the country during the past financial year to see how they were performing against a range of measures, including how long patients wait for treatment, patient safety, cleanliness and how well the organisation is run. Barts and The London scored highly overall. The ratings build on an already strong track record, including one of Britain’s best survival rate records and seven unbroken years of achieving break even or better.
“Maintaining our ‘excellent’ quality rating is a huge achievement,” said Julian Nettel, Chief Executive of Barts and The London NHS Trust. “Sustaining high performance in this way is never easy, particularly when the bar is set higher every year. We can take pride in our accomplishment, but it is certainly not a time to sit back. The standards we need to achieve this year are even more exacting, and we will need to maintain a sense of urgency in our service improvement if we are to maintain our top quality rating.”
The Royal London Hospital’s one-stop nurse-led clinic, which has halved waiting times for chronic kidney disease patients, has won a national award for its innovative service. The clinic, which has been treating patients for over a year, has won the British Journal of Renal Medicine Innovations Award, and a prize of £5,000.
Althea Mahon, Consultant Nurse at the clinic said the new system has made a huge difference to chronic kidney disease patients. “The clinic has improved the way chronic kidney disease patients can access and receive their care. Most of our chronic kidney disease patients are now receiving their care in the community, including annual check-ups. This means our patients are receiving the treatment and advice they need, and only come to hospital when it’s necessary,” she said.
Previously, patients had an initial hospital appointment for assessment and tests, and then returned to hospital to receive the results. The new system invites patients to be seen by the Consultant Nurse who assesses individual needs and provides advice about chronic kidney disease and how to maintain a healthy lifestyle. Most patients have then gone on to receiving their care and annual check-ups in the community.
The clinic’s Consultant Nurse and Consultant Nephrologist design a personalised care and management plan which is sent to patients’ GP. Patients are also sent a letter detailing how often they should have their kidney function checked, with details of any other arrangements and confirmation of any follow-up appointments.
Of the 208 patients the clinic has treated since its beginning, all rated the service as either ‘good’ or ‘excellent’ when surveyed.
A lorry driver who nearly lost his leg in a freak accident has an intensive course of leeches to partly thank for his successful recovery.
In total David Isitt, from the Isle of Dogs, needed more than 30 leeches over a week to suck blood out of a large skin flap on his leg where the skin was struggling to survive. Had the treatment failed the father of two might even have been facing amputation. Instead he is back standing on both legs and starting to rebuild his life.
Mr Isitt was injured in March in North Greenwich when he slipped off the side of his tipper truck while checking that his cargo of concrete was secure. He fell nearly 2.5m onto the road and shattered several major bones in his right leg.
Within minutes a trauma doctor and paramedic from London’s Air Ambulance were on the scene to stabilise the 49-year-old and prepare the patient to be moved. He was taken straight to The Royal London Hospital, in Whitechapel. There he underwent the first of several major orthopaedic operations by expert surgeons to save his leg.
A final operation involved a specialist Plastic Surgeon moving a large skin flap to the front of Mr Isitt’s leg to cover the newly repaired bone. In complicated procedures such as this it is sometimes difficult to maintain a normal blood flow in the skin flap. This was the case with Mr Isitt and the tip of the skin flap started to go blue. It was at this point that the Clinical Nurse Specialist, Daren Edwards, decided to use leeches to save the skin flap.
The leeches can draw the blood away from the skin which allows it to survive long enough for the veins to start working normally again. They produce a small bleeding wound that maintains venous circulation in areas where it is impaired.
Within days colour returned to the skin flap but in total the leeches were needed for more than a week to restore effective circulation of the blood. Daren Edwards said: “The use of leeches is no longer viewed as outdated by the medical profession. Mr Isitt’s case is a great example of the invaluable assistance they can provide to patients. Without the assistance of the leeches his flap may have failed, and a more complicated reconstruction been required. At worst, the fracture may have become infected, and he may have lost that leg.”
A report shows that Barts and The London NHS Trust has one of the lowest mortality rates of 152 trusts in England. The Dr Foster report has found that Barts and the London NHS Trust – which is made up of The Royal London, Barts and The London Chest hospitals – is in the top fourteen percent of trusts across England and has a mortality rate – or death rate - that is eleven percent lower than average. Charles Gutteridge, Medical Director at Barts and The London NHS Trust, said: “We’re not complacent, but this report shows that we have an excellent track record in terms of mortality, having sustained low rates since 2001.
“Given the existing low mortality rates at the Trust, it is a challenge to sustain significant improvement year on year, but we are constantly looking at areas for further improvement. To achieve this, we are among the first trusts in the UK to participate in the Safer Patients Initiative, which will involve us working with the Health Foundation and the US - based Institute of Healthcare Improvement to explore the best ways of making our hospitals even safer for patients. The aim is to reduce mortality rates by 15%. Through the initiative Barts and the London aims to improve its safety culture to truly world class levels”.
Barts and The London NHS Trust is launching a new clinic that will give patients fast access to expert medical care if they are suffering from heart palpitations and blackouts.
The Rapid Access Palpitation Clinic will examine patients within 24 hours of referral from their GP or A&E department and enable quick diagnosis and treatment. This will be a dramatic improvement for patients who have traditionally had to wait of two to three months to see a specialist in clinic.
The new clinic has been made possible thanks to a £23,000 donation from the Barts and The London Charity which supports the hospital trust to achieve excellence and innovation in healthcare.
The new clinic, which will be based in the Cardiology Department at Barts Hospital, will be able to review 30 patients every week and offer access to ECG’s, Echocardiograms and heart monitor recorders. Once the patients are examined the specialist nurses and cardiologists can identify those who are suffering cardiac disease and also those not suffering from any cardiac problems. Following diagnosis a plan of treatment and follow-up care can be designed to assist patients. Research has also shown that the clinic will have the added benefit of reducing the need for hospital admission amongst such patients by more than 50 per cent.
Dr Richard Schilling, Consultant Cardiologist at the Trust, said: “This is an important step to ensuring that patients get rapid and early accurate diagnosis for both benign and potentially life threatening heart rhythm problems. The heart team at Barts and The London NHS Trust is committed reducing and eliminating any unnecessary suffering or death resulting from heart rhythm problems and rapid diagnosis is key to this.”
Two cardiac nursing teams from Barts and The London NHS Trust have won awards at the first ever Cardiac Nursing Awards ceremony, held at the Café Royal in central London.
The Trust’s Cardiac Rehabilitation Team were overall winners of the award for ‘Excellence or innovation in Cardiac Rehabilitation’ in recognition of their successful work with Bengali patients in Tower Hamlets.
The nursing team recognised that Bengali patients had a high mortality rate from coronary heart disease and in response worked with local agencies to develop a programme to deliver cardiac rehabilitation specifically for this group. The rehabilitation is for patients who have suffered a heart attack or other heart condition and is designed to help patients regain strength, prevent their condition worsening and reduce the risk of future heart problems. The team tailored the service so it met the important cultural needs of the Bengali patients. This included the introduction of ‘men only’ programmes and ‘women only’ programmes and ensuring the clinics did not conflict with prayer times.
The Heart Failure Team was also singled out for praise with a joint second place award in the category ‘Excellence or innovation in Heart Failure Care’. The Heart Failure clinic reduces the need for admission to hospital by helping patients suffering from heart failure to self-manage their conditions through attending sessions with specialist nurses and pharmacists. Most participants at the clinic see improvements to their symptoms and a have a better quality of life.
The award was in recognition of the integrated Heart Failure Service which works closely with the Tower Hamlets Community Heart Failure Nursing Team. Staff from the Hospital Trust and the Primary Care Trust have built up strong links to enable them to work together as one team. This has created more effective working practices that ensure continuity of care throughout primary, secondary and tertiary areas. The result has meant that patients have access to quality care at diagnosis and throughout their treatment.
A Government advisory group has singled out Barts and The London’s Sexual Heath Services for praise in a report aimed at improving services nationally. In their annual report, The Independent Advisory Group on Sexual Health and HIV commended the way the Trust had responded to overwhelming patient numbers by creating a service that was consultant-led but predominantly delivered by nurses.
A nurse consultant role was created to oversee the creation of a new nursing team in which senior nursing staff including Nurse Practitioners were able to deliver clinical care to patients. Under the new structure, Nurse Practitioners and registered nursing staff were trained to treat sexually transmitted infections and provide contraceptive services, leaving them able to manage a patient visit to the clinic without the need for a doctor.
Celia Skinner, Associate Clinical Director of Sexual Health Services at the Trust said: “Fifty percent of our patients at Barts are now managed by nurses, and we hope to get that up to seventy or eighty percent in a year. We are also starting to roll this out at The Royal London to the more challenging population in Whitechapel.”
Barts and The London NHS Trust has the final go-ahead to redevelop Barts Hospital in West Smithfield and The Royal London Hospital in Whitechapel.
The Department of Health and HM Treasury approved the Trust’s plans to rebuild both hospitals, which paves the way for the Trust and its private sector partner Skanska Innisfree to move towards financial close on the project, which will enable building work to begin.
The redevelopment programme – Britain’s biggest hospital redevelopment – will transform Barts and The Royal London. Barts will become a Cancer and Cardiac Centre of Excellence with the bulk of care provided in a new eight-storey, state-of-the-art facility. Most of the services currently provided at The London Chest Hospital in Bethnal Green will also move to Barts. Clinical services at The Royal London, including London’s leading trauma centre, the capital’s second biggest children’s hospital and one of Europe’s largest renal units, will be brought together in a new landmark 18-storey building.
“The future of our world renowned hospitals is now assured,” said Paul White, Chief Executive of Barts and The London NHS Trust. “After decades of underinvestment, the people of East London and our 8,000 staff can now look forward to the world class new hospitals they deserve."
Sylvia Denton, President of the Royal College of Nursing and a Senior Clinical Nurse Specialist at Barts and The London Breast Care Centre, was awarded a CBE and Intensive Care Nurse Julia Peterkin was awarded an MBE.
Sylvia Denton has worked in nursing for 46 years, beginning her nursing career with a qualification in general nursing from the Royal London Hospital. Sylvia practised in the area of thoracic medicine and as a specialist health visitor for homeless families before moving into cancer in 1980 becoming one of the UK’s first clinical nurses specialists in breast cancer care. She was awarded an OBE in 1996 for services to nursing and has been President of the RCN since October 2002.
Responding to news of her CBE, Sylvia said: "I am delighted and deeply touched to have received this honour. I think this award helps to raise the profile and acknowledges the value of nursing and that is the important thing."
Julia Peterkin was the nurse in charge of the Intensive Care Unit on 7 July, when The Royal London Hospital cared for those injured in the London bomb blasts. Seven critically ill and multiply injured patients were cared for on the unit, including a number who required ongoing surgery and specialist care for several weeks following the incident.
According to a survey by Nursing Times magazine, Barts and The London NHS Trust is one of the best places in the UK for nurses to work. Only one other acute hospital trust in north east London made the list of 100 top nursing employers.
The judges said: "Our survey showed that nurses' views and ideas really count at Barts and The London. 'We're involved at all stages of planning,' states one respondent. Staff say there is a genuine commitment to education, professional development and family-friendly working practices. And nurses feel they are treated 'as equal members of the mutli-disciplinary team.' "
In January 2005, Barts and The London became one of the first trusts in the country to be awarded Practice Plus accreditation in the national Improving Working Lives (IWL) initiative. The independent IWL validation team said:
"The message from staff is that they feel valued and supported by their managers and enjoy working in the Trust... it was very obvious that there is top-level executive commitment... the workforce is very much a priority for the Trust."
And here are just some of the reasons for their conclusions:
- One of the most progressive childcare services in the country.
- A web-based career innovation zone on the Trust intranet.
- A mediation service to help resolve conflict and improve work relationships.
- Robust equality and diversity policies.
The latest National Staff Attitude survey shows high satisfaction levels for staff at Barts and The London. The Trust scored well in many key areas, particularly in comparison with other trusts, ranking in the top 20% of all acute trusts in England, and above average on most indicators. Among London teaching hospitals, the Trust scores above or equal with peer trusts in 27 of 29 categories.
On a special visit to The Royal London Hospital, to thank staff for their role in treating people injured in the July 7th London bomb attacks, the Queen said:
"I want to thank you and all members of the emergency services and Transport for London who are working with such care, professionalism and sensitivity often in very difficult conditions. You have the respect of us all as you go about your business." Staff at the Trust feel a justifiable pride in the Queen's recognition of their exemplary response throughout the crisis.