From Board to Ward – May 2024
We’ve had another busy month here at UHP, with ministerial visits, new facilities opening, complete with some ‘hellos’ to new colleagues and ‘goodbyes’ to long-standing ones!
We welcomed the Minister of State in the Department for Health and Social Care, Helen Whately, as part of her visit of various healthcare settings in the city, alongside local city MP and Minister for Veterans Affairs, Johnny Mercer. They learned more about our recent incremental improvements in Urgent and Emergency Care and about the challenges we face and what is needed to overcome them, including the construction of a new onsite Urgent Treatment Centre and Fracture Clinic, and the new Urgent and Emergency Care Centre replacing our current Emergency Department (ED). Staff in our ED, Same Day Emergency Care, MAU, colleagues from End-of-Life Care and the team from the Chestnut Unit (which was purposely built at the end of 2023), took time to talk to the Ministers and update them on their work to see and treat patients in the right place more quickly.
On the theme of new spaces, we were delighted to see the opening of the South West Peninsula Children’s Surgical Unit. This new facility is the only dedicated children’s surgical unit in the South West, outside of Bristol Children’s Hospital, and only one of two in the country. This service which provides protected theatre space for children will ensure the delivery of high-quality surgery for children in a safe environment, looked after by dedicated staff who are trained in preparing children for surgery and looking after them afterwards.
Chairman James Brent also welcomed Anthony Hemsley our new joint Interim Chief Medical Officer. We announced Anthony’s arrival last week on secondment from the Royal Devon University Hospitals where he is currently the Medical Director, Royal Devon University Healthcare NHS Foundation Trust – Eastern Services. More recently Anthony has also been working as the Medical Director for Urgent and Emergency Care at the Devon ICB. Anthony will join current our existing Interim Chief Medical Officer, Paul McArdle.
There was also time to say a goodbye and thank you to Dr Joe Rahamim. Joe is a Consultant Cardiothoracic Surgeon who began operating in Plymouth in 1979, and officially joined Derriford Hospital in 1992. The Board listened to Joe talk about his life and career in Plymouth, and how proud he is of having contributed to the teams he has worked with across the region. Thank you, Joe, and we wish you all the best in your retirement.
Highlights from May’s Board
In May’s Board to Ward we share three key highlights to demonstrate key progress on projects, decisions made and share in an open and transparent way some key developments.
Our three for May:
PLACE Assessments
Our Future Hospitals Director Stuart Windsor, reported on the recent findings of the Patient-Led Assessments of the Care Environment, otherwise known as PLACE.
PLACE is the national system for assessing the quality of the patient environment and is carried out by patient representatives. They look at eight domains:
- Cleanliness
- Food
- Organisation food
- Ward food
- Privacy, dignity and wellbeing
- Condition, appearance and maintenance
- Dementia
- Disability
This assessment is fundamental in understanding the experience patients have of our environment – the assessors tell us how the hospitals look and feel from the eyes of the patient, experiencing mealtimes from the bedside for example.
The most recent round of assessment took place on 4 December 2023 and 15 December 2023, with the results published at the end of February. 190 trusts were part of the national assessment and we are pleased to report UHP scored above the national average in 7 of the 8 assessed domains – a significant improvement on the previous assessment which was carried out in 2022.
Read about the PLACE assessments results
Headlines from PLACE 2023
- The graph below shows the published scores from the recent inspections between September and December 2023 and includes the national average for each domain (dotted line).
- Derriford Hospital scored above the national average in 7 of the 8 domains with only ‘Privacy, Dignity and Wellbeing’ scoring 0.8% below the national average.
- Scores at our Community Hospitals were, in general, higher than those at Derriford. Only Tavistock scored below the national average in ‘Privacy, Dignity and Wellbeing’ by 3.28%
(How our facilities scored in 2023 PLACE Assessments: includes Derriford Hospital, South Hams Hospital, Tavistock and Mount Gould)
Whilst we are pleased to be above national average, Stuart reiterated the intention to keep going in the improvement we have seen to date. This includes a renewed focus on meal service, not just on the food but also the patient experience of the service as a whole. During stays in hospital, mealtimes can often be the highlight of the day.
Stuart closed the update on PLACE by emphasising a big thank you to all the patient representatives who took part in the assessments, as well as the UHP staff involved in facilitating the visits – “their wisdom and time are so valued.”
Learning from end of life experiences. This month’s patient story
“Families want to be with them when they die, I promised him I would not let him die in pain.”
At each Trust Board meeting we hear a story from patients and their families who have experienced care with us. Their stories help to inform learning and development from what we do well, and the things that we also did not get right.
This month the board were joined by Nicki Kerwin, the daughter of David Richie, in what was an emotional recollection of her experience of her dad’s death. Shaen Milward, the trust’s End of Life Lead, opened by introducing from the End of Life team and warmly thanked Nicki for attending board. Shaen described how Nicki had kindly attended today to paint a picture of the poor experience she, her dad, and their family experienced as David was not recognised as an end-of-life patient in a timely manner. “End of life care is a privilege to provide,” said Nicki, and “…and I always promised my dad I would be there at the end of his life.”
Nicki is a healthcare professional and currently works in Launceston where she has been for 16 years. She was previously a nurse here at Derriford Hospital, describing Brent Ward as being the place she earned her love for palliative and end of life care. Nicki detailed David’s treatment following a diagnosis of lung cancer in 2017. She talked about how her dad had told her he did not want to die in pain, and how he didn’t want to leave Nicki to look after her mum who has Multiple Sclerosis. David was her main carer. He also had a traumatic memory of death from his own dad, and wanted to die at home.
After receiving treatment for his initial diagnosis, in December 2022 David was diagnosed with a secondary cancer. He had tolerated previous therapy and was then started on another course of treatment. By now, David had become lot frailer, with increasing worry about his memory and mobility. David was “becoming a very different person, losing interest in the things he loved.”
(from left to right: Doug Hooper, Shaen Millward, Nicki Kerwin, Ali Griffiths and Nicola Wood)
After readmissions into Derriford it was becoming clear to Nicki that her dad was deteriorating and entering into his final phase of life. At this point there was a lack of joined up working for those involved in his care, a lack of communication to Nicki and her family about the next steps for David. She wished he would have been identified as end of life, with a plan put in place to make him more comfortable, and ultimately to enable a dignified death. She felt her voice, and David’s voice, was lost.
After a further deterioration late at night, Nicki was called to come and see her dad in hospital, collecting her mum on the way. Subsequently, Nicki and her mum were unable to be with David in the very final moments of his life. Had there been a better identification of needs, care plans, communication, and holistic support for David earlier, they could have provided a much more holistic support plan for the final days of David’s life.
Nikki was extremely courageous coming to share her experience, and it moved the whole Board.
Members of the Board apologised to Nicki and recognised the opportunities missed to enable a good death and a good outcome for the family. When done correctly, a good death can signal the start for a better grieving process for families if they’re not left with questions and reflections of a poor experience, and this unfortunately did not happen for David and his family.
Nicki had said her dad always wanted to donate his body to medical science, but by recollecting his story and working with our End of Life team to learn from experiences she feels she is doing his wish justice.
It is important we hear stories directly from patients and their families, as it leads to ways of improving our services. Since August 2023, there has been lots of work on the End of Life pathway, particularly from our Emergency Department to the specialist End of Life beds at Skylark and Kingfisher at Mount Gould. These beds have been providing patients with a more dignified and comfortable death.
The pathway provides a big difference between the experience patients previously may have had in the Emergency Department, and families have been quick to acknowledge the difference it has made to them for their loved ones in their final days. Sisters Gail and Donna Walker’s mother Sheila was one of the first patients to use the pathway, and you can watch a short clip about their story: End of Life Care Pathway at UHP - Donna and Gail's story
A focus on Urgent and Emergency Care
Sarah Brampton, our Deputy Chief Executive reflected on the good progress the trust has made on cancer, elective and diagnostic waits, but recognised the need for our work in improving emergency care. At present, patient waits for emergency care are not acceptable, but we are making some incremental gains.
To address the root causes of the delays, we are concentrating on five specific improvements in the immediacy. Some of these aspects are already underway and in the last four weeks, we have improved the waits in the Emergency Department by 7-10% from our position in March. The immediate focusses are:
- Alternatives in the hospital to the Emergency Department or medical assessment by creating new or expanded services e.g. early pregnancy assessment, children's emergency care and assessment, urology emergency services for common conditions (you can see more about that below)
- Getting better at consistently delivering our ambulatory and minor emergency presentations in our hospital and off-site facilities
- Creating an expanded medical assessment unit to meet daily emergency demand for the community and expanding our medical same day emergency care which will diagnose, assess and treat patients during the day rather than admit them to a hospital inpatient bed.
- Increasing the staffing of senior decision takers in the emergency department and the medical admissions services to match the daily demand
- Redesigning the acute model of care for medicine to improve efficiency and effectiveness
You can see the work of the Urology team in this short video, which is making a difference to pull patients from the Emergency Department arriving with urological problems. They are among the first in the country to introduce a Urology Same Day Emergency care model.
On the topic of the relocation of Urology to the new Chestnut Unit, works have now completed to create an expanded area for the Endoscopy Unit. Supported through national capital funding, we now have additional endoscopy and procedure rooms alongside expanded assessment and recovery spaces. This redesign should see an improvement in efficiency and a reduction in waiting times, alongside enhanced privacy and dignity for patients.
Sarah paid tribute to colleagues across the whole trust who have been welcoming, receptive and committed to the change in approach as we recognise the efforts needed to overcome the challenges we face.
To end
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.
You can see who makes up our Board at University Hospitals Plymouth on our Trust Board page:
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? Dates, venue details and papers are on our Trust Board meetings and papers page
