Inside Story is the UCLH staff magazine

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Beating the bugs – page 3ANDBattling dementia – pages 4 & 5PLUSTackling taboos – page 8

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Corporate savings add up to QEP successRecruitment and Facilities are among the corporate teams that contributed £4.4 million savings towards the Trust’s QEP target last year following a number of key changes to their services.As well as some major projects, there are over one hundred local initiatives which are successfully cutting costs and increasing efficiency to deliver a 6% cost reduction year-on-year – for example by reducing our agency and consultancy spend and challenging all requests to recruit. Each area of support services is challenged each year to deliver cost savings without reducing quality. Some areas, for

example, procurement and facilities are working across UCL Partners to reduce costs.

In recruitment, the general and medical teams have now reduced costs by merging to create a leaner and more efficient service which aims to fill vacant posts faster. Chris Randall (pictured below), WEP Programme Manager, said: “The changes in recruitment have been driven by a desire to improve efficiency, reduce costs and improve quality. The team are focussed on ensuring their customers, both internal and external, receive the very best service.”

Other projects underway include the opening of a new “Arrivals Lounge” on the ground floor at 250 Euston Road to speed up recruitment process.

Meanwhile the Estate and Facilities team has also launched a number of schemes led by deputy director Andy Bowman.

The boiler system in the UCH tower has been upgraded to reduce the amount of gas used.

The air filter system is due to be updated in 2012/13 and will save on the Trust electricity bill.

The facilities team is currently in discussions to provide an electronic sign in advertising space opposite Warren Street Station.

For further information on the Recruitment Service, please contact Sue.O’Brien@uclh.nhs.uk.

newsJulie’s a winner!Clinical nurse practitioner Julie Jenks who launched an holistic service for UCLH patients with bladder problems has won a British Nursing Journal award for outstanding achievement.In conjunction with consultants, Julie developed a sacral nerve stimulation programme to insert pacemakers into the bladder to control activity. She also pioneered Europe’s first nurse-led test lead implantation service allowing nurses to implant test wires after appropriate training. Patients are also offered nurse-led acupuncture and PtNS (peripheral electrical stimulation to a designated nerve pathway) within the service.Julie said: “I was so surprised to be nominated, but even more surprised to win! I wish to thank all the multi-disciplinary team I work with for their encouragement and support, and I

share this award with them.” She was nominated by consultants Tamsin Greenwell and Jeremy Ockrim for her work within the female and reconstructive urology service.Julie leads nationally on the Urology

SNS nursing support group and this month her acupuncture paper won third prize at the 65th Urological Society of Australia and New Zealand annual scientific meeting in Darwin, Australia.

Contact us If you have any information you would like included in Inside Story, or on Insight, contact: Communications Unit, 2nd Floor Central, 250 Euston Road, London NW1 2PG. Email: communications@uclh.nhs.uk, Tel: ext 79897, Fax: ext 79401.

Front cover: Joana Tavares, healthcare assistant

Julie Jenks receiving her British Nursing Journal award for outstanding achievement

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newsInfection control – the battle continuesFrom porters and cleaners to nurses, doctors and bed managers, staff across the board have played a significant role in reducing the number of cases of MRSA bacteraemia and C Difficile.In 2011/2012 there were five recorded cases of MRSA and 54 cases of C Difficile at UCLH – within the Government threshold set for the Trust. In both cases, there was a marked improvement on previous years.Annette Jeanes, director for infection prevention and control, said: “A great many staff have made a real contribution to reducing infection rates – the infection control culture in the Trust is changing and patient safety is

now firmly fixed in people’s minds. “Individual members of staff may feel they can’t make a difference. But they can. Small actions can have a big impact. The results may not be immediately evident but somewhere down the line your actions could mean the difference between a patient acquiring an infection – or remaining infection-free.”“It’s not only the infection control nurse raising awareness in the wards or the nurse at the bedside cleaning her hands. Lots of staff have contributed and that is something to celebrate. But we face further challenges this coming year and we will need to do even better.”

Has Mrs Smith been screened for MRSA?

How can I make sure an isolation bed is always available?

Good work – but must do even betterEven more stringent Government thresholds come into force this year and Trusts face penalties of millions of pounds if they exceed them. The C Difficile threshold is 44 cases or under (compared to 59 in 2011/2012). The MRSA threshold remains the same – five cases or under – but with more patients being treated it may be statistically harder to attain.

Are my hands really clean? Should I remove this central IV line to help protect Mrs White from infection?

Is it safe to give Mr Brown these antibiotics or could it put him at risk of C Diff?

Key areas that require specific attention: rapid identification of diarrhoea cases and prompt isolation

correct antibiotic prescribing nursing and pharmacy staff to challenge inappropriate antibiotic prescription and to prompt the switch from IV to oral antibiotics

patients should be informed promptly of their diagnosis, care and treatment

rapid cleaning and disinfection of the patient environment

hand hygiene

Are the curtains, beds and furniture spotlessly clean?

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focus on dementiaUnlocking the mysteries of the mind – our teams may hold the key Honorary consultant neurologists Professor Martin Rossor, Professor Nick Fox and their colleagues at UCLH and UCL are on a quest to unravel one of the greatest medical mysteries. Like cancer and HIV decades before, the solution to stopping dementia in its tracks has remained stubbornly intransigent. But there is hope, as Elke Tullett reports. The race to find a cure for dementia has never been more critical: within ten years there will be around one million people in the UK with this devastating condition – many of whom will spend their last few years severely impaired and dependent on others for care.On the day that Prime Minister David Cameron visited the UCLH/UCL Dementia Research Centre in March, he announced plans to double research funding after describing dementia as a “national crisis.”UCLH/UCL is at the research epicentre and has recently been awarded grants totalling over £30 million.Clinical researchers are faced with a dual challenge: they must develop new treatments to prevent, slow or stop the disease – and identify as early as possible those who will benefit from these treatments. Ideally before symptoms start showing.

Professor Nick Fox, has been instrumental in developing and refining a method of identifying dementia at the very earliest stages. The MRI-based image analysis system accurately measures brain tissue loss and can be used to assess the effects of particular treatments on the brain over a period of time, not only for Alzheimer’s but other neurological conditions too.

“Seeing parts of the brain actually shrinking and the loss of brain cells is a very powerful image,” said Professor Fox. “Dementia is often difficult to diagnose and can be mistaken for other conditions. This technique helps us make a more accurate clinical diagnosis and to determine which patients would be most suitable for research trials. “

He added: “At present, existing

therapies help manage the symptoms but we desperately want to be able to offer something that really slows down or halts the disease. There is increasing recognition that the most effective therapies will be those offered to patients in the very earliest stages of disease and this idea is at the heart of our research work.”For example, as part of an international trial UCLH/UCL is analysing brain scan images sent from around the world. The aim of the study is to see if an infusion of antibodies slows the disease’s progression by attacking Beta Amyloid, protein deposits which are one of the hallmarks of Alzheimer’s.Up to 400 new dementia patients are referred to the NHNN each year, many are in their 50s and 60s and some even younger. Professor Fox said: “It’s a cruel, and increasingly common, condition but these numbers are probably the tip of the iceberg, with many more remaining undiagnosed. It’s a dreadful disease yet I am always impressed with the way patients and their families cope. It is both humbling and inspiring.”Professor Nick Fox

Professor Martin Rossor

“We did it with cancer in the 70s. With HIV in the 80s and 90s. We fought the stigma, stepped up to the challenge and made massive in-roads into fighting these killers. Now we’ve got to do the same with dementia.” – Prime Minister David Cameron.

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focus on dementia

Caring for dementia patients at UCLH

Increased dementia awareness training for all nurses, nursing assistants and students.

UCLH has developed the “forget me not” symbol for patient notes, a visual method of quickly responding to patients with dementia

A UCLH dementia charity has been established to fund activities for patients.

Professor Martin Rossor

Research portfolio Prime Minister pledges to double national research funding for dementia over the next three years (£66 million by 2015)

National Institute for Health Research (NIHR) awards (each of £4.5m over 5 years) to establish four new biomedical research units into dementia – including one based at UCLH/UCL

The Wolfson Foundation awards £20 million grant to create a new centre dedicated to the research and treatment of neurodegenerative diseases including Alzheimer’s. The facility where patients can

be treated safely with new therapies will be based on the ground floor of the NHNN.

An international research network into frontotemporal dementia, a rare inherited neurodegenerative condition, has been established by the Medical Reseach Council. It is led by Prof Rossor from UCLH/UCL

A Medical Research Council grant of £3 million has been awarded to the UK’s network of brain banks, including one at UCLH/UCL. Brain tissue donated by dementia patients is vital for research.

Meanwhile, in his office at 8-11 Queen Square, Professor Martin Rossor, recalls his first “Eureka” moment in 1991. He was working with Professor John Hardy, when they identified the first Alzheimer gene. “At the time it was a massive problem, an interesting problem, but people didn’t seem to be focusing on it.” If you are unlucky enough to be born with the gene, you have a one in two chance of succumbing at a relatively early age.Prof Rossor had the privilege of talking about his work to Prime Minister David Cameron during his recent visit to Queen Square.

Shortly before, the Prime Minister had announced a new target to recruit at least 10% of dementia patients on research trials. As director of the National Institute for Health Research (NIHR) dementia and neurodegenerative research network (DeNDRoN), Professor Rossor has that target firmly in his sight.“We must rise to the challenge. It’s an empowering challenge and demonstrates real political support. In the past, dementia research has been under-funded but that is now beginning to change.”On the NIHR Queen Square biomedical research unit programme, clinicians and scientists are adopting

a four-pronged attack to investigate causes and possible treatments: research into molecular mechanism (Professor John Collinge), signatures of disease (Professor John Hardy) and biomarkers of change (Professor Nick Fox). Professor Rossor will concentrate on experimental treatments such as the new drug CPHPC which has been developed by Professor Sir Mark Pepys at UCL.

“In the past dementia was not talked about. But in the past 30 years of research, there have been dramatic changes. We are beginning to understand so much more.”

The images demonstrate widespread brain shrinkage (brain loss shown in blue/green and increases in fluid space in red/yellow) progressing at a rapid rate in patient with Alzheimer’s disease (right image). The left image is that of a control patient.

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A look behind the scenes The opening of the University College Hospital Macmillan Cancer Centre last month was not only a significant milestone for frontline staff and patients but also for the huge number of staff who have worked behind the scenes to make it happen. There are too many names to mention everybody but here’s just a flavour of who has been doing what. From the moment the building was handed over by Skanska, Nives Pupovac’s to do list doubled in size. As the project manager from the Trust’s estates and facilities team it was Nives’ role to manage the building during the commissioning period – the time from handover to getting the building ready for opening. Nives said: “It’s been extremely challenging. Everyone who came on site had to undergo an induction and be managed – we’ve had staff around 100 contracting companies who have come in to do various jobs – that’s a lot of coming and going!”Steve Last is the Cancer Centre project accountant and is part of the team that managed the capital spend of the £100m business case, and provided financial decision support to the Cancer Centre Project Board, the group for making the key decisions about the Cancer Centre. Steve has also gone the extra mile literally,

raising over £1,500 for the Cancer Centre appeal by doing a sky dive and a cycling challenge.The Cancer Centre is not just about a new building but about a new improved patient experience. Eva Salm’s work as the ICT project manager for the Patient Scheduler and the Check and Track projects will make a big difference to patients. Eva said: “The new systems bring to an end the ‘different appointments by different departments’ process which was confusing and difficult for patients to manage. They are a great step forward for the patient experience”. Siama Rashid worked with the

cancer outpatient teams to redesign cancer outpatients in readiness for the move to the Cancer Centre. With the help of the team leaders, services have been re-designed so that they will operate much more efficiently. Siama explained:”This major project fundamentally changes the way the services are delivered. We have re-structured staff into three teams – staff members will no longer be wedded to one particular clinic but will work across clinics. Each team will manage certain clinic areas and can therefore build and share expertise. This system gives us much more flexibility to manage changes in workloads”.

interview

One month on...In the first four weeks after opening (on 2 April) around 3,500 patients had their treatment at the new Cancer Centre. Feedback from patients was collected and analysed in the first week to identify areas for immediate action, Jessica Tudor Williams, cancer centre general manager, said: “The feedback is generally very positive but we aren’t complacent and will continue to listen to and learn from our patients and staff as we have done from the very beginning of this project.

For example, some patients weren’t keen on having their name on the live screens that tell you how long you have to wait for your appointment, so we are now more explicit about the option of a patient setting up an alias when they arrive. As more patients use the Centre, their feedback will be collected, analysed and used to ensure that the services truly meet the needs expressed by the majority.”

Did you see?The Cancer Centre’s opening week was featured on London Tonight and BBC London news programmes. Visit www.uclh.nhs.uk to view coverage featuring staff and patients.

Eva Salm, Steve Last and Nives Pupovac in the Cancer Centre

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our trustUCLH is top performer according to patientsUCLH is the top performing acute Trust in London for the third year running and our A&E department is among the best in the country, according to the latest national inpatient survey.The results published this month by

the Department of Health show UCLH top of the London league table – ahead of all other teaching hospitals in the capital. The Trust’s A&E is the third best in the country based on the information patients receive, privacy during treatment and not having to

wait a long time to be admitted to a bed or ward. UCLH was also praised for the cleanliness of its rooms and wards; confidence and trust in our doctors; information given to patients about their condition and treatment and involving family and friends in discussions. It scored better than other Trusts in these areas.Trusts are rated as better, about the same as, or worse than expected. UCLH did not score “worse” in any category, about the same as expected in nine categories and better in one (A&E).The results are based on a survey undertaken at UCLH by The Picker Institute. Picker also found that 96% of patients who responded to the survey would recommend UCLH to their family and friends.See Insight for further information.

Surgeon hailed a hero in quake rescueA UCLH consultant surgeon who crawled up a collapsed staircase on his hands and knees to help rescue a woman during an earthquake in New Zealand has been honoured for his “selfless act of bravery.”Julian Shah helped the severely injured victim who was pinned under a fallen beam on the top floor of a Christchurch building until she was taken down to ground level on a rescue crane.Shortly afterwards, he and his fellow rescuers who were on the fourth floor were forced to leap across a chasm onto a neighbouring roof when a powerful aftershock rocked the building.This month Julian flew to Darwin, Australia to receive a medal presented at the Urological Society of Australia and New Zealand annual scientific conference. He had been among hundreds of urologists who had been attending a conference in Christchurch when the earthquake struck last February, killing 185 people.Following the disaster, he told Inside Story: “People were saying we were heroes and although I wouldn’t go that far, we did our best – we didn’t shirk from trying to help.”The inaugural Christchurch Medal for Bravery was presented to four urologists. The medal is a particularly poignant item – it is forged from metal taken from the destroyed Crowne Plaza Hotel, where the conference delegates had been staying.

Julian Shah (right) receives his medal from Steve Ruthven, president of the Urological Society of Australia and New Zealand

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the back page

Archives The first ever X-ray was used to treat a patient in 1896 at the emergency department of The Middlesex Hospital. The patient was treated for a needle in her hand. The Middlesex Hospital opened it’s first X-ray Diagnostic Department in 1901.

A new book celebrates the history of the Schools of Radiography at The Middlesex Hospital and explores the development of imaging and radiation treatment, using archives and personal accounts. The book costs £10 and profits go to radiographic charities. It is available from Amazon or by contacting Patricia Ducker p.ducker.barber@btinternet.com

Secret lives Make no mistake, faecal incontinence is not usually a laughing matter. But in the bowels of the Rockefeller building, gastroenterologist Professor Alastair Forbes is happy to be the butt of the joke.So, take a flute-playing consultant, a kooky Japanese writer called Kazuko Hohki, a team of talented actors and a series of sketches, stories, songs and science and what have you got? A show called Incontinental.Funded by the Wellcome Trust, it aims to bring the subject out of the closet and educate health professionals, patients and public about one of the last taboos of the 21st century – losing control in the trouser department. Alastair said: “The writer said she wanted to write something about a medical subject that was never spoken about. So I said ‘faecal incontinence’. She went white for 30 seconds and then shrugged and said ‘sure’. So, the sketch – to the Dambusters music – is of a World War 2 pilot bailing out of his trousers, an

executive who knows the location of every public lav in town and Lou an air stewardess on board a fictional Incontinental flight, pointing out the 18 emergency toilets.Alastair admits: “It is difficult getting the balance right. We want it to educate people in a light-hearted way and to get the subject out in the open but we are mindful that it must never be demeaning. Patients often don’t want to travel, socialise or talk about faecal incontinence – you can’t underestimate the far-reaching impact it has on someone’s life.”

He plays the straight-talking expert who intersperses the whole fandango with serious messages that gets to the bottom of a distressing condition which affects one in 100 people. He gives advice about the condition and possible treatments.“I’m keen to publicise the condition. One prime-time BBC programme about it would probably do more good in the long-term in terms of raising awareness than seeing twenty patients in clinic every day for the rest of my life.” So watch out!

Incontinental. Photo courtesy of Alex Brenner

Surgeon steps into school

Consultant Professor Fares Haddad presented prizes to three winning students in a schools competition run by NHS Careers. The students from South Hampstead High School researched one of the 350 different career opportunities in the NHS and produced a job advertisement and CV of the ideal candidate for their chosen role. Over 1,250 students from across England entered the competition.

Georgina Alford, Genie Harrison and Zoe Viner were the London regional winners