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					                        Briefing on Oxford Radcliffe Hospitals

 19 July 2010 – Issue 9

    This briefing is intended to be a regular update for our partner organisations and key stakeholders
        within the wider community that we serve. It will contain the latest news from the Trust.


Contents                                                                                 Page

  1    Dr Edward Baker appointed as the Trust’s new Medical Director                     2
  2    Clinical management and the new operating framework                               2
  3    Creating a Healthy Oxfordshire                                                    4
  4    New Quality Account                                                               5
  5    Safety and standards                                                              5
  6    Our digital future – introducing electronic patient records                       6
  7    Paediatric cardiac surgery                                                        6
  8    Better Healthcare Programme for Banbury                                           7
  9    Ward changes in maternity services                                                7
  10   MBE for ORH Sister Ann Readhead                                                   8
  11   Commendation for John Radcliffe mortuary staff                                    8
  12   Oxford Radcliffe Hospitals in the news                                            9




                                               Page 1 of 11
1 Dr Edward Baker appointed as the Trust’s new Medical Director
Dr Edward Baker MA, MD, FRCP, FRCPCH has been appointed as the Trust’s new
Medical Director. Ted Baker will be starting on 1 September 2010, taking over from Dr
James Morris who will be stepping down as Medical Director after a decade in the post.
Ted is coming to the Trust from his current position as Executive Medical Director of
Guy’s and St Thomas’ NHS Foundation Trust, a position he has held since 2003. He
trained at Cambridge University and St Thomas’ Hospital Medical School, before
undertaking specialist training at several major hospitals, including Pittsburgh Children’s
Hospital in the USA.

Ted Baker has been a consultant paediatric cardiologist at Guy’s and St Thomas’ since
1987. His previous managerial roles there have included Assistant Medical Director,
Clinical Director of Children’s Services, and Group Director of Women’s and Children’s
Services. As the Trust moves into the new Clinical Management Structure, Ted will play a
key role in developing clinical management and leadership across the Trust.

2 Clinical management and the new operating framework
The Trust has been moving towards a new clinical management structure in order to
better achieve its strategic objectives. These include meeting our patients’ high
expectations and meeting our quality standards, as well as securing financial stability for
our Trust.

In October 2010, the ORH will be moving to a new configuration of clinical services. The
six new Divisions will bring together our specialties in a way that best reflects the way
that they work with each other, their geographical location and how their work is
integrated with the clinical research done in our hospitals.

It will increase the involvement of clinicians in management decisions, and provide new
tools to help services deliver high quality patient care. The new structure can be seen on
our website at the links below.

      New configuration of clinical services (pdf)
      Description of each of the Divisions (pdf)

You can find out about all of our services here.

Clinical Leadership
Each of these new divisions will be led by a practising clinician who will devote a
significant part of their time to the leadership and management of the Divisions. Many of
                                         Page 2 of 11
our key leaders in the Trust are already doctors, nurses and other health professional; our
Chief Executive is a former renal consultant; and clinicians are returning more and more
to leadership and management roles.

The new structure makes these roles more concrete – granting greater autonomy to
services, but also formalising responsibility and accountability. It doesn't mean that
clinical service will be free from the must-dos of meeting quality, performance, and
financial standards – but it will mean that they can play a greater role in how the Trust
meets these demands so that we can deliver effective, efficient and safe patient care.

To accompany these changes, the Trust will be moving to a way of working known as
Service Line Management, a combination of management and business planning
techniques that can improve the way healthcare is delivered. This is an important part of
our journey to becoming a Foundation Trust. If you are interested in the technical details
of Service Line Management, you can read more at the Monitor website.

The revised NHS Operating Framework
A revised NHS Operating Framework was published in June, which sets out some
changes to the performance targets that we are measured on as an acute trust. It also set
out accelerated savings in management costs in Primary Care Trusts and Strategic Health
Authorities.

The immediate changes relevant to acute trusts such as the ORH are:
    Up until June this year, 98% of all patients arriving as an emergency, had to be
      treated, admitted or discharged within four hours. The new requirement is that this
      should apply to 95% of patients. This change is based on clinical advice and will
      allow better management of patients for whom longer monitoring and care in the
      Emergency Department is a better choice than admitting them to hospital. A new
      quality measure, to be defined, will replace this target from 2011/12.
    The Department of Health will no longer performance manage the 18 week target
      (which requires patients to have their first hospital treatment within 18 weeks of
      referral by their GP). However, the data will still be published, and our contracts
      with Primary Care Trust commissioners to deliver against this target remain.
    Targets for cancer patients access to treatment remain as they are currently.

In other words, commitments to our patients remain, and monitoring and management of
performance is shifting from a national to a local level. Our income will become
increasingly dependent on delivering performance and quality standards. Our aim as a
Trust is to provide good, timely treatment for every patient with exceptions needing to be
clinically justified.
                                        Page 3 of 11
3 Creating a Healthy Oxfordshire
The Trust continues to support Creating a Healthy Oxfordshire, the Oxfordshire-wide
programme established by NHS Oxfordshire, the Primary Care Trust and Oxfordshire
County Council. The aim is to create a better health and social care system for Oxfordshire
while responding to the strategic and financial challenges.

The five key workstreams of the programme are:
    Acute Care: improving referral processes and arrangements; taking acute skills and
       specialisms into the community; and improving discharge and care closer to home
       arrangements.
    Primary Care: GPs and primary care working more closely with hospital
       consultants; better integrations between primary and social care to enable patients
       to stay longer in their own homes or return more quickly from hospital; and
       extending primary care teams to provide better continuity of care.
    Self-care: Helping patients to help themselves, in particular, those with long-term
       conditions and those at risk of becoming frequent users of urgent care services and
       their carers.
    Integrated community teams: Closely linked to the Acute care programme –
       putting the patient at the centre of care, supported by primary care and community
       teams with rapid access to specialist services when needed; simplified access to
       service with people able to access the right services in the right place.
    Disinvestment: Commissioning healthcare in a way that means that the NHS can
       withdraw resources from health care practices, procedures, technologies or drugs
       where there is evidence to indicate that they provide little or no health gain.

These initiatives will be closely linked to, and support, the ORH’s internal cost
improvement efforts. The Acute Programme, of which Sir Jonathan Michael is the co-
sponsor, aims to:

      Improve early diagnosis and management of illness, particularly for long term
       chronic conditions.
      Reduce the need for hospital admissions by strengthening access to advice, expert
       diagnosis and management closer to home.
      Improve collaborative working and integration across the health and social services
       in Oxfordshire.
      Improve access to hospital care for those who need it.
      Only keep patients in hospital as long as their clinical condition requires.


                                        Page 4 of 11
4 New Quality Account
From this financial year, all NHS trusts have been required to publish an annual Quality
Account. The ORH published its first Quality Account on 30 June this year. This sets out
what the Trust has done in 2009/10 and also describes our plans for all aspects of quality
in the current year.

The Quality Account covers three critically important areas: safety, patient experience and
the effectiveness of care and treatment. It also demonstrates the commitment of the Board
and the staff of the ORH to deliver the highest possible quality of care with the available
resources.

We welcome comments on the report and how it might be improved for next year, and
also on how we can take better account of the views of our patients, their families and the
local and wider health community.

A link to the Quality Account can be found here on the Trust’s website:
www.oxfordradcliffe.nhs.uk/aboutus/reports/100630qualityaccount.pdf. There is also an
invitation to give us feedback about it.

5 Safety and standards
The Trust continues to focus on the safety and quality of care. The ORH is running a
programme called Serious about Safety and Standards that uses the inquiry into standards of
care at Mid Staffordshire NHS Foundation Trust (the Francis Report) as the basis of this
work. Clinical staff from across the Trust are attending events run on all sites every
Monday morning and analysing and discussing key issues relating to the standard and
safety of care of our patients.

The programme emphasises the key roles and accountabilities of clinical staff in a wide
range of areas such as bladder and bowel care, personal and oral hygiene, nutrition and
hydration, prevention of pressure ulcers, privacy and dignity, discharge management and
infection control.

Features of this programme are its focus on hearing the ‘patients’ voice’, learning from the
Francis Report, and providing staff with helpful audit tools and developmental techniques
that enable them to discuss and develop standards within their teams.

Future sessions will include privacy and dignity, communication, discharge management,
record keeping, and cleanliness and infection control. The programme is proving both
popular and useful and has strong support from and involvement of the Trust Board.

                                         Page 5 of 11
6 Our digital future – introducing electronic patient records
The ORH has wanted to replace the current paper records for patients with an Electronic
Patient Record for a number of years. The Nuffield Orthopaedic Centre (NOC) has already
pioneered this in Oxfordshire. Contracts have now been signed with BT to deliver two
Care Record Service (CRS) products to a number of organisations in London and the
South of England. For the ORH this will mean the implementation of Cerner’s Millennium
Electronic Patient Record software. We anticipate this going live in 18 months time at the
end of 2011.

The delivery of Electronic Patient Records, and other digital advances in hospital
information, amount to one of the largest transformation projects ever undertaken in the
NHS. It will build on our existing uses of technology in healthcare, including PACS,
electronic discharge documentation, increasingly automated laboratories, telemedicine
and the research into the use of mobile phone technology to help manage long term
conditions.

Moving from paper notes to an Electronic Patient Record is a much larger proposition
than any of these, but so are the benefits. At the end of this process, we can look forward
to:
     tracking our patients on a central system while they are in our hospitals, which will
      help us treat patients more quickly and manage our beds more efficiently
     transparent, secure and auditable access to all clinical information, wherever and
      whenever needed
     the universal use of one system for all diagnostic requesting with access to all
      results and all notes
     electronic risk assessment, discharge and clinical correspondence.

Electronic prescribing and medicines administration will be part of a second phase of
deployment, which is planned to start as soon as the organisation is ready. Before we
launch the new system, the ORH will start scanning the entire paper health record and
make these records available securely online. When the ORH launches the new system,
the NOC will also get an upgrade so that there is a single, unified Electronic Patient
Record across the acute NHS hospitals in Oxfordshire.

7 Paediatric cardiac surgery
The Trust continues to participate in the Safe and Sustainable National Review into
children’s heart surgery which is being carried out by the National Specialised
Commissioning Group. Recommendations from that Review are due in September and a
national public consultation on the recommendations is expected from October onwards.

                                        Page 6 of 11
The SHA-led Independent Review into paediatric cardiac surgery services and clinical
governance at the Oxford Radcliffe Hospitals is due to report to the SHA Board on 29 July
2010. The SHA will publish the report on their website on 29 July.

8 Better Healthcare Programme for Banbury and surrounding areas
At a specially convened meeting of the Board of Directors held on 14 June, the Trust
agreed to implement proposals from NHS Oxfordshire for the delivery of paediatric and
maternity services at the Horton General Hospital. Directors thanked all the staff involved
in delivering the interim arrangements at the Horton for their hard work and dedication in
keeping services going through this transitional period and also all those who have been
involved in drawing up the new proposals. At the same meeting the Board considered a
framework for developing a new vision for the services to be provided from the Horton
and agreed to set out a new strategic plan for the hospital based on this vision.

Members of staff at the ORH are now working hard to implement the Horton proposals.
The new service across the two hospitals will cost about £2.5 million extra a year to
deliver, with the costs being shared between NHS Oxfordshire and the ORH. The plans
require the ORH to employ an additional 12 paediatricians in addition to the five we
currently have. The ORH will also need to recruit additional anaesthetists and
obstetricians. Adverts for the first new jobs are due to be placed in August.

For more details on the Better Healthcare Programme, including agendas and papers for
meetings, please see: www.oxfordshirepct.nhs.uk/bhp/

9 Ward changes in maternity services
As you will already be aware, as usual at this time of year, the John Radcliffe Hospital’s
maternity services are temporarily reducing the number of beds in use and consolidating
the open beds over the school summer holiday period in order to manage staffing
efficiently. Our initial plans involved slightly reducing the numbers of beds open and
moving all open beds from Level 6 to Levels 5 and 7 of the Women’s Centre.

After further consultation within the Trust, the maternity department has revised its plans
for summer staffing in maternity services. The maternity service will now continue to
work on both Levels 5 and 6 but with a reduced number of beds on Level 6.

We will reduce the number of beds on Level 6 by eight, to 17. We will then increase the
number on Level 5 by four beds. There will still be an overall reduction of four beds and
this is necessary to safely maintain our service with the available staff. However, we
believe that we should be able to offer care on Level 6 for all women that need it.
                                        Page 7 of 11
We will be monitoring these arrangements very closely to ensure that services are being
provided at the high quality level we would expect, and, if necessary, we may need to
revise these plans.

These changes have been agreed by the midwifery and obstetric team. We have also taken
into account the views of our patient support groups. The new arrangements are intended
to maximise safety and quality of care for all women using the service, within the current
restraints.

We are only able to make these changes thanks to the willingness of midwives to go the
extra mile by working more hours, and for consultants to give ongoing support. We
would like to take this opportunity to thank our staff for the commitment they have
shown - and continue to show - to the mothers and babies in our care.

We anticipate that the number of midwives will continue to improve throughout the next
two months, and we intend to return to the usual configuration of beds on all three levels
from Monday 27 September 2010.

10 MBE for ORH Sister Ann Readhead
Sister Ann Readhead has been awarded an honorary MBE in the Queen’s Birthday
Honours. Ann was closely involved with the relocation of the Geratology Unit from the
Radcliffe Infirmary to John Radcliffe, and it subsequent refurbishment. Ann was a
champion for the creation of a sensory garden for geratology patients. She has worked
tirelessly - showing great determination to have the garden built to the highest standard.
In her voluntary role as Prospects Manager she has helped raise £200,000 for the garden
and equipment. Her passion for her role has also helped raise the profile of care of elderly
patients both in the Trust and in the community as a whole. We are delighted that Ann’s
work has been recognised with this well-deserved honour.

11 Commendation for John Radcliffe mortuary staff
The Provost Marshal of the Army has given a Commendation to the mortuary staff at the
John Radcliffe Hospital. The Mortuary Manager will collect this at an awards ceremony on
the 28 July at Bulford Camp on behalf of his team. This is a well-deserved recognition for
the very sad and difficult work members of staff in the mortuary do for the fallen soldiers
and their families. This is also a chance for the military to thank the doctors, radiographers
and other members of staff who help provide this service to the Ministry of Defence.




                                          Page 8 of 11
12 Oxford Radcliffe Hospitals in the news
In a typical month, the Oxford Radcliffe Hospitals Press Office receives between 50 and
100 media enquiries. This translates to a similar number of print and website articles and
broadcast media items. A few of the stories in the media since the last briefing are as
follows.

Sir Jonathan Michael interview in the Oxford Times
The Oxford Times carried a double page spread interview with ORH Chief Executive Sir
Jonathan Michael in June. Nursing us through the bad times

Paediatric cardiac services
There was more local coverage including in the Oxford Times, Oxford Mail, Bicester
Advertiser, Meridian, Witney Gazette, BBC South and Northants Chronicle and Echo
about the NHS National Specialised Commissioning Group that is leading the national
paediatric cardiac services review. Coverage included publicity for the public engagement
event held by the national Safe and Sustainable Programme on the future of paediatric
cardiac surgery at the John Radcliffe Hospital. Operation to keep city unit alive, Mum
launches campaign to save JR children’s heart unit , Bid to save child heart unit in city ,
Have your say on child heart ops rethink, Debate over heart surgery, Leave heart unit
alone, say parents, Anger as parents battle for heart unit, Parents of miracle baby join
appeal

Horton General Hospital and the Better Healthcare Programme
BBC Oxford, Banbury Sound, BBC Radio Oxford, Heart FM, Oxford Mail and Banbury
Guardian all covered the story about paediatric and maternity services at the Horton
General Hospital. The ORH Trust Board agreed to fund the services an extra £900,000 per
year to provide a Consultant-delivered service. There was also further coverage of a
debate in the House of Commons called by local MP for Banbury Tony Baldry on the
Horton General Hospital. Health Minister Simon Burns MPcongratulated Mr Baldry and
ORH staff for their role in sustaining paediatric and maternity services at the Horton.
Hospital wins 24-hour care, Delight as Horton services are safe, Delight as Horton services
are safe, Oxfordshire MP wants support for smaller hospitals.

BBC Two Documentary featuring the Trust’s ‘brain bank’
A BBC Two documentary ‘The Story of Science: Power, Proof and Passion’, about
scientific understanding of the brain, included a demonstration in the brain bank, based in
the JR West Wing, by Professor of Clinical Neurology Margaret Esiri, also of the
University of Oxford department of Clinical Neuropathy. Episode 6: Who Are We?


                                        Page 9 of 11
Coverage of pioneering ‘bionic bone’ implant
The Daily Mail ran a story about a 14-year old cancer sufferer whose right leg has been
saved by a pioneering ‘bionic bone’ implant. The £20,000 bionic bone that will let Sophia’s
leg grow

Update on the sextuplets born at the ORH in May
The Daily Mail ran a first interview with the parents of the sextuplets born at the John
Radcliffe Hospital in May. Our five little fighters There was then further coverage on
BBC Radio Oxford, Oxford Mail and Heart FM Sextuplet parents recount joy and
heartache

Charity helps our hospitals
The Oxford Mail in particular continues to be very generous in its coverage of our
charitable appeals for our hospitals and didn’t disappoint over the last few months. There
has been a great deal of coverage of individuals fundraising for our hospitals as well as the
OX5 RUN.
    Oxford Mail article about the OX5 Run appealing for sponsorship money to be
       returned, the race has raised £50,000. OX5 RUN: Running total reaches £50,000
      Oxford Mail article about a mother who has fundraised for the Spires Cleft Centre,
       JR, after her son’s cleft palate was corrected by the centre. It included an interview
       with Tim Goodacre, ORH Consultant Plastic Surgeon. ‘JR doctors gave my son his
       smile’
      Northampton Chronicle & Echo article about the family of a patient who
       underwent brain surgery at the JR who is thanking the public for their help with
       her fundraising effort. Mum thanks public for appeal support
      Oxford Mail and Oxford Times article about Dan James, a mobile phone project
       manager who is taking two months off from his job to work for the SSNAP the
       charity that supports the Neonatal Intensive Care Unit. Dan's doing his bit in
       memory of Lily, Abingdon man whose baby died in early weeks hits back by
       working for hospital charity
      Oxford Mail article and editorial about a cancer charity having reached its halfway
       point in its £3m fundraising drive for a new ‘Maggie’s Centre’ in Oxford. Maggie’s
       half-way to £3m for new cancer support centre. Further coverage on p10 Terrific
       record
      Maidenhead Advertiser article about Eastenders’ actress Lucy Benjamin, who has
       raised more than £200,000 for a charity which provides weekly music therapy at the
       John Radcliffe. Home-grown actress raises £200k for town charity
                                         Page 10 of 11
     Daily Mirror article about the father of a patient who has undergone extensive
      corrective surgery, who with his military squadron, are running 800 miles to raise
      money for the Children’s Hospital and the family accommodation unit at the JR.
      Just being able to wave is amazing for Finley




This briefing was prepared by
Susan Brown
Senior Communications Manager
Oxford Radcliffe Hospitals
Tel: 01865 231475
Email: susan.brown@orh.nhs.uk
22 July 2010


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