Highlights 2014 /15
The child first and always Great Ormond Street Hospital (GOSH) is one of the world’s leading paediatric research hospitals. Our clinical colleagues and support teams are dedicated to meeting the needs of the patients that we treat. In turn, these children, young people and their families inspire us to do all that we can to improve the health of children here, across the UK and around the world.
Three-year-old Hassan on Lion Ward.
Great Ormond Street Hospital for Children NHS Foundation Trust • Highlights 2014 /15 • 1
1,581
97%
51
outpatient clinics
Welcome
of parents and patients would recommend the hospital
specialties
885
8,832
scientific papers contributed to by clinicians
Foundation Trust members (excluding staff) Baroness Blackstone Chairman
875
active research studies
84,048
255,000
patient visits
procedures performed
19
highly specialised national services
Dr Peter Steer Chief Executive
The children and young people we care for at Great Ormond Street Hospital have some of the most complex and rare conditions that exist today. Due to the concentration of these patients at our hospital, we have both the opportunity and responsibility to drive forward new treatments and cures.
Underpinning this strategy is work that we have done defining our values. Launched in March 2015, ‘Our Always Values’ define the core of who we are and how we should behave across the organisation. They shape the expectations we have of each other and others have of us.
Demand for our services continues to increase, taking place against a backdrop of heightened financial uncertainty and a complex and changing health landscape. This year, we revised our strategy in collaboration with a range of key stakeholders in order to respond to these changes and plan for how we can make the greatest possible impact on child health.
We recognise that the high standards of care we aspire to are not always matched by the quality of accommodation we have. Last year, we forged ahead with the construction of the Premier Inn Clinical Building, ready for the completion of the Mittal Children’s Medical Centre in 2017. We are also making progress in the creation of the Centre for Research into Rare Disease in Children, due to open in 2018. The new centre will enable hundreds of researchers and clinicians to work together under one roof supported by state-of-the-art facilities to advance our understanding of rare diseases and identify new and better treatments. Work such as this would not be possible without the help of Great Ormond Street Hospital Children’s Charity and our wonderful supporters.
Striving for excellence should be at the heart of everything we do and underpins our ambitious vision to be the leading children’s hospital in the world by 2020. We have identified five key areas where we want to deliver excellence, which form our strategic objectives: • To provide the best patient experience and outcomes. • To be an excellent place to work and learn. • To deliver world-class research. • To be the partner of choice.
94%
4,153
of staff would permanent and recommend fixed-term staff the hospital 2 • Great Ormond Street Hospital for Children NHS Foundation Trust • Highlights 2014 /15
• To be sustainable.
This year’s Highlights Report is testament to the hard work and determination of our staff. They remain our greatest strength and, by working together as one team, we can continue to meet the challenges before us and provide the care that our patients deserve.
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Our milestones New hospital main reception opens
Transformative gift to create new rare disease centre
Dr Peter Steer joins as new Chief Executive
Launch of new test for Down’s syndrome
Great Ormond Street Hospital’s (GOSH) welcoming seascape main entrance opened on 25 April 2014, following a redesign with patients, parents and staff. The area features a boat-shaped reception counter and a shoal of colourful fishes drawn by patients at the hospital.
Great Ormond Street Hospital Children’s Charity received a £60 million gift from Her Highness Sheikha Fatima bint Mubarak in recognition of GOSH’s unique position to advance treatments and cures in rare diseases. The donation will help fund the new Centre for Research into Rare Disease in Children.
Dr Peter Steer joined the Trust as Chief Executive on 1 January 2015 after serving as Chief Executive of Children’s Health Queensland Hospital and Health Service since 2009.
GOSH launched a new noninvasive prenatal test for Down’s syndrome, which offers expectant mothers greater accuracy and a reduced need for invasive tests that have previously led to miscarriage.
GOSH wins Patient Safety Award
New discovery in epilepsy surgery
A project that aims to increase levels of patient safety across the hospital was recognised in the 2014 British Medical Journal awards. Acknowledging the continual efforts being made to improve experiences of patients and families, GOSH was given the Patient Safety Team of the Year award.
A team from GOSH and the UCL Institute of Child Health discovered that a type of brain surgery conducted in childhood for epilepsy can protect memory development. The discovery represented an important breakthrough, as epilepsy surgery is associated withrisk of memory damage.
Visit from the Duchess of Cornwall
Plans approved for new research centre
Her Royal Highness the Duchess of Cornwall visited the Arthritis Research UK Centre for Adolescent Rheumatology, where she met GOSH patient Malaika. The centre is the world’s first dedicated to understanding how and why arthritis affects teenagers.
Councillors at Camden Town Hall approved plans for the new Centre for Research into Rare Disease in Children, set to open in 2018. It will be the world’s first centre dedicated to paediatric research into rare diseases.
Surgeons play key role in foetal surgery project
GOSH named key centre in 100,000 Genomes Project
New Chief Nurse and Medical Director
Celebrating NHS Sustainability Day
It was announced that paediatric surgeons and doctors at GOSH will play a key role in a new foetal surgery research project to create better tools, imaging techniques and therapies for future operations on unborn babies.
GOSH was announced as a key centre in an initiative to analyse the DNA of 100,000 NHS patients and their families using a process called whole genome sequencing. The project will ultimately help treat rare and inherited diseases and common cancers.
GOSH announced the appointment of new Chief Nurse Juliette Greenwood, who returns to the hospital after working here for five years previously, and new Medical Director Dr Vinod Diwakar, who joined the team from Birmingham Children’s Hospital.
A 62-metre piece of artwork depicting the journey that GOSH needs to take to become a more sustainable hospital was the star attraction at the hospital’s Sustainability Fair. The artwork decorates the walls of the ‘hospital street’ and features drawings by more than 100 children and young people.
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A chance for survival thanks to ECMO Ella was born in September 2014. During birth, she went into distress: she struggled to breathe and her body began to shut down. Her organs required much more oxygen than normal to function. After 12 hours, Ella was stable enough to be transferred to GOSH, where her only chance for survival was a life support machine called extracorporeal membrane oxygenation (ECMO), which oxygenates the blood.
Critical Care and Cardio-respiratory The Critical Care and Cardiorespiratory (CCCR) division comprises the clinical specialties of Cardiothoracic, Respiratory, and Critical Care services, as well as the Children’s Acute Transport Service (CATS). The division includes six highly specialised NHS services: Paediatric Extracorporeal Membrane Oxygenation (ECMO), Neonatal ECMO, Bridge to Transplant, Cardiothoracic Transplant, Pulmonary Hypertension and Tracheal Services.
“The staff at GOSH took the time to allow my husband and I to process how sick our little girl was and explain the procedure and the potential complications,” says mum, Natalie.
“ The team at GOSH worked tirelessly to ensure that Ella had the best care.”
The team successfully operated on Ella that day: “Over the next few days, the team at GOSH worked tirelessly to ensure that Ella had the best care. Specialists were called in from other departments to ensure she would make the best recovery possible.” “There was accommodation so that we could be close to Ella. We were able to come and see her at any time along with other family members and we were informed all the time about her progress.” After 10 days, Natalie was able to hold Ella for the first time since she was born. “That was the happiest day for me. She’s now seven months old and has been given a clean bill of health. She is our little miracle.”
Key achievements • Implanted the first Heartware device on a patient waiting for a heart transplant, allowing the patient to be discharged home on the device. • Introduced a non-invasive ventilation (NIV) pathway to ensure the consistency and safety of the 270 patients currently on home NIV. • The Sleep Unit opened an additional cubicle and started to run a seven-day-a-week service. • The division established rapid-access clinics for Cardiology to allow urgent patients to be seen more quickly. • The division introduced ‘Patient at a Glance’, electronic boards displaying patient information aimed at improving flow out of the intensive care units. • CATS introduced a third retrieval team over the winter months to ensure more children were transported during the winter surge period.
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Surgery The Surgery division provides nine highly specialised surgical services: Cleft, Craniofacial, Maxillofacial, Ear, Nose and Throat (ENT), Plastic Surgery, Orthopaedics, Spinal, Urology, and Special Neonatal and Paediatric Surgery. It also provides Specialist Audiological and Dental services on a mainly outpatient basis. The Surgery division includes the department of Anaesthetics and an Acute and Chronic Pain Service. It runs 11 operating theatres, three interventional radiology theatres and a procedure room on Magpie Ward.
Key achievements • The division established a new anaesthetic pre-operative assessment service, which opened in January 2015. All surgical patients will be screened through this service prior to general anaesthetic. • Work was undertaken with staff on Squirrel Ward to support and enhance leadership and team working so that it runs more effectively for the benefit of patients. • Puffin Ward, the same-day admission unit, had a very successful first year. They saw an increased number of patients and maintained a high-quality patient experience. The team introduced personalised fasting plans to reduce the length of time patients are without fluids. • Puffin Ward was recognised by Keele University for its outstanding work for patients with learning disabilities. • The entire surgical directorate team adopted the new electronic discharge summaries and maintained an improvement in the timeliness of completions. • Woodpecker Daycare Ward increased the number of beds from eight to 10 within the existing staffing structure and consequently supported an increase in daycare work.
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Reconstructive ear surgery using patient’s own ribs Surgeons at Great Ormond Street Hospital perform more ear reconstructions than at any other hospital in the UK. Between 35 and 40 procedures of this kind take place every year, five of which are bilateral reconstructions (both sides). Ten-year-old Kieran was born with bilateral microtia (a small or absent ear) and underwent surgery to reconstruct his ears in 2014. Consultant Plastic and Reconstructive Surgeon Neil Bulstrode carried out the six-hour operation using ears sculpted from cartilage in Kieran’s ribs. “The operation brings a significant improvement in quality of life,” said Mr Bulstrode. “The child’s confidence improves exponentially, as does their performance at school. If you can increase a young person’s confidence, you can alter their whole trajectory in life.” Before his operation, Kieran said: “I’ve always wanted big ears, and now I’m finally going to have them.” As soon as he woke up, Kieran’s parents Louise and David helped him to take a ‘side selfie’ of his new ears, and Kieran responded: “Wow.” Kieran returned to the hospital for a follow-up operation in February 2015 and three months on, his surgery was deemed a huge success. “It’s weird but I feel great,” said Kieran. “Mr Bulstrode is the best surgeon, as he made my wishes come true – I’ve got ears and can wear sunglasses!”
Gaining independence thanks to epilepsy surgery Sixteen-year-old Yona was on holiday with friends when she had her first seizure. Upon her return to the UK, she underwent an MRI scan and telemetry tests, which showed she had a form of epilepsy. “I was 13 years old and it was a lot to deal with,” says Yona. “I started taking medication, but I kept on having seizures.”
Neurosciences The Neurosciences division at Great Ormond Street Hospital (GOSH) provides services to children with conditions of the brain or eyes. The division also includes the General Paediatric team, the Clinical Site Practitioners, Corporate Outpatients and Bed Managers who provide pan-hospital support. In 2015, the division expanded further with the centralisation of all Psychology and Play Services into the Neurosciences division.
After the seizures became more dangerous, Yona’s doctor recommended she see the specialists at GOSH. “My first visit was quite daunting, but I remember walking up to Koala Ward and meeting all the nurses who were so nice and immediately put me at ease.” A series of tests to measure Yona’s brain waves showed that there was something in her brain causing the epilepsy. She had surgery to remove the cause, but a series of complications meant that Yona had to undergo three procedures.
“ The surgery has made a huge difference to my life...”
“My parents were able to stay with me in my room on the ward. It was reassuring to have them so close. GOSH even has special areas for different religions, including a Shabbat Room, which was important to me.” Thankfully, Yona’s third operation in December 2014 was a success. “The surgery has made a huge difference to my life – I haven’t had any episodes since then and I’ve been able to enjoy some independence. Since the surgery I’m much more positive about my future.”
Key achievements • The Child and Adolescent Psychiatry team received an ‘excellent’ rating for a recent Quality Network for Inpatient Child (QNIC) review. • The Psychology Services won an NHS England bid to create patient-centred outcomes. • The Children’s Epilepsy Surgery Service has commenced SEEG, a new method of minimally invasive monitoring of the brain, with two procedures performed to date. • The division implemented home telemetry in February 2015, which has provided a better patient experience, allowed more accurate recording of seizure patterns and helped release bed capacity. • The division introduced a new clinical nurse specialist post for Batten disease, the first in the UK. The post is hosted by GOSH and funded by the Batten Disease Family Association for a three-year period. • GOSH became a UK centre for surgery in retinopathy of prematurity, with a new collaboration with Oxford University Hospitals NHS Trust.
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Medicine, Diagnostic and Therapeutic Services The Medicine, Diagnostic and Therapeutic Services division encompasses the Endocrine, Metabolic Medicine, Gastroenterology, Adolescent Medicine and Renal specialties. It comprises many of the hospital’s supporting services, including Pharmacy, Radiology, Dietetics, Social Work, Psychology, Physiotherapy, Occupational Therapy, Speech and Language Therapy, Bereavement Services, Chaplaincy, Volunteer Services, Biomedical Engineering, Orthotics and Play.
Key achievements • The division introduced the Paediatric Gastro Ambulatory Unit (PGAU) where patients with inflammatory bowel diseases who require rapid access are assessed quickly and treatment started as appropriate. The success has allowed the team to manage patients more effectively. • The division reviewed the service model for lysosomal storage disorders to ensure the expertise is sustained across the Metabolic team. A robust model is now in place. • Imaging Services achieved the Imaging Services Accreditation Scheme from the United Kingdom Accreditation Service. This scheme is a mark of high-quality paediatric imaging services, and we are the only accredited paediatric service in the UK. • The division completed a review of the Psychology Service and proposed a new structure, moving all psychology services under one division. • Two departments developed their research capacity. The Radiology service employed two research radiographers to embed research skills within the service. The Metabolic service built six sessions of research time into the consultant rota to support research. • The division introduced extended working and service provision in Radiology to accommodate the Phase 2B building works. Consequently, they now provide evening MRI and nuclear medicine sessions every day.
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New treatment gives hope to ‘untransplantable’ children Fifteen-year-old Megan was born with kidney problems. She received a kidney transplant in 2011, but the organ was rejected by her body. Surgeons removed the kidney the following day and Megan was forced to undergo life-saving dialysis on a daily basis.
“ It was like Megan had come to life in front of our eyes.”
Megan was placed back on the transplant list, but her elevated levels of human leukocyte antigen (HLA) antibodies meant that the chances of her rejecting another kidney were high. Great Ormond Street Hospital (GOSH) Consultant Paediatric Nephrologist Dr Stephen Marks provided Megan’s family with an alternative treatment. He outlined a technique that flushed out HLA antibodies, which meant that Megan’s dad, Edward, who wasn’t previously considered a viable donor, could offer his kidney. After travelling to GOSH to have her antibodies removed, Megan successfully received a kidney transplant from her dad. Megan’s mum, Carol, said that it was “like she had come to life in front of our eyes. Her hair was glossy, her eyes were bright, she had colour in cheeks and she was the child that we should have had before.” Now, Megan’s immune system is almost up to full strength and she’s a happy, normal child. Carol says: “It was fantastic of Dr Marks to take us on. We were at our wits’ end and we felt like all avenues led to a brick wall.”
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“ Herbie was first and foremost in the minds of the staff...”
Bone marrow transplant to treat rare disease In December 2012, Herb was diagnosed with Nemo, a rare genetic disease that can cause infections and affect skin, teeth and hair. He received immunoglobulin replacement therapy – a blood infusion that provides antibodies needed to fight infection – and all seemed well, until sister Lily became very ill. A chest X-ray showed she had severe lung disease and, after various tests, Lily was also diagnosed with Nemo.
Infection, Cancer, Immunity and Laboratory Medicine The Infection, Cancer, Immunity and Laboratory Medicine division manages patients with cancer, infectious diseases, problems with fighting infections (immunology), rheumatology and dermatology. Great Ormond Street Hospital’s (GOSH) main laboratory services are part of this division.
Herb and Lily required bone marrow transplants to replace their faulty immune cells. Their siblings Rufus and Kitty were tested. Rufus was a match for Herb but not for Lily. “At that point, Herbie didn’t need a transplant,” says mum, Emily. “It was Lily who was ill.” Following several months of treatment, Lily started to get better. But by January 2014, Herb’s condition had worsened, and it was clear that he needed a bone marrow transplant quickly. The procedure took place in May 2014 and Herb spent 10 weeks on GOSH’s Robin Ward. “The staff were so caring and friendly,” says Emily. “Herbie was first and foremost in the minds of the staff, but they would always ask about our other children and make sure I was OK too.” Herb is now doing well, Emily says: “There’s still a lot of care but we can see the Herbie we knew prior to him becoming ill. The bone marrow transplant is still on hold for Lily, but she and Herb are seen regularly at GOSH.”
Key achievements • The palliative care foundation skills training course was delivered to more than 200 nurses within GOSH and externally. • Findings from a GOSH investigation were incorporated to improve governance of autologous (originating from the recipient) stem cell transplant, which had implications nationally. • The genetics service (clinical and laboratory) has been incorporated into the division. • A non-invasive prenatal testing and diagnostic service was implemented. • GOSH became a lead partner in the successful Genomics England bid. • The Haemophilia team received the National Institute for Health Research award for commercial trial activity.
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International and Private Patients The International and Private Patients (IPP) division treats children with rare and complex conditions from across the world. The division’s work helps maintain and grow the international reputation of Great Ormond Street Hospital (GOSH) as a world leader and provides a significant financial contribution to the hospital, enabling us to treat more NHS patients. The majority of our international patients are funded by their own government, as the treatments at GOSH are not available in their home country.
Key achievements • The division introduced ‘Nervecentre’ to both of its wards. The system enables staff to electronically record observations, therefore removing paper observation charts. It allows improved escalation and aids communication. • The division received recognition for middle-grade doctor posts from the Royal College of Paediatrics and Child Health. • The division reviewed ward rounds and introduced a standardised lean approach to improve efficiency, safety and ultimately clinical outcomes and experience. • The division developed and maintained strong relationships with key embassies in London and health ministries in referring countries. • The Arabic Interpreting team is now delivering a seven-day service, providing vital support to patients and their families. • The division worked in partnership with the School of Oriental and African Studies to develop a one-day Arabic cultural awareness programme. The trial received excellent staff feedback and future study days are now being rolled out Trust-wide and externally.
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Life-changing transplant for Essa Fourteen-year-old Essa was born with one kidney, which had not formed properly. When he was five years old, his kidney began to fail and he underwent a kidney transplant in the Philippines. But eight years later, Essa’s kidney function continued to decline and he required kidney replacement therapy with haemodialysis. After a recommendation from their local health office in Dubai, Essa’s family agreed to take him to GOSH.
“ I think of GOSH as our hospital... We’re not going anywhere else.”
Consultant Paediatric Nephrologist Dr Stephen Marks and his team decided that Essa would need a second transplant, and his mother was proposed as a donor. Unfortunately, Essa had a high level of human leukocyte antigen (HLA) antibodies, meaning that the likelihood of his body rejecting his mother’s kidney was very high. In order for Essa to receive his mother’s kidney without his body rejecting it, his HLA antibodies were removed using a blood filtering process. Essa’s transplant was successful. His recovery has gone well and his family have returned to Dubai, although they visit GOSH for follow-up appointments. “Since the operation, Essa has been absolutely fine,” says his father Ahmad. “He has been out and about with friends and has a normal life.” “The medical staff have been very good with us… I think of GOSH as our hospital and Dr Marks as our doctor. We’re not going anywhere else.”
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Participating in a clinical trial to help others Lottie, age 10, and her brother Ashley, age nine, have been coming to GOSH since 2014 to see Consultant Paediatric Nephrologist Dr William van’t Hoff. They are taking part in a new commercial clinical trial for children like them who have been diagnosed with X-linked hypophosphatemia (XLH) rickets. This genetic condition prevents normal levels of phosphate being maintained in the blood, and can cause pain, bending of the bones and poor growth.
Research Great Ormond Street Hospital’s (GOSH) strategic aim is to be one of the global leading children’s research hospitals. We work in partnership with our academic partner, the UCL Institute of Child Health, to find diagnoses, treatments and cures for some of the most complex and rare conditions that affect children. GOSH also has the benefit of access to the wealth of wider University College London research capabilities and platforms.
“Being on the trial is fun,” said Lottie. “The injection and blood tests only take a few minutes and then the rest of the time you get to do fun things.” Initially, Lottie and Ashley visited GOSH’s Somers Clinical Research Facility every fortnight for an injection that aims to maintain the phosphate levels in their blood. But a home care package means the family’s visits to GOSH are now every four weeks, which has reduced time away from school.
“Since being on the trial, Ashley is very energetic and Lottie can walk further...” 18 • Great Ormond Street Hospital for Children NHS Foundation Trust • Highlights 2014 /15
The trial is planned to run for more than a year. Every few months, Lottie and Ashley have physiotherapy assessments as part of the trial. Mum Gemma says: “They used to complain of leg ache a lot and they would stop frequently and take time to get going. Since being on the trial, Ashley is very energetic and Lottie can walk further, so we have definitely seen a difference.”
Key achievements • It was announced that GOSH would play a leading role in the co-ordination of a network of hospitals participating in the Genomics England 100,000 Genomes Project, an initiative to analyse the DNA of 100,000 NHS patients and their families. • GOSH saw continued growth in research activity, with more than 3,000 patients taking part in research. • GOSH’s investigators received awards from the National Institute for Health Research (NIHR) Clinical Research Network for their contribution to clinical research: Dr Ri Liesner as a Leading Commercial Principal Investigator, Dr William van’t Hoff for “delivering above and beyond”, and Professor Francesco Muntoni for “consistently delivering to time and target” and “first global or European patient”. • GOSH is committed to developing the next group of clinical academics and, through our NIHR Biomedical Research Centre, developed a comprehensive training programme, including the appointment of our first Clinical Academic Programme Lead Nurses and Allied Health Professionals. • GOSH has appointed our first Clinical Research Nurse Practice Educator, who will play a key role in further integrating research with clinical care.
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O ur people It is vital that the people who work at Great Ormond Street Hospital (GOSH) are trained, supported and valued in order to deliver the best possible care to our patients and families. Our challenge is to provide the environment and tools for everyone who works here to be exceptional, and for that quality to be demonstrated within every service we offer.
Key achievements • GOSH recruited 270 nurses, carefully selecting newly qualified and experienced nurses to provide the best care to our patients and families. • Against a backdrop of increasing temporary staffing costs in the NHS, the majority of temporary shifts for staff were filled by bank rather than agency staff, allowing us greater control of cost and quality. • GOSH launched the new NHS Staff Friends and Family Test. Three surveys took place in 2014/15: 94 per cent of staff said they would recommend the hospital as a place to be treated (compared to 77 per cent nationally), and 72 per cent would recommend it as a place to work (compared to 62 per cent nationally). • Our monthly and annual staff awards have been embraced by GOSH as a way to recognise the many people who live Our Always Values. We received almost 600 nominations from patients, families and staff for individuals across the organisation. • Our commitment to the health and wellbeing of our staff was reflected in the high take-up of services, including:
Who our employees are
Our Always Values On March 24 2015, we formally launched Our Always Values. This marked the culmination of an 18-month process in which we engaged with our patients, families and staff to create a set of values that guide everything we do. Our Always Values – Always Welcoming, Always Helpful, Always Expert and Always One Team – are underpinned by a set of behaviours. The values and the behaviour statements draw directly from the feedback we received so everyone can recognise and understand them. Prior to the launch, we ran leadership sessions that were attended by more than 220 of our key clinical and non-clinical leaders, including our Executive Directors. These sessions provided a clear explanation of how living Our Always Values will result in improved patient outcomes. We have embedded Our Always Values in staff appraisals, and are redesigning all of our recruitment processes to test applicants on their ability to demonstrate our values. We have already used them to help us recruit to our most senior and influential positions.
Administrative and managerial 787
Doctors and dentists 558 Non-clinical support 113
Nursing and scientific support 471
Scientists and therapists 611
Registered nurses 1,257
We will continue to work on a range of ways to further embed Our Always Values. As our staff become familiar with Our Always Values, we will increasingly be asking our patients, families and carers to help us recognise when we live our values, and when we could do better.
• More than 300 on-site staff physiotherapy appointments. • 174 staff contacting our 24-hour free and confidential counselling and advice service. • 500 members of staff participating in sports and social activities organised by GOSH.
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Education and training
Patient experience Great Ormond Street Hospital (GOSH) seeks to provide the best possible services to our patients and families. We engage with our patients and their families in order to help shape healthcare at GOSH so that it is appropriate to their needs and make improvements where we need to.
Education and training at Great Ormond Street Hospital (GOSH) are designed to ensure staff have the skills, knowledge, attributes and confidence to provide high-quality, safe and effective care. The Trust made good progress against key educational priorities in 2014 /15.
Key achievements Key achievements
• We launched Our Always Values, a new set of values and behaviours reated through active engagement with patients, families and staff (see page 22). They will be a key driver to ensure we consistently provide an excellent experience for our patients and families.
• Postgraduate Medical Education (PGME) addressed the challenges of accessing learning for junior doctors by launching new intiatives. Educational Supervision accreditation rates rose from 35 per cent to 92 per cent thanks to support and training for portfolio completion.
• We continued to implement improvements in the service we provide to our patients with learning disabilities, including an alert system to enable staff to plan more effectively and make reasonable adjustments for those with a learning disability. We developed online information and provided relevant training to staff, which increased staff confidence in supporting patients with learning disabilities.
• Working with London South Bank University, GOSH developed an accredited child health-specific education programme for Healthcare Assistants (HCA). The team were also commissioned by Health Education North Central and East London to develop a pilot for HCA Care Certificate for caring for children and young people.
• We expanded the Friends and Family Test to include all inpatient areas, and started to roll it out to outpatient and day care areas. In March 2015, the response rate was 34.9 per cent and 97 per cent of families said they would recommend GOSH.
• Allied Health Professionals and scientists undertook Masters programmes in advanced clinical practice, specialist clinical courses in therapies and train-the-trainer programmes. A number of staff have shared their work at conferences.
• Market research company Ipsos Mori conducted a biannual independent telephone survey of patients and their families’ experiences of our outpatient care. Overall, 95 per cent of patients and their families were satisfied with their outpatient experience (94 per cent in 2012), and 95 per cent were likely to recommend GOSH to friends or family members (96 per cent in 2012). Trust and confidence in staff in the Outpatient department was high at 97 per cent.
• GOSH continued to innovate the delivery of mandatory training by offering a variety of methods to complete learning. • GOSH’s Leadership Pathway continued to offer leadership development tailored to staff. In total, 1,019 places were taken across all programmes. • Twenty-seven apprenticeship places were commissioned for existing staff, and seven new apprentices began employment. Since our Apprenticeship Programme began in 2012, 32 new apprentices have joined GOSH. The Trust was ‘Highly Commended’ for this work at the 2015 Camden Business Awards.
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Nine-year-old Anthony on Elephant Ward.
• The number of patients/parents having to cancel/rearrange their appointments reduced by 10 per cent to 46 per cent. The number of appointments cancelled by GOSH staff fell by six per cent to 41 per cent.
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Measuring the quality of what we do The people who work at Great Ormond Street Hospital (GOSH) strive to improve the quality of the healthcare they provide for the hospital’s patients. We can measure all aspects of this care, including: • how safe our hospital is • the effectiveness of our clinical care • the experience of our patients We routinely monitor these aspects against established measures to determine how well we are doing and identify areas for improvement. We are committed to transparency about the quality of our services and to continuous improvement in all we do.
Key achievements • The number of hospital-acquired grade three pressure ulcers has reduced from seven in 2012/2013, to three in 2013/2014, to zero in 2014/2015. There have been no grade four pressure ulcers in all three years. • GOSH reduced the number of central venous line (CVL) infections, from four per 1,000 line days in 2007/08, to two per 1,000 line days in 2011/2012. In 2012 and 2013, we introduced extra interventions that could help drive down infection rates further. In 2014/15, there was a sustained decrease in infections, with the rate down to 1.4 per 1,000 line days. • GOSH made clinical outcomes more accessible to the public, adding 47 outcomes across 17 clinical specialties to our website. Further progress was made to find new ways to measure our outcomes with our peers.
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Quality priorities
Over the next year, we aim to align all our improvement work with the Trust’s quality standards. Using these as our measurement, we will be able to see where are efforts are applied and identify where further work needs to be done.
In this year’s report, we highlight the ways in which we measure safety at the hospital.
Quality standards Safety Zero harm
Clinical effectiveness Demonstrate clinical outcomes
• Standard 1 Develop a strong governance structure for Quality and Safety with a systems approach.
Experience Deliver an excellent experience
• Standard 2 Maintain high levels of medication safety. • Standard 3 Decrease and eliminate hospital-acquired infections.
Safety We are committed to reducing avoidable harm and improving safety year on year and as rapidly as possible. Our Zero Harm programme aims to ensure that every patient receives the correct treatment or action the first time, every time. We are keen to move on from retrospective measurement and use the Vincent framework for safety measurement and monitoring (building on the model from the Health Foundation). This framework will support the Trust’s approach to monitoring safety and will help us to better understand what it means to be safe within our organisation. This framework will also support local safety discussions, which will focus on four key questions: • What has happened?
• Standard 4 Improve reliability in handover of clinical information at all interactions.
Past harm
• Standard 5 Eliminate all pressure injuries occurring in hospital.
Integration and learning
• Standard 6 Recognise and respond to unexpected deterioration of children and young people.
Reliability
• Standard 7 Decrease unnecessary delay in all processes in the patient journey.
Safety measurement and monitoring
• Standard 8 Develop clear measures of clinical outcomes to provide evidence of Top Five Children’s Hospitals status. • Standard 9 Measure and continually improve the experience for children, young people and families.
Anticipation and preparedness
• Standard 10 Provide equal access to all children and young people who need our care.
Sensitivy to operations
• Standard 11 Accelerate standardisation of clinical care.
• What should happen? • What do we anticipate will happen? • What needs to be done?
The Vincent framework for safety measurement and monitoring.
• Standard 12 Develop reliable and accurate documentation of care.
Great Ormond Street Hospital for Children NHS Foundation Trust • Highlights 2014 /15 • 25
Our buildings Our redevelopment programme is replacing cramped, outdated buildings with new facilities that match our world-class paediatric care and research. We are also planning for the future to meet growing demand for our services and support the increasing complexity of specialised care.
Phase 2B
Phase 3A
Premier Inn Clinical Building
The Centre for Research into Rare Disease in Children
In June 2014, Skanska commenced deconstruction of the Cardiac Wing to make way for the Premier Inn Clinical Building, opening in 2017. The new building will connect to the Morgan Stanley Clinical Building that opened in June 2017 to complete the Mittal Children’s Medical Centre. Once finished, the centre will house a new surgery centre and high-specification acute facilities, with space for a parent or carer to stay comfortably by their child’s bedside.
Masterplan 2015 During 2014, a review was undertaken to ensure the hospital is on track to maximise on-site opportunities and support clinical and research activity. Masterplan 2015 has identified the Frontage Building site as the next phase for development (Phase 4), with the potential to provide additional beds, outpatient consulting rooms, diagnostics and clinical procedure areas, patient welfare facilities, and extra research, teaching and education space.
Where our money comes from Education and training £8,325
Other income £27,050
Research and development £16,685 Non-NHS patient care income £46,115
£000s
Plans to create a world-leading new Centre for Research into Rare Disease in Children are on track. The centre is being developed as a partnership between GOSH, University College London and Great Ormond Street Hospital Children’s Charity. Situated adjacent to the hospital, it will incorporate an outpatient department caring for children and young people with a range of rare and complex conditions. It will also house laboratories and workspace for experts to develop diagnostic procedures, manufacture gene and cell therapies, and create personalised medical devices.
NHS patient care income £299,083
How we spend it The figures below do not include impairments resulting from property valuations.
Other £32,457 Depreciation £17,800 Premises £26,425
Staff £200,993
Research and development £14,823
We received town planning consent in March 2015 and demolition of the existing disused office block on the site of 20 Guilford Street has commenced. The building is scheduled to open in 2018.
26 • Great Ormond Street Hospital for Children NHS Foundation Trust • Highlights 2014 /15
Our finances
£000s
Other clinical supplies and services £50,561
An artist’s impression of the Centre for Research into Rare Disease in Children.
Medicine £40,610
Great Ormond Street Hospital for Children NHS Foundation Trust • Highlights 2014 /15 • 27
Great Ormond Street Hospital Board of Directors 2014 /15
Great Ormond Street Hospital Foundation Trust Members’ Council
Non-Executive Directors
Trust Board Executive Directors
Baroness Tessa Blackstone BSc (Soc) PhD Chairman of the Trust Board and Members’ Council
Dr Peter Steer MBBS FRACP FRCP FAAP GAICD Chief Executive from 1 January 2015
The role of the Members’ Council is to provide challenge to the Trust Board and hold the NonExecutive Directors individually and collectively to account. They ensure that the views of the hospital’s patients and wider communities are heard and reflected in the strategy for the hospital. Councillors represent specific constituencies or stakeholder groups and are elected or appointed to do so.
Mr Charles Tilley FCA FCMA CGMA Non-Executive Director and Deputy Chairman Ms Mary MacLeod OBE MA CQSW DUniv Non-Executive Director and Senior Independent Director Ms Yvonne Brown LLB Solicitor Non-Executive Director Mr David Lomas Non-Executive Director and Chairman of the Finance and Investment Committee Mr John Ripley Non-Executive Director until 27 March 2015 Professor Rosalind Smyth CBE FMedSci Non-Executive Director
Mr Julian Nettel Interim Chief Executive until 31 December 2014 Mrs Claire Newton MA (Cantab) ACA MCT Chief Finance Officer Mrs Elizabeth Morgan MSc RN Adult RN Child RNT RCNT Dip N IHSM Diploma Chief Nurse
In February 2015, the Trust held an election for the council’s second three-year term of office.
Professor Martin Elliott MB BS MD FRCS Co-Medical Director
Election results for newly elected and re-elected councillors, including our appointed councillors
Mr Ali Mohammed Director of Human Resources and Organisational Development
Six councillors chose not to nominate for re-election.
Ms Rachel Williams Chief Operating Officer
John Charnock Parents or carers from outside London Lynne Gothard Parents or carers from London
Dr Catherine Cale MB ChB PhD MRCP FRCPath MRCPCH Interim Co-Medical Director
Ian Lush North London and surrounding area (and Lead Councillor)
Mr Akhter Mateen Non-Executive Director from 28 March 2015
Lewis Spitz North London and surrounding area Louise Clark South London and surrounding area Dhimple Patel Staff
Seven-year-old Jessica on Safari Ward.
28 • Great Ormond Street Hospital for Children NHS Foundation Trust • Highlights 2014 /15
Edward Green* Patients outside London
Simon Hawtrey-Woore*** North London and surrounding area
George Howell* Patients outside London
Gillian Smith*** South London and surrounding area
Sophie Talib** Patients from London
Stuart Player** Rest of England and Wales
Susanna Fantoni*** Patients from London
David Rose*** Rest of England and Wales
Matthew Norris** Parents or carers from London
Jilly Hale** Staff
Lisa Chin-A-Young** Parents or carers from London
Clare McLaren** Staff
Mariam Ali*** Parents or carers from London
James Linthicum** Staff
Claudia Fisher** Parents or carers from outside London (and Lead Councillor)
Rory Mannion*** Staff
Camilla Pease** Parents or carers from outside London Carley Bowman*** Parents or carers from outside London Trevor Fulcher** North London and surrounding area Rebecca Miller** North London and surrounding area
Prab Prabhakar*** Staff Jenny Headlam-Wells** London Borough of Camden Christine Kinnon** UCL Institute of Child Health Olivia Frame self management uk Muhammad Miah** The Children’s Hospital School at Great Ormond Street Hospital and University College Hospital
Mary De Sousa*** North London and surrounding area *Elected uncontested to serve a second three-year term. **Re-elected to serve a second three-year term. ***Newly elected to serve a first three-year term.
Great Ormond Street Hospital for Children NHS Foundation Trust • Highlights 2014 /15 • 29
Great Ormond Street Hospital for Children NHS Foundation Trust Great Ormond Street London WC1N 3JH gosh.nhs.uk facebook.com /GreatOrmondSt twitter.com /GreatOrmondSt
Thank you to everyone who was interviewed for, or gave permission for their picture to be used in this report, as well as the many members of Great Ormond Street Hospital staff who helped during its production. This Highlights Report is available to view at gosh.nhs.uk
Cover: One-year-old Delilah on Giraffe Ward.