Connections Summer 2019 by Isle of Man Department for Enterprise

A newsletter for the 2,500 people who work and volunteer at Noble’s Hospital, Ramsey Cottage Hospital and the Isle of Man Ambulance Service - sharing information, marking achievements and highlighting strong teamwork Published by the Department of Health and Social Care Crookall House, Demesne Road, Douglas

Connections

Summer 2019

Chief Secretary spells out the health and care change agenda gramme is being led by the Island’s most senior civil servant Chief Secretary Will Greenhow. Here, Will writes about the challenges ahead for our health and care service, and in particular our hospitals.

ur greatest asset as an organisation is our staff. So it was pleasing Sir Jonathan’s report began by recognising something we already knew: we have a talented, compassionate and committed workforce with staff that strive to provide the best care possible, and who believe patients and service users should be at the heart of everything we do.

Chief Secretary Will Greenhow In May, Sir Jonathan Michael published the final report of his independent review into the Isle of Man’s health and social care system. It concluded that the current system is clinically and financially unsustainable, and called

for a fundamental transformation of the way services are provided in future. The transformation process began after Tynwald accepted Sir Jonathan’s report in its entirety. A transformation board with a political mandate to deliver the pro-

The report looks ahead to 2035 and asks what model of health and social care will best suit the Isle of Man. Clearly, given rising demand, we must use funds wisely to ensure maximum benefit for the people of the Isle of Man. The report outlines the steps needed to create sustainable, fully

integrated health and care services that will provide for future generations. It makes clear that a top-tobottom transformation is needed – this will take up to five years to implement but will ultimately enhance the system you, as professional healthcare workers, operate in. Acute focus for hospital Let’s look at themes relevant to hospital-based services. We’re told the Island has an ideal opportunity to provide integrated services – in fact, the report says that if the Isle of Man can’t make this work for a population of 85,000, then nowhere can! That will mean fewer centralised services and more community-based care, provided as close to the individual’s home as possible – something we know the public wants too. At present the Isle of Man provides a higher proportion of planned care in hospitals than is the case in

contd on page 2...

Connections Summer 2019 the start that we cannot over-burden staff already busy doing their day job, but your support and advice will be crucial. A dedicated team is being put together to move this huge project forward so that our health professionals can get on with what they do best.

Sir Jonathan Michael other healthcare systems – despite this being the most expensive and least appropriate place to deliver some of these services. We know that the patient ‘journey’ through our current system is longer and more costly than it should be, and we cannot allow this to continue. So, as the integrated care project expands, we’ll see much more collaboration among providers in the community, so that with your help, they can offer people the help they need in the right place at the right time. This in turn will ease pressure on hospital services, freeing-up hospital staff to deliver improved and timely acute care – reducing waiting times and ensuring quality targets are met. Now you’ve read about the Transformation programme, why not get involved? The team is putting together a bank of expertise drawn from the public

New approach to out of hours care Another key issue for the Transformation team is the lack of a single centre for out-of-hours care. Our current system sees GPs staff the MEDS service alongside the Emergency Department at Noble’s, plus care available at the MIU in Ramsey – a set-up which may be unsustainable. A stand-out recommendation from the report is the establishment of a 24/7 air bridge so that patients can be stabilised locally before being moved quickly and safely to specialist centres in the UK. Crucial need for data

on the DHSC’s activities. This is vital to see if we are achieving good outcomes for the sums spent. Looking at the bigger picture, the report recommends that a new operational body is created to focus on the delivery of care – separate from the body that makes decisions on policy, strategy and spending. This new organisation, possibly named Manx Care, will be at arms’ length from the Department – separating the two functions, to provide an entirely new model of health and care delivery for many years to come. A strong will for change

As well as these specific areas, there are systemic issues to tackle – such as the need for better quality data

As the Transformation project gathers pace, we will begin to see changes on the ground, and some of these may affect you. We have been quite clear from

service, so when needed, they can call on colleagues’ individual skills, knowledge or experience. This is an exciting opportunity to help drive one the defining programmes of this government and develop your

career at the same time! The team is actively looking for practitioners and managers in health and care, as well as project managers, business managers, engagement facilitators and people with an under-

You may wonder how this project will succeed where other such reviews have been left to gather dust. It’s a fair question. Health and Social Care Minister David Ashford is determined Sir Jonathan’s report will be acted upon; he chairs the Transformation political board which is overseeing the development of work streams and projects as I write. My responsibility to steer this high priority piece of work is a clear indicator there is a collective will to act. We share a sense of positive anticipation driven by the knowledge that our current system will buckle under pressure if we do nothing. I am always willing to speak to staff, to hear suggestions and listen to concerns, so please feel free to contact me if you would like to discuss any aspect of this game-changing programme further. Will.Greenhow@gov.im standing of health and care finance. Please contact Clair Barks, Head of Health and Care Transformation to discuss the opportunities - email clair.barks@gov.im

Connections Summer 2019

PPU consultation data to be crunched

public consultation on one of the most complex projects ever undertaken at Noble’s Hospital - the redevelopment of private medical services - closed on 1 July after a two-week extension.

The outcome will influence the model chosen for provision of private healthcare in the Island in the future. Three options are on the table: a partnership between DHSC and a third party; outsourcing the operation in whole or part to a private sector operator; or setting up a new-look inhouse private offering. The views of those who’ve made use of the

PPU will be crucial in shaping the future offering. The exercise also aims to capture the views of potential clients who haven’t used private health services in the past, but may be willing to in the future. Island businesses, clinicians, health workers, politicians and a variety of interest groups have provided a wide spectrum of views – making the job of crunching the feedback far from straightforward. A number of private sector firms in the field have visited the Island since January and if a third party provider is to be part of the solution, a formal tender process will begin with a view to awarding a contract later this year.

Humanist celebrant joins Chaplaincy team By Vicky Christian Chair, Isle of Man Freethinkers

ou may have read about the recent arrival on the Hospital Chaplaincy Team of a non-religious pastoral supporter, and I would like to share with you the background to this exciting development.

Isle of Man Freethinkers, the local group for those who do not have a religious faith, have been committed for some time to seeking to provide pastoral support to non-religious people, just as religious people have such support from the existing hospital chaplains. Many patients, staff and visitors will really benefit from the provision of non-religious support. We

believe it is important for people to have the option to receive care from someone of like mind at a time of crisis. Although non-religious people believe that this is the one life they have, they may face the same fears, hopes anguish, sense of loss and bereavement as religious patients. As part of our shared humanity, they need and want appropriate care and support. From the start, the Lead Chaplain, Reverend Philip Frear has been very supportive of our aim to provide such care, and so I am absolutely delighted to join his team. In due course, we will have volunteers who will be able to offer this service to patients in other health care settings as well as Noble’s Hospital. Thank you very much all those members of staff who have sent welcoming emails and greeted me warmly since the

Vicky Christian announcement. I look forward to meeting you in the course of the next few weeks.

Vicky is a Humanist celebrant and has been a hospital volunteer since 2009.

Connections Summer 2019

Interim director’s rallying call to hospital staff

t’s a difficult circle to square: meeting increased demand and rising public expectations at the same time as driving performance improvement and developing new services.

The healthcare landscape is crowded with opportunities and pressures. We need to save, we need to invest. We want to deliver more but cannot rely on ever-increasing funds. It’s a tough set of challenges for Interim Director of Hospitals John Coleman. . John moved to the Island to take up the helm in Hospitals’ Directorate in January 2019, having been recommended to the Department by NHSI. John has worked at large number of NHS Trusts & Health Boards in England and Wales at senior and executive level in transformational turnaround. He’s made it clear that every member of staff can play a part in achieving the government’s ambition to become the best small island health and care system anywhere. The dimensions of his remit are far-reaching from overseeing a review of staff job plans to a service-by-service analysis of spending and performance. All this with no let-up in efforts to improve patient safety, recruit and retain a skilled and committed workforce and ensure professional standards are met. We invited John to talk about the role in his own words.

John Coleman Q: What were your first impressions of Noble’s and Ramsey Cottage Hospitals, in terms of services and facilities, and staff morale? A: I thought that the estate was extremely impressive. To me, part of coming to work is the environment in which you work. Staff morale seemed fair and in some places good. Although it felt as though there was work to do in order to make Hospitals an employer of choice.

Q: You were brought in as a ‘turnaround’ expert, to reduce costs at the hospital, which has been notoriously overspent in recent years, and help the DHSC come in on budget. What attracted you to this formidable challenge? A: Having undertaken this role across a number of NHS Trusts, the challenge was one that I was extremely excited to be part of. Having met with the CEO and deputy CEO in London and being given

an idea of the remit it was a challenge I wanted to accept, as I felt that it was achievable within a certain time period Q: It must have been a steep learning curve; what surprised you most when you took up the position as interim Director of Hospitals? A: In all honesty, it felt very similar to a number of NHS Trusts I had worked in previously. The issues were and are identical. At times you have to go back to basics and reintroduce the various standards across departments. This in turn lifts expectations and improves outcomes, which also reduces cost. This is where we started, with the introduction of the Internal Professional Standards. Q: What issues and challenges do you face running a general hospital for a small population – have you come across a system like the Isle of Man’s elsewhere? A: Some of the challenges are unique. One that is very noticeable is single handed consultant roles. If that particular member of staff is off or on leave they have to be covered by a Locum doctor. Recruiting to the island has historically been problematic - though we are now seeing a really positive reverse of this, with high numbers of consultants applying for any posts we advertise. This is great news. Q: The recent independent review into health and social care in the Island has concluded the current system is

Connections Summer 2019

L-R: Lesley Treadway, Ann Daugherty, Michael O’Neill, Christine Jeremiah, Leslie Fairbrother and Lydia Kotoka

Year of Giving Generously at Theatre department

oing something for others less fortunate than ourselves is all part of the Christmas spirit.

But how many of us continue to spare a thought and continue giving once the festive season is over? Instead of sending cards last year, staff in Recovery and Main Theatre decided to donate to the Isle of Man Food Bank, and throughout

financially and clinically unsustainable in the long term. How do you see healthcare developing here over the next decade? A: The review calls for a full review of services that we currently provide in the hospital setting. The outcome from this will be that many of the services we currently provide in the hospital will in future be provided in the community or shift into the Primary Care setting. This is how we will fully integrate our services, providing care at or closer to the patient’s own home.

December, they collected items for distributing to local families in need. Tremendous support from colleagues around the hospital inspired the team to extend its goodwill across the year, so they kept the collection going, donating to the Food Bank on a monthly basis. Recovery nurse Diane Batty said: ’None of us wanted to stop collecting for the Food Bank. It’s so

Q: What changes that you are responsible for have made a positive difference so far – to patient care and to the efficient running of the hospital? A: We have implemented Internal Professional Standards across the Hospital. These have assisted in improving the 4 hour target performance from circa 70% to 91% in 6 months. Length of stay is reducing across the hospital. This is in stark contrast to the trend in England and the NHS. We now have 4 Care Groups and a Clinical Board that manages the hospital oper-

easy to pop a few extra few items into the shopping trolley and bring them into work, knowing that together we can make a real difference. We have two boxes in the staff room, one for items of food with a long shelf life and one for toiletries. If anyone wishes to contribute please feel free to drop them off at Theatres Reception.’

supported in 2017 - on both occasions ideas were discussed and put to the vote.

The Food Bank is quite a departure from the Toilet Twinning project the staff

Summer holiday food poverty, when stretched families have children at home, has been recognised as presenting problems as acute for some, as at Christmas. So we salute theatre and recovery staff for their year-round commitment to keeping a focus on the needs of fellow citizens facing hard times.

ationally. This is proving very effective. Q: Recruiting and retaining specialist doctors is a problem at many UK centres; in the Isle of Man, more so, as taking up a job means a major move for the individual and their family. What is our ‘X Factor’ when trying to grab the attention of potential new recruits? A: The Isle of Man just like any other region of the UK, has the same difficulty in recruiting, that is true. One of the things that we can show to prospective employees is the fantastic working environment,

training facilities that are all on site and the level of support given to new recruits and permanent staff alike. My understanding is that the schools are excellent on the island and this coupled with pretty much zero crime, means that the island would be a great place to bring up young children. The whole package would be difficult for any hospital across to beat. We have also recently commissioned the making of new videos showcasing the island and hospital, featuring some of our long standing senior doctors.

Connections Summer 2019

New Pharma post breeds hope for drug resistance battle We would be mistaken to think the Isle of Man is beyond the reach of this global problem. Increasingly, at our laboratory at Noble’s, resistant microorganisms are being isolated as a matter of course, and our links with hospitals across increases the risk of inviting the more cosmopolitan varieties into our midst.

By Matt Davey Antimicrobial Pharmacist

t was in March last year that I first visited the Isle of Man.

Two months earlier, while tussling with a pile of prescriptions, a colleague called me over to view something on his computer screen. “You should apply for this” he said, half-jokingly. The advert was for a new position at Noble’s Hospital, that of antimicrobial pharmacist. I suspect he imagined the Island was a place where I’d feel at home, far from the madding crowd. Not being a fan of social events, nor easily lured by cosmopolitan life, had gained me a reputation for being something of a closed book. Of course, these foibles don’t fit me for life in the Isle of Man, which is certainly not the remote enclave

my friend imagined it to be. Nevertheless, the ad caught my attention, and for my friend’s interruption I was grateful. I had been working as an antimicrobial pharmacist for two years at a district general hospital not dissimilar to Noble’s in the south west of England. I’d been there for eight years and it was time to move on. I needed a new challenge, and starting from scratch in a brand new position with a clean slate, in a unique environment like the Isle of Man, seemed to fit the bill exactly. I decided to apply. In May I was invited to an interview, and at the end of August, I found myself moving to the Island to start work in September. The creation of this position at Noble’s demonstrates that the issue of antimicrobial resistance is now being recognised for what it truly is - one of the

most pressing healthcare challenges of our day. Bacteria, viruses, fungi, and even parasites are forever developing ways to survive exposure to the drugs designed to eradicate them, and we are rapidly running out of options for treating the infections caused by these organisms. To understand the gravity of the situation, consider the critical role of antimicrobials in modern medicine: the majority of surgical procedures and cancer therapies for instance, would be too hazardous to attempt without effective antimicrobial drugs. Their arrival on the commercial marketplace in the middle of the 20th century brought about a seismic advance in medical care. Now, this advancement is being undermined by decades of antimicrobial overuse, and chronic underinvestment in the development of new antimicrobial agents by the pharmaceutical industry.

From international data, we know that those nations which consume the highest volumes of antimicrobial drugs also experience the greatest incidence of resistant infections. The reason is self-evident: where antimicrobials are used, microorganisms will be busy developing ways to survive their onslaught. Thus, if the burgeoning spread of resistance is to be reined in, great care must be taken to ensure that these critical drugs are used only when absolutely necessary – a task which is easily stated, but not so easily accomplished. For me, one of the chief frustrations of working in the UK was that the structure of the health service – the way it’s composed of multiple disparate organisations - is not conducive to working collaboratively towards eliminating systemic problems such as the inappropriate prescribing of antimicrobials. I am optimistic that things can be different in the Isle of Man. The structure of the healthcare system here is much simpler, and by pursuing a truly effective integration of primary and secondary healthcare sectors, I believe that meaningful change is possible. It is vital to ensure that antimicrobials are used in an informed and intelligent way. This means identifying the specific microorganism

Connections Summer 2019

Global impact

Aggravating factors

In 2016, over 700,000 deaths worldwide were caused by drug resistant microorganisms. Without radical action to slow the trend, this number is predicted to increase to an annual count of 10 million by 2050 – more people than currently die each year of cancer. The problem comes with a significant economic burden associated with the problem. Published data reveals that some resistant organisms cost twice as much to treat compared with those sensitive to first-line drugs, and the cumulative cost to global economic output, assuming continuation of the current trajectory, will likely reach a staggering $100 trillion by 2050.

A number of socio-economic factors converge to compound the problem of antimicrobial resistance. These include: an ageing population; an upsurge in global travel; an increase in the availability of antimicrobials, especially in developing countries where their supply is often unregulated; the gratuitous use, still evident today in some parts of the world, of antimicrobials as growth promoters within agriculture; and, most decisively, a highly profit-driven pharmaceutical industry which, due to the relatively low returns associated with antimicrobial drugs, has typically invested its research and development resources elsewhere.

responsible for the infection and then using an antimicrobial which will specifically target it. If the correct drug is selected, an adequate dose administered, and the full treatment course completed, the chances of the target microorganism sustaining a fatal blow are enhanced. Reducing the spread of resistance depends upon many agencies playing their part, and as this is a global problem, cooperation is needed across national boundaries. This point was made by then Prime Minister David Cameron at a meeting of the G7 nations in Brussels in 2014, and since then the review which he commissioned has resulted in a plan of remedial action.

Consultant Microbiologist Rizwan Khan and Matt Davey in the laboratory

Accordingly, only a handful of new antibiotics have entered the market over recent decades – a stark contrast to the stream of novel anti-cancer therapies which has continued to run at a near constant pace throughout the same time period – and drug discovery has therefore not kept pace with the development of resistance.

Biomedical scientists Chris Helm and Jenny Barks Suggested interventions include incentivising antimicrobial-related R&D in the pharmaceutical industry; reducing the spread of infection by improving sanitation and access to vaccinations; reducing the unnecessary use of antimicrobials in agriculture; and improving international surveil-

lance of antimicrobial consumption and resistance. Data from the UK’s surveillance programmes and those carried out by the World Health Organisation and the European Centre for Disease Prevention and Control, provide us with a useful benchmark. In view of the

self-contained nature of our healthcare system, and our motivated workforce, I see no good reason why we should not aspire to lead the world in the stewardship of antimicrobials. This is my ambition for the Island, and the vision with which I hope to inspire others.

Connections Summer 2019

Digital request system is just what doctor ordered

igital order comms has become business as usual at Noble’s - and is delivering a major efficiency dividend.

With 22,000 test requests to the blood clinic made in January and February, online requesting is saving time at the order stage and at the point of sample testing. Across all disciplines, the project has produced a 75% reduction in rejections, overcoming problems caused by illegible hand writing on forms and sample labels. Order Comms is one of DHSC Digital’s ‘Big 5’ projects and has involved the complex interface of separate IT systems, ensuring enhanced transfer of essential patient information. Installation has been completed in-house following two pilot runs. The Department’s

Gregor with iPads for the clinical assessment and noting project Chief Clinical Information & Digital Officer Gregor Peden said: ‘This is a long overdue project but we have now caught up with UK hospitals and are seeing the benefits of digital requesting, which make the

process quicker, safer and more efficient.’ Now that electronic requesting is embedded we are close to implementing electronic filing of results. Once the paper reports have been switched off we

will save around 750,000 sheets of paper per year. Roll-out of digital clinical assessment and noting – the biggest of the five projects – began this spring and is expected to save 7000 sheets per day.

Welcome boost for Noble’s in

hen Manx health issues are covered in the UK media, we get to see how we’re seen from the outside. What makes our healthcare system different from elsewhere makes it newsworthy. A case in point in this month’s Nursing Times, where an article focusing on the Integration and Transformation agendas highlights unique opportunities for career-minded nurses. §Reporter Gemma Mitchell visited the Island for her research, interviewing DHSC Minister David Ashford, nursing staff and managers in

the hospital and community, along with the department’s HR partner. I n an article tagged ‘Exclusive’, Mitchell portrays a health system on the brink of long-term and progressive change, suggesting the Island has every chance of success, where larger-scale efforts have stalled elsewhere. The article highlights the appointment of a new Director of Nursing with a seat at the executive leadership table, in line with the minister’s ambition to increase nurseled services, in turn offering expanded roles for those who are enthusiastic about health and social care integration. The arms-length organisation Manx Care, when in place,

may be ‘an exciting lever for ambitious nurses’ – and it could also prove an asset in future recruitment efforts.

million miles from the bustle of the NHS [across]’ could well pique interest among readers.

The slogan ‘Step away from NHS pressures’ has been used in recent off-Island job advertising, and Mitchell’s impressions of the reality of life in the Island’s only acute hospital back it up, in precious editorial form. A snapshot it may be, but Mitchell lives and breathes daily NHS life and her impressions of ‘walking along the near empty corridors of Noble’s on a Friday afternoon’ and feeling ‘a

Testimony from several Noble’s nurses alongside references to nurse education, relocation packages and other benefits for new arrivals add to a positive, prominent item about Noble’s in the UK’s leading independent nursing publication. Check out the article online at the periodical’s website https://www.nursingtimes.net search for the Isle of Man.

Connections Summer 2019

Senior clinicians drive board-level governance By Marian Kenny Communications Executive

management shake-up has transformed the body which leads the running of the Island’s hospitals, the Clinical Board.

Directors of reorganised care groups were announced earlier this year and as part of a wider transformation, these senior professionals will report directly to the Clinical Board. ENT consultant Neel Umapathy heads the Women’s and Children’s Division and has also undertaken a role promoting culture and values across the organisation. Consultant orthopaedic surgeon Ian Wright takes the lead in Scheduled Care, while consultant physician and geriatrician Dr Ishaku Pam has the corresponding role in Unscheduled Care. The line-up is completed with consultant anaesthetist Dr Adrian Dashfield heading-up Diagnostics and Clinical Support. The Clinical Board is chaired by Medical Director Dr Tim Kerruish who said: ‘This is a turning point in clinical governance and in big-picture terms means front-line clinicians will co-design how our hospitals are run. We have a clear mission: to ensure the delivery of high quality, safe and efficient patient-focused care, within budget, so that we become the best small island health and care system.

L-R: Neel Umapathy, Ian Wright, Adrian Dashfield, Ishaku Pam This is an ambitious mission and rightly so, and our new-look Clinical Board is specifically designed to deliver on it. Our approach directly addresses criticism of ‘top down’ management in the past. It ensures key decisions are clinically advised.’ Alongside clinical leads, the Board comprises the Director of Hospitals, the heads of Nursing, Therapies and Midwifery, the medical directors for safety and quality, HR and GP reps, and the head of Patient Care, Quality & Experience. A vacant place at the table for a lay member is expected to be filled soon. I was invited to a board meeting as an observer, and witnessed focused, informed discussions on a range of issues from waiting lists to webinars. Clinical leads shared news, views and concerns from their areas in Care Group Updates, a standing item on the agenda. Immediate issues were dealt with as consensus was reached, alongside debate on topics needing a more

strategic approach. While concerns around resources, recruitment, workload and training were expected, refreshingly there was much talk of doing things differently – looking for innovative solutions to problems, for better outcomes. Suggestions here ranged from the value of forging closer ties with a Liverpool centre of excellence to improving communication with GPs when an in-patient is discharged. The Clinical Board doesn’t have sign-off on spending if a bid for funding gets its blessing. But in being asked to consider cases vying for funds - be that a new staff position, extra piece of kit or extending a service, the Board knows its collective view on any bid will be seen at CEO and often at Ministerial level. Patient Story – another regular agenda item – saw some frank speaking about a case where missed opportunities resulted in prolonged treatment for an individual. There was a genuine will among clinical

leads to tackle key issues at the centre of the case, including the ability for staf to voice opinions. Sitting-in on the meeting offered a fascinating insight into the pressures involved on the front line of healthcare, and to see where success is flourishing. It must also surely offer the clinical leads a useful view of the bigger piece, and their part in it. In the long term this hands-on approach is expected to drive improvement and greater staff engagement at all levels. Dr Kerruish is confident he has put the right people in the right jobs: ’Our new clinical directors were appointed after a rigorous selection process in which they demonstrated commitment to driving quality and safety improvement across patient services. This is a focused and dynamic body –where discussion and reflection are matched by actioning and doing.’ A note’s been made to give this venture a health check in 12 months’ time.

Connections Summer 2019

Plaudit for paediatric ICU team

he paediatric critical care team at Noble’s has maintained its pre-eminent position among hospitals in the north-west of England.

The team belongs to the Cheshire and Mersey paediatric critical care network, and is reviewed by peers from the UK, most recently by the Alder Hey paediatric intensive care (PICU) consultant.

The Merseyside centre receives critically ill children from hospitals across the region and so can compare the approach of partner / feed-in hospitals when patients are referred or transferred to them. Noble’s was commended as an ‘excellent district general hospital’ which aims to keep patients if at all possible. The PICU consultant had previously praised the team for

working well in conjunction with the anaesthetic and emergency medicine teams, to facilitate stabilisation and transfers. The report concludes: ‘They go above and beyond what any local DGH does because they have to – and they manage sick children very well.’ Consultant paediatrician Willliam van der Merwe has welcomed the review, saying recognition for his team’s achievements in

a remote island location ‘means that in return we receive all the support our patients need, when we really need it.’ PICU provides sick children with the highest level of medical care. It differs from other parts of the hospital, like the general medical wards, in that the PICU allows intensive nursing care and continuous monitoring of things like heart rate, breathing, and blood pressure.

Fond farewell to esteemed colleague Dr Annie Kurien

By Dr Prakash Thiagarajan Consultant Paediatrician & Neonatologist

r Annie Kurien, Consultant Paediatrician and Lead Clinician for Paediatrics retired at the end of December 2018 after 21 years of service to the children of the island. Dr K was only the second paediatrician

to be appointed in the Island and was one of only two consultant paediatricians in the hospital’s first 10 years. She undertook her basic medical training in Alwaye Medical College in India, completing her Speciality Paediatric training and qualifications in the UK. Annie established the sub-specialist children’s diabetes service, which is exemplar in the region. She was Lead Consultant Paediatrician from 2005 till 2010 and again from 2016 until retirement.

Annie is a very kind, soft-spoken, knowledgeable and empathic paediatrician who always remained a ‘hands on’ practitioner. She has also been the Undergraduate tutor, responsible for undergrads across the hospital and continues to be a tutor at the Royal College of Paediatric & Child Health, of which she is a Fellow. Annie has been my mentor and friend and her loss to the hospital is a big one.

Editorial board John Coleman, Interim Director of Hospitals john.coleman@nobles.dhss.gov.im Anna Featherstone, Cancer Services Team anna.featherstone@nobles. dhss.gov.im Chukwuka Anaziah, Doctor

chukwuka.anaziah@nobles. dhss.gov.im Leslie Murphy, Midwife leslie.murphy@nobles.dhss.gov.im Janet Austin, Systems Administrator janet.austin@nobles.dhss.gov.im Diane Batty, Recovery Nurse

diane.batty@nobles.dhss.gov.im Frances Butler, Children’s Therapy frances.butler@gov.im Gill Horsey, Stroke Nurse gillian.horsey@nobles.dhss.gov.im Liz Lillis-Ingram, Thie Bee Commercial

liz.lillis@gov.im Marian Kenny Communications Executive marian.kenny@gov.im If you have an idea and want to contribute please get in touch by emailing editorialboard@nobles. dhss.gov.im

Connections Summer 2019

Martin Hamm and Jamie Hawkins

Jeff May, Rebecca Elliott and Vince Roberts

Diverse challenges for staff at Ramsey MIU

from reception for walk-in patients and an ambulance bay linked to the patient care area, the unit now has optimal capability.

amsey’s Minor Injuries Unit does what it says on the tin – and a great deal more.

Its six full-time staff - five nurse practitioners and a ‘see-and-treat’ nurse - plus part-time RN provide cover at the walk-in unit 8am until 8pm daily – and they’re ready to deal with whatever comes through the door, which can include complex cases. ‘People naturally head for the nearest hospital in an emergency,’ says Jamie Hawkins, team leader at the MIU, ‘so we see people with a wide range of injuries and conditions – from strains, bruises, fractures and scalds to road accident trauma injuries.’ As the nearest centre of emergency care, the unit deals with casualties sustained in the surrounding area. For complex cases, patients are assessed, stabilised and managed before transfer to Noble’s by ambulance, a process which requires a wide combined skill set. ‘Our team is hugely experienced and capable of dealing with the massive spectrum of cases

we’re faced with,’ explains nurse consultant Martin Hamm. ‘The team has a wide range of expertise and skills, including a qualified midwife. They complement each other very well.’

configured flexibly thanks to the specially-commissioned moveable roll-out screens displaying stunning Manx scenes – an artistic take on standard ward curtains.

The MIU also handles minor illnesses, and as with injuries, the cases coming in can be more major than minor - it’s not uncommon for people with stroke symptoms and chest pains to check-in at reception. Staff will stabilise, assess and ensure the patient receives the specialist care required, locally or at Noble’s.

While Ramsey Cottage Hospital is an all-Island facility, it’s a lifeline for northern communities, not least when heavy snow makes routes to Douglas impassable – as has happened three times in the past 11 years.

The team sees an average 24 cases each day, but it can be as many as 50, making full use of the four patient care areas and two observation bays. Space is

Three years ago, the MIU shared outpatient examination rooms on a busy corridor, amid the comings and goings of the rest of the hospital. A refurbishment of the former physiotherapy suite has enhanced facilities and improved patient flow. With direct access

Ramsey’s MIU isn’t linked to a large general hospital, so effective liaison and links with colleagues at Noble’s Emergency Department are paramount. There are plans for staff at both centres to work on secondment at each other’s, offering exposure to different demands and broadening experience. The hospital is proud of its close relationship with the community, and at a grass-roots level the MIU offers an opportunity to see a nurse – a valuable option for the ‘worried well’ who need reassurance and advice, including some awaiting a GP appointment. Like so many Manx institutions, the MIU is a unique hybrid. Staffed by dedicated healthcare professionals, its capability belies its name - and while it’s not somewhere you want to be taken, it’s good to know safe pairs of hands await when you need it.

Connections Summer 2019

Employee of the month January: Anne Harrop, HCA Ward 2

February: Edith Van Genuchten, Physiotherapist A patient and colleague wrote ‘since being diagnosed with breast cancer, Edith has always been there for me, supporting and encouraging through and after treatment. Nothing is too much trouble for Edith. All patients are treated with compassion, professionalism and equity and her excellent clinical judgement instils confidence for those in her care. Every service needs an Edith!’

A colleague wrote ‘Anne on several occasions has stayed late and even gone home and returned to the Ward to help us as she knew we were very busy and struggling. Anne always thinks about the patient’s welfare and supports her colleagues. I would love her to be recognised for her efforts and the years of dedicated service.’ March: Andrea Barlow, Senior Secretary Colleagues wrote very complimentary observations regarding Andrea’s work ethic, her willingness to undertake duties that were not within the remit of administration staff. She is a perfectionist, conscientious, hardworking and is always seeking out ways to help. If you could make all staff have Andrea’s ‘can do’ attitude, this hospital would be amazing!’ Andrea is an asset to the hospital.’

April: Alexis Teare, RN, ED

A colleague wrote ‘Lexi is a credit to Noble’s ED and to the nursing profession. She gets along with everybody she meets. She’s a hard worker and always goes about her task with joy, never uttering a complaint. Her sunny disposition, endless energy and kindness are totally infectious! As a doctor, it’s been a pleasure working alongside her and if I were a patient I would want Lexi to be my nurse!’

Once completed, either email employeeofthemonth.nobles@gov.im or send to Employee of the Month Nominations, Management Suite, Noble’s Hospital. The winner is chosen by the Operations Management Team. All the Employees of the Month will be invited to a celebration next year. We’ll keep you posted.