Our Trust COVID special | Issue 13 | Autumn 2020

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London North West University Healthcare

NHS Trust

OurTrust Recognising your heroic effort This special issue of Our Trust is dedicated to all staff and volunteers who have worked tirelessly in response to the Covid-19 pandemic Issue 13 | Autumn 2020

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Our Trust

Director’s Cut

Recognising your heroic effort

Contents 12

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Chris Bown, Chief Executive

It is thanks to your efforts that we have come through what has been, without doubt, the most challenging period in the history of the NHS. Every single one of you, no matter your service or role, can take pride in this extraordinary effort.

The road has not been an easy one. Members of our own team and those of the extended NHS family have been lost to coronavirus. I know that for many of you, this remains a difficult time.

Please know that we are here to support you. If you need to talk to someone just ask or send me an email, chris.bown@nhs.net While there are still many unknowns, we are starting to return to a more normal way of working across our sites. In midJune, we performed our first planned surgery following the Covid-19 outbreak. This could not have happened without a massive

team effort that enabled Central Middlesex Hospital to become a Covid protected site.

Some elective surgery restarted at Northwick Park Hospital and St. Mark’s Hospital during July, as did emergency surgery at Ealing Hospital. Imaging services and endoscopies have restarted across all our sites, ensuring that our local communities can access these key services. In the community, our teams are working extremely hard to offer care from our patients’ homes, and in many cases, this involves new pathways as well as closer working with our partners in health and social care.

Distancing restrictions and the need to wear protective masks are obvious signs that the virus continues to pose a significant risk. There has been a great deal of work done to ensure that our hospital and community sites remain safe for patients and staff and we will all need to adapt to these new ways of working.

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3 Nurses win battle with Covid-19 4 Responding to the Covid challenge 7 Embracing change to care for IBD patients 8 Supporting colorectal cancer patients 9 Maintaining a productive and happy team 10 In the news

11 Surgical team first in the UK 12 LNWH Charity 14 Community stories 16 Recognising an extraordinary effort 17 United in a single goal 18 Ealing’s Rapid Response Team 19 Always in our thoughts 20 Thanking the children of TeamLNWH

GET IN TOUCH

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n responding to the virus staff have needed to think and work differently. Our Trust highlights many of the innovative ways of working that emerged across the Trust and that have allowed us to continue to provide the highest standards of care to our patients.

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This special issue of Our Trust is dedicated to all staff and volunteers who have worked tirelessly in response to the Covid-19 pandemic.

We also acknowledge the amazing support received from individuals, groups and businesses in our local community and beyond.

London North West University Healthcare

NHS Trust

The next issue of Our Trust will be published in the winter.

If you have an interesting story to tell or would like Recognising your heroic effort to showcase your team’s innovative work in the next edition, please call 020 8869 2235 or email lnwh-tr.communications@nhs.net

OurTrust This special issue of Our Trust is dedicated to all staff and volunteers who have worked tirelessly in response to the Covid-19 pandemic

Issue 13 | Autumn 2020

My sincere thanks to you all for your ongoing commitment and support.

Chris Bown Chief Executive

Some of the photographs published in this issue of Our Trust were taken before the requirements to maintain safe distancing and to wear face masks came into force.

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Nurses win battle with Covid-19

Colleagues give Alicia a big send off

Alicia’s story Senior nurse, Alicia Borja, first started feeling unwell during a shift in A&E. She went home early and received a call the next day to say that she had tested positive for Covid-19.

Three days later Alicia was admitted to A&E with a fever and struggling for breath. Alicia spent more than a week on intensive care. She was in hospital for a total of five weeks.

There wasn’t a dry eye in the house on the day that she left hospital. Alicia says: “I remember my matron Laura asking if we could do a little detour through A&E before I left as some colleagues wanted to say goodbye.

“I was completely overwhelmed when the doors opened and the corridors were lined with people clapping and cheering. I burst into tears because it was such a wonderful surprise. I call them my second family.”

Once home Alicia’s friend and colleague Franco Palo rang to see how she was. They chatted but when she rang back a couple of days later she was told that Franco had fallen ill.

Franco holds on Franco Palo, A&E nurse at Northwick Park Hospital, was cheered out of hospital after winning a nine-week battle with Covid-19.

The father of three, who has worked at the hospital for nineteen years, spoke about the day when his feeding tube was removed. Franco says he asked for ice cream: “They didn’t have any on intensive care but the word went out and Steve Root, our resus guy, bought me a tub of Ben and Jerry’s.

That was the best tasting ice-cream I ever had in my life.”

Franco credits his family, faith and colleagues for helping him pull through and - even in the nothingness of sedation - believes a voice inside was urging him to keep fighting.

“It just told me to ‘hold on.’ So, I did.”

Thumbs up! Franco with his wife Grace

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Our Trust

Responding to the Covid challenge It is said that necessity is the mother of invention. Across the Trust there have been many great examples of how Trust staff have adapted to the challenges posed by the pandemic.

Emergency Department at the epicentre of Covid Northwick Park Hospital’s Emergency Department (ED) found itself at the epicentre of the pandemic in the UK. On February 18, John Ross was promoted to be our first ever ED nurse consultant. The next day he was made the ED lead for our Covid-19 response.

John spoke to Our Trust about his experience.

In my role I wrote over three hundred pages of standard operating procedures (SOPs). Specific focus was on how we would manage aerosol generating

procedures which are the most high-risk Covid interactions. I also led a group of nurses who trained over a thousand staff in the correct donning and doffing of PPE and taught the intensive care unit consultant and registrar group specialised Covid intubation and enhanced PPE. On 3 March, we saw our first patient with Covid to attend ED in a blue-light ambulance. I coordinated the attendance which included the initial management using our SOP action cards, transfer for a CT scan, transfer to the infectious diseases ward then intubation and transfer to intensive care. In reviewing the case we found not one staff member, patient or hospital visitor had been put at risk of an unsafe interaction with the Covid positive patient.

We arranged for changes to be made in the ED including new doors, temporary walls, and a new ‘green’ entrance. In addition, an ambulance streaming pod, operated from a cabin outside of the ED, enabled clinical staff to direct patients to the appropriate assessment area rather than going through the ED. During the height of the pandemic we co-ordinated the ‘red’ ambulance entrance and the ‘red’ resus, which, at its peak, included 45 ambulances arriving in three hours.

I am immensely proud of the work I have done to support patients and even more so of my team over this challenging period.

John Ross, centre, with the emergency streaming pod team

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Drive-through pharmacy puts patients in the fast lane A drive-through pharmacy, introduced at Northwick Park Hospital, allows patients to collect their prescriptions quickly and safely without the need to go into hospital.

The drive-through design means that patients do not need to find a hospital parking space or even get out of the car. It can also be used safely by patients coming to hospital on foot.

Unprecedented demand on ITU leads to dialysis innovation During the pandemic, there was unprecedented demand placed on Intensive Care Units (ICUs), to deliver life-saving support to patients. Northwick Park Hospital was one of the first, and hardest hit, needing to more than triple its ICU capacity with a significant number of patients requiring dialysis.

The challenging situation led to staff conceiving a novel approach to providing haemodialysis within the ICU, ensuring continuity of this life-saving therapy to critically ill patients.

Naina Patel, Lead Pharmacist at Northwick Park Hospital, says: “The challenge presented by Covid-19 was twofold. Firstly, we needed to find a safe way for patients to collect their prescriptions. Secondly, we had to offer a pharmacy service to outpatient clinics that had switched to running virtual appointments.”

Anaesthetists form the largest single hospital medical specialty and their skills are used in all aspects of patient care. The nature of their work means that they must be ready to deal with sudden changes in a patient’s medical condition, including medical emergencies.

Dr Amardeep Riyat, Consultant Anaesthetist and college tutor, had seen the challenges faced by healthcare workers in China and Europe, and realised early on that this would be like nothing the NHS had ever faced before. A way was needed to prepare staff quickly and safely and simulation training provided the answer.

The machines are normally used by patients who have permanent kidney failure, to dialyse at home. The ICU used the machines to provide an alternative and reliable method of dialysis in the ICU. The innovation ensured patient safety and relieved pressure on the overwhelming demand for the standard dialysis technique.

Tariq Husain, Clinical Lead for Intensive Care, said: “We quickly progressed the technique, dialysing our first patient within three days of inception of the new approach. To ensure continuity, and to help reduce the pressure on the ICU nursing team, we developed a bespoke training package to utilise available non-ICU clinical staff. 12 healthcare staff, redeployed to ICU from the hospital’s operating theatres, underwent the training and became fondly known as the “Dialysis Dozen.”

The service is staffed by the pharmacy team including a pharmacist who can discuss the medication with the patient and answer and questions where necessary.

Training crucial in preparing anaesthetists for Covid-19

The hospital’s ICU became the first in the world to use an innovative method of dialysis, embracing and utilising mobile home dialysis machines. A partnership between the Trust and Imperial College Healthcare NHS Trust saw the deployment of NX Stage dialysis machines. The machines do not require replacement pipes or special fluid and operate more quickly than hospital machines, meaning they can be used on several patients a day.

Mobile kidney dialysis machine

Dr Joe Masters, anaesthetic registrar, was among those to who benefitted from the simulation training, he said: “The pandemic presented a unique challenge for anaesthetic trainees with all of us working on the edge of our comfort zones. The intubation training sessions were invaluable in giving us the confidence to manage patients with Covid-19 and helped to allay fears that many of us had about our own safety.”

The new technology continues to be used within the ICU and the approach has been widely praised within regional ICUs. Tariq added: “As a team we feel immensely proud of our vision and innovation, at the time when the NHS faced the biggest healthcare crisis in its history.”

Virtual clinics and visits show their value As the pandemic hit London a no visits policy was established across all wards.

In response to the lockdown, and the need to maintain social distancing, virtual clinics and virtual visits were introduced.

Consultant Laparoscopic Surgeon, Alberto M Isla, says that virtual clinics have quickly shown their value:

Working together with Dr Rita Russai, Simulation Lead, practical teaching sessions were developed. The training started in early March which meant that nearly 60 members of the team had taken part before treating patients on the wards.

Dr Riyat says that Covid-19 required a different way of thinking and working: “We turned our learning from the simulation training into new operating procedures. This ensured that anaesthetists could work safely knowing that they had undergone the right training, and that they had access to the equipment they needed.”

“I am seeing up to 20 per cent more patients than I did in my face-toface clinics, while the number who do not attend appointments has also declined. This saves us both time and money.“ “There is no denying that Covid-19 has put an immense strain on the NHS. But it has also forced us to think and work differently. New technology means that virtual clinics are relatively easy to set up, and for most patients communicating via a PC, tablet or mobile device is second nature.”

A great substitute for face-to-face Expectant mothers have been using virtual clinics to speak to their midwife via the Attendanywhere app.

The initiative is being trialled with diabetic women who are one of the at risk groups.

Virtual visits

Sharon McCarthy, Diabetes Nurse Consultant at Northwick Park Hospital ➡

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Responding to the Covid challenge

Infectious diseases team at the forefront of testing Our infectious diseases unit is one of the largest in the UK and its staff were at the forefront of the NHS’s response to the pandemic. The team was able to draw on past experiences which included being the assessment site for Heathrow Airport during the Ebola crisis in 2014/15.

Staff working at our Northwick Park and Ealing hospitals provided expertise and innovative thinking from the outset. This enabled the Trust to become the first in the country to do community screening for Covid-19 in the very early stages of the pandemic. The community testing scheme started at the end of January 2020. Protocols developed by staff and lessons learned influenced the way community testing was subsequently rolled out across England.

Healthy Vibes allows loved ones to send messages ➡ said: “Patients prefer it to a phone call. We can see mums and, if need be, guide them through taking their own blood pressure, monitoring blood sugar levels, giving themselves insulin injections and using various pieces of kit they have at home. At present, we have up to ten mums using the virtual clinic a day.”

Zoe Hyman, who is expecting her third child, said: “It’s been a great substitute to a physical face-to-face appointment and just being able to see Sharon has been a great reassurance.”

Helping parents stay in touch with their babies The neonatal unit at Northwick Park Hospital, which looks after several hundred premature babies a year, has had no reported cases of Covid-19 thanks to its lockdown procedures.

Parents of premature babies are usually allowed to visit their child 24/7 but we restricted visiting to reduce the threat of infection.

In response, the neonatal team has introduced virtual visits. Staff on the neonatal intensive care unit use iPads to call parents to see and hear how their baby is doing as well as giving them updates.

Dr Edit Fukari-Irvine, Neonatal consultant, says: “This is a great example of technology bridging the gap. The aim is to reduce the emotional stress on families, and pressure on wards, by keeping families updated.”

Patient monitoring and tracking tool born out of crisis A new piece of software is proving invaluable to clinical teams at Northwick Park and Ealing hospitals, helping them to monitor and track the progress of Covid-19 patients in intensive care.

Pathpoint ICU is based on digitising various patient pathways without being specialty specific. It allows large numbers of patients to be tracked and reviewed with up-to-date handover information immediately available to clinical staff during shift changes.

It can also group patients based on changes in their condition.

The software was developed by Open Medical founder and orthopaedic registrar Harry Lykostratis who, like so many others doctors from different specialisms, has been reassigned

Virtual clinics

The infectious diseases team also pioneered drive-through testing for the coronavirus on our hospital sites, work that has been widely shared and is now used across the country.

during the pandemic. It was adapted in less than a fortnight by Harry who had developed a similar tool to manage orthopaedic patients.

Tariq Husain, Clinical Lead for Intensive Care at LNWH, said: “It’s been an incredibly helpful tool for us. Born out of crisis it will almost certainly continue to be used within Intensive Care when the Covid-19 pandemic ends.”

Healthy vibes at Ealing Ealing Hospital is helping patients and loved ones keep in touch, despite ongoing visitor restrictions imposed by Covid-19.

Healthy Vibes allows loved ones to send messages, greeting cards, pictures and short video messages via lnwh-tr. healthyvibes@nhs.net Staff then print them out or show to patients on an iPad. Healthy Vibes was the idea of Dr Bhavya Tyagi and colleagues who recognize the healing power of communication, especially during the pandemic. Bhavya said: “Visiting hours are the highlight of the day for most people so having that taken away is tough. It is easy to forget that human contact - even if it is via an electronic device - is part of the healing process. It isn’t just about medicine.”

Daily washing of up to 300 pairs of googles

Volunteers play crucial role in supporting PPE distribution during Covid crisis Medical Students from Imperial College London volunteered to work with our procurement and central stores department to coordinate ordering and delivery of PPE across Northwick Park Hospital.

At the height of the pandemic over 35,000 items of PPE were being requested each day. The 33 students, together with redeployed staff from across the trust, worked to handle calls to the PPE hotline, and organised the daily washing of up to 300 pairs of googles.

The support provided by the volunteers was crucial. St. Mark’s Foundation also played a key role in helping the Trust to purchase PPE. In addition, donations of equipment were received from local schools, colleges, businesses, clubs, individuals and, even from the BBC drama Holby City.

Imperial College London medical students volunteers

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Embracing change to care for IBD patients Lisa Younge, Nurse Consultant in inflammatory bowel disease (IBD) hopes that change will become easier to implement in the post Covid era, and deliver long-term improvements and benefits to patient care. This is her story.

Managing patient concerns Many of our patients require regular follow-up in secondary care for a long-term condition which, for a large number, is managed with immunosuppressant and biological therapies.

Understandably, patients were concerned that their underlying condition would put them at increased risk if they contracted Covid-19. We received lots of questions from patients about whether they should continue with medication, could go to work safely or should be shielding.

At the same time, all of our routine face-to-face clinics were put on hold, and access to diagnostic tests and procedures, monitoring of disease, and medication became challenging, with restrictions on access to endoscopy, blood tests and surgery.

Our patient advice line activity almost doubled overnight with concerned and confused patients.

Providing access to information We worked together with charities and national registries to develop an online risk management tool for patients with IBD. We also reviewed our own patients to identify those at greatest risk so that we could contact them directly with advice and support.

To help minimise confusion and distress we ensured that clear guidance and information was readily available. We also prioritised calls to our advice line to identify those patients who were becoming unwell to reduce the need for emergency attendance.

The IBD community has long been working on the delivery of care in this way, promoting self-management and less routine follow-up care models combined with timely access when required.

This helped us to adapt quickly and safely in the face on the pandemic and ensure the impact on patient care was minimised as much as possible.

Ensuring safe treatment We do have therapies which are administered intravenously. Once it had been established that, where possible, the safest thing to do was continue with treatment we worked closely with a clean unit off site and within our own infusion day care unit to continue to provide these therapies for patients.

Pre-screening was incorporated the day before treatment to identify any potential issues or discuss concerns that patients had. Where people felt unable to attend due to worries about the medication

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urna Ghale was one of thousands of UK citizens who were abroad when international travel restrictions were introduced to help combat the coronavirus pandemic.

Purna, who works as a cleaner for Medirest at Northwick Park Hospital, was visiting family in Nepal when his return flight was cancelled. He spent three weeks in the capital Kathmandu before the UK Government arranged for a flight to repatriate 300 British citizens.

We continued to run routine telephone multi-disciplinary team clinics (MDT) wherever possible, and provided face-to-face emergency clinics for patients who absolutely needed them. This allowed us to continue to monitor patients and, in many cases, proactively provide support, advise and reassurance.

Many of the barriers to working in different ways such as remote monitoring, shared care and self-management strategies were easier to put in to place than they had prior to the pandemic.

The pressure on services to keep patients safe at such a challenging time meant we needed to think and work differently.

Travel restrictions can’t stop Purna returning from Nepal to Northwick Park

and the virus, or were unwell and needed to delay treatment, we developed monitoring pathways to ensure ongoing support and access.

Non face-to-face follow-up and contact was well received. As we come out of the initial crisis and start to reopen services, it is likely that the use of remote or telephone monitoring will continue to be developed, and become much more of the norm in our service.

Our IBD nursing team have led the way with telephone consultations and remote triaging for patients, and will be in a strong position to help develop this aspect of our service, working with all members of the MDT including primary care and GPs. We also have well-functioning and engaged patient panel, which will be essential as we move forward to ensure that the patient voices are heard.

In the future, it is likely that monitoring patients will require a mixture of face-to-face and remote management, including patient education and self-management.

Both these aspects of the IBD nursing role are already embedded in practice but should become easier to implement post Covid.

In turn, this will bring long-term improvements and benefits to patient care.

Purna, who has worked at the hospital for 16 years, said special transport was laid on to collect people from their homes as the city went into total lockdown:

“There were only a handful of reported Covid-19 cases in Kathmandu, but the lockdown was very strict. It was a relief to get back to my family in the UK” Despite the 4,500-mile journey, Purna came straight back to work. He is one of hundreds of non-clinical staff who work behind the scenes to support our healthcare services. He is typically modest about his role: “I’m just doing my bit like everyone else.”

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Our Trust

Supporting colorectal cancer patients throughout the pandemic Dr Claire Taylor, Macmillan Nurse Consultant in colorectal cancer, describes how responsive and flexible working enabled substantial changes to be made in care delivery.

Coping with change Elective cancer surgery became impossible at our hospital due to Covid-19. Within days we had established a new pathway for cancer patients completely off site (with an independent provider) to conduct urgent and time-sensitive surgery.

Three weeks later, NHS England formed specialist cancer hubs and we then had to change our pathway and provider to work within this model.

Four weeks later, the pathway changed again to provide greater theatre capacity. So, there was a lot of change.

Supporting patients We developed new patient information and established a screening pathway for each patient to be screened for Covid-19. We also created a database of all of our patients awaiting surgery, and they were all prioritised.

Every patient was counselled on the risks of surgery during the pandemic and some chose to defer and remain on a monitoring pathway.

Those wishing to proceed with their operations required an extended consent process to ensure they understood the risks, and how we intended to mitigate them.

We also had to stop all usual outpatient clinics as no-one was allowed into the hospital and, at this point, we did not have the technology to offer video consultations as we do now.

However, we improvised where possible to connect with patients that we really needed to reach - such as those who were to receive difficult news. We now use Attend Anywhere, the NHS video call service.

Patients on a diagnostic or surveillance pathway for colorectal cancer did not receive the usual planned investigations in the early phases of the pandemic and this generated much anxiety.

We have been inundated with calls from patients seeking information, advice and support. My role has been to help co-ordinate the surgical list and optimise theatre capacity. I have acted as a liaison between patients, surgeons, anaesthetists and the team at the provider site.

I also provide direct support to patients preparing to enter, and on discharging, this pathway.

Reducing the risk 112 patients received urgent colorectal surgery during this time, the great majority for colorectal cancer.

The aim was to get as many patients as possible safely to surgery. Our pathway was designed to reduce the risk of Covid-19-positive patients entering the hospital in the first place, and hence reduce risks for staff and postoperative recovery. A patient pathway was developed with rigorous assessment and screening for Covid-19 In responding to the pandemic, our team have shown how responsive and flexible we can be when making substantial changes in care delivery.

We have demonstrated that highquality surgery for colorectal cancer can be delivered during the Covid-19 pandemic using considered measures to mitigate risk.

The importance of teamwork, keeping focused on the overall goal and everyone having clear roles and responsibilities cannot be underestimated.

The aim was to get as many patients as possible safely to surgery. Our pathway was designed to reduce the risk of Covid-19 positive patients entering the hospital in the first place, and hence reduce risks for staff and postoperative recovery.

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Maintaining a productive and happy team to deliver stoma services Zarah Perry-Woodford, Consultant Nurse for pouch and stoma care, believes that the changes made in response to Covid-19 have placed the service in much stronger position, should there be a second wave of the virus.

The stoma and internal pouch nursing team.

Zarah is pictured (rear centre) and Joy (rear second left)

Flexible approach One of the main changes we introduced was to have a nurse co-ordinator available on the telephone and email advice lines, so that patients and staff had direct nursing advice. This role also coordinates the admissions and scheduling for surgery, pre-assessment counselling, and stoma siting.

Telephone clinics are used to pre-assess our cancer and IBD patients who are having surgery at three different sites across London. The team have also changed their working hours and been flexible in working across different sites.

As well as running webinars for patients, and writing a patient handbook to incorporate all stoma information in one place, we are also working towards the introduction of virtual clinics. In addition, we have run webinars for our national patient support groups.

We have also redesigned and updated the clinical pathway and agreed novel protocols and guidelines to better manage the complex St. Mark’s stoma care patients. Our website and business cards were also updated so patients have current information and direct contact details for our service.

Supporting team members We have rotated the stoma nurses on Covid-19 positive wards which helps provide a break from the stresses of wearing PPE. Our clinic room was converted to an area where staff could change and wash properly, therefore reducing the risk of bringing Covid-19 back to the office.

Working with local CCGs

Protecting our vulnerable colleagues and supporting wellbeing was a top priority. Vulnerable staff were given coordinating, procurement and admin roles while daily meetings during the crisis were an opportunity to check how we were all feeling.

We have worked with Ealing and Brent CCGs to enable new patients to gain access to our prescribing hub (which was established already with Harrow CCG). The prescribing hub relieves pressure on local GPs, and ensures an efficient prescription service for all local patients. My lead nurse, Joy Odita, has continued her non-medical prescribing course via online modules and examinations, and passed her physical assessment module. That means she can support the prescribing hub with me.

I am proud that the team have continued to provide excellent care through the pandemic. We successfully streamlined stoma services for all our patients who needed operations, and ensured that they were well supported. We also relieved the burden and anxiety for local GPs having maintained a productive and happy workforce able to deliver care. Crucially we are in a much stronger position should we experience a second wave of Covid-19.

Flying the NHS flag for a fundraising bike challenge Ten-year old Finn Bissett from Ealing Common organised his own Bike around the Block to raise more than ÂŁ3,000 for our Trust.

Finn completed his 35-mile challenge with an NHS flag flying from the back of his bike, cheered on by family and friends.

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Our Trust

In the news...

Throughout the pandemic the communications team ensured that positive news stories about the work of our staff reached the media.

In depth reports looking at how we responded to the Covid challenge were shown on the national BBC News bulletin and on BBC London News, reaching millions of viewers.

A day in the life of Dr Harmandeep Singh Harmandeep, who is a consultant in acute medicine and cardiology at Ealing Hospital, recoded a video diary for BBC London in April in which he spoke about the impact of Covid-19 on the BAME community. He explained that: “a lot of hospital staff are BAME and, despite the fears, they still come to work to do their job.”

Harmandeep and his wife both overcame coronavirus and their story was covered widely in the media including The Sun, Daily Mirror, Daily Mail and My London.

The London hospital hit by a ‘tidal wave’ of patients A report reflecting on how the Trust coped with the initial surge of Covid patients was aired on BBC London’s main evening bulletin in early June.

The story was also turned into an online news feature that was published on the BBC website https://www.bbc.co.uk/news/ukengland-london-52812457 and includes interviews with Tariq Husain, intensive care consultant, Dr Rachel Tennant, consultant in acute and respiratory medicine, John Ross, emergency department nurse consultant, Yvonne Smith, head of facilities, Trish Mukherjee, head of nursing, Emma Leahy, nurse, Dr Martin Kuper, medical director and Chris Bown, CEO.

Coping with Covid In July, the BBC’s health editor, Hugh Pym, came to Northwick Park Hospital to film a report that focused on how Trust staff had coped with the pressures of treating thousands of Covid patients.

In the report Mike O’Connor, intensive care consultant, spoke candidly about the pressures staff faced in treating Covid patients and how the support and goodwill that came from the public had been so important.

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Surgical team first in the UK to use leading-edge digital catheter

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surgical team led by Mr Alberto Martinez-Isla, Consultant Laparoscopic Upper GI Surgeon, has become the first outside of the United States to use the leading-edge SpyGlass Discover Digital Catheter to perform a laparoscopic common bile duct exploration. The procedure, which involved a patient who was admitted with jaundice during the Covid-19 crisis, took place in July at Central Middlesex Hospital.

The bile duct is a hollow tube running from the liver to the small bowel, providing a passage for the flow of bile. Stones slipping out of the gall bladder and into the bile duct can cause obstruction and jaundice, as well as acute pancreatitis.

Laparoscopic bile duct exploration (LCBDE) is part of a single stage procedure, which enables fewer interventions, shortens the length of stay in hospital, and reduces surgical complications and risks in patients with bile duct stones. By comparison, the standard treatment involves at least two hospital visits and a much longer recovery time.

During the LCBDE, a tiny incision is made in the abdominal wall and a 3 mm tube is inserted into the abdomen. A camera is then inserted through the tube (in this case the SpyGlass) to locate the

gallstones. Next, a laser is guided through the tube to blast the gallstones into small pieces which are collected after which the gallbladder is removed.

Mr Alberto Martinez-Isla says we are a leader in the field for this type of surgery: “The SpyGlass Discover Digital Catheter features

All eyes on Central Middlesex In June, the ophthalmology team at Central Middlesex Hospital became the first in London to re-start elective cataract surgery.

Evelyn Mensah, Consultant Eye Surgeon and Lead Clinician for Ophthalmology, explains how the team prepared to safely re-start cataract surgery: “We treat a complex group of patients, primarily from the BAME community who have the highest prevalence of diabetic eye disease and glaucoma in the country.

“The first task was to look at all the patients currently on our cataract waiting list and

risk assess them. The next step was to contact suitable patients who were low risk for Covid-19 to find out if they wanted to come for surgery. 80% agreed to come in for their surgery, and to self-isolate for seven days before their treatment.

The pre-operative assessment team helped with Covid swabbing 72 hours before the patients’ surgery.

“To limit the amount of time that patients spent in the hospital on the day of surgery we produced a patient information leaflet, in partnership with our pharmacy

colleagues, to explain how patients needed to self-administer their own dilating eye drops on the day.”

“Our goal is to increase cases to 12 patients a day, as we still have a large waiting list in the North West London sector, and to help neighbouring trusts clear their cataract waiting lists.

“The message to our patients is that we have robust procedures in place to keep you safe when you come for your surgery.”

high resolution and lighting to provide a clear view of the bile duct. By using the very latest technology we can streamline surgical procedures and enhance patient safety.

Crucially, as the NHS tackles the ongoing challenges of Covid-19 we can also reduce hospital admissions.”

From porter to pop star is there something we should know?

Simon Le Bon, lead singer with Duran Duran, one of the 1980s most successful bands, briefly worked as a porter at Northwick Park Hospital before finding global fame.

During the lockdown Simon mentioned us in a tweet saying: “Many years ago, I worked as a porter at Northwick Park Hospital.

They’ve asked me to help with their Covid-19 fundraising. I’m not saying that they need it more than any other hospital does, but here it is #NHS’

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LNWH Charity

View from LNWH Charity Stepping up to the challenge LNWH Charity stepped up to the Covid-19 challenge in an unprecedented way, empowered by the community’s support and generosity.

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e explored fundraising opportunities and co-ordinated with members of the community to support our staff in a myriad of inventive ways. This article provides a glimpse into the hard work that went into supporting the Trust through the biggest healthcare crisis seen by the NHS in its 72-year history.

Coordinating donations During the pandemic, cafes and shops needed to be shut down. This made it difficult for staff to get the snacks, refreshments, and coffee needed to keep them going through long, gruelling shifts.

As a small charity, we wanted to effectively hand out the number of donated goods coming through. We devised and executed a system for the delivery of goods and even carried those goods ourselves (all while following physical distancing advice for the safety of our kind donors).

Deliveries were arranged across Northwick Park and St. Mark’s, Ealing and Central Middlesex hospitals.

At Northwick Park Hospital, we arranged to use the Costa Coffee outlet as a secure storage area.

Our determined staff volunteered to help carry, store and divide all donated goods into individual boxes before they were sent to wards across the Trust.

In the early stages of the pandemic, LNWH Charity also organised pop-up shops twice a week at our hospitals. Wards and services were

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invited to pick up the donated goods at pre-assigned timeslots.

The pop-up shops ran successfully for two months.

Staff well-being LNWH Charity set up a Covid-19 appeal fundraising page on JustGiving on the first week of the lockdown to raise funds to support staff well-being. It has so far raised over £450,000, that has, and will continue to directly help our staff.

We were also glad to provide staff well-being spaces such as the Medawar Room at Northwick Park Hospital. These areas allow staff to relax during their breaks, and are packed with comfortable bean bags, sofas and over-sized cushions.

We filled the space with amenities including coffee machines, phone chargers, and treats to help reenergise staff on their breaks.

We arranged for individuals and local businesses to come together and donate coffee, tea, biscuits, nuts, crisps and chocolates. Corporate donors, charitable trusts, foundations and local charities generously donated pallets worth of fresh fruits, coffee machines, coffee pods, beverages and care packages.

The care packages included hand creams, facial creams, hand wash,

shower gels, socks, sleeping masks, blankets and pillows, all aimed at making the lives of our staff more comfortable as they care for our patients.

In May, Project Wingman touched down. The initiative was a joint effort between various UK airline employees who volunteered their time to establish ‘first-class lounges’.

These lounges were designed to offer the staff a relaxed and comfortable area to unwind and recuperate during their breaks.

For several weeks, LNWH Charity provided refreshments at these spaces. As a result, Project Wingman was well-received and we are proud to have played our part.

Funding life-saving equipment We designated funding we received from various charitable trusts and foundations to acquire life-saving equipment for critically ill patients.

Patients with coronavirus often have difficulty breathing and many suffer renal failure. Medical equipment included new ventilators to help patients breathe, pumps to help provide nutrition and medication to patients, as well as haemofiltration machines that help kidneys filter unwanted substances and fluids.

A HUGE

Thank you The incredible show of solidarity and kindness we have experienced during the pandemic has been an excellent demonstration of humanity at its best.

On behalf of the LNHW team we would like to say a huge thank you to every single one of our supporters and donors. We are forever grateful for your support.

We would also like to take this opportunity to express our sincerest and deepest thanks to everyone at the Trust for your dedication, commitment and hard work in providing healthcare when it is needed the most - we are truly inspired by you and you are all heroes in our hearts!

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Our Trust

District nurses at the heart of the community

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istrict nurses, which include the twilight and night teams, are at the heart of community care. They play a crucial role in delivering nursing care for Brent residents.

During the pandemic they continued to ensure that their patients were safely cared for at home. They empowered patients’ families to support their loved one’s care, minimising their level of contact wherever possible, particularly for our more vulnerable patients.

They also continued to support primary care colleagues by visiting patients who were shielding so unable to attend their GP practice or hospital appointments.

The team worked day and night with their colleagues from the bladder and bowel and care co-ordinator teams to ensure that

demand was met, and that patient care was never compromised but delivered safely at home.

Head Nurse, Edgar Swart, says he is proud to be part of the district nursing team: “District nurses incorporate their many skills in meeting the complex health and nursing needs of people in a dynamic, multicultural and diverse borough.

“Our core values and beliefs, to keep patients safe in their own homes by providing nursing care, empowering patients and carers, sharing knowledge and promoting independence, were maintained throughout the pandemic.”

STARRS continue to shine brightly

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ur Short Term Assessment, Rehabilitation, Reablement Service (STARRS) team did a fantastic job during the Covid-19 pandemic.

They not only prevented patients from needing care in hospital, but also supported hospital discharges.

STARRS is an umbrella term for several teams, including Rapid Response Brent, Early Supported

Discharge, hospital discharge co-ordinators, as well as a small team of nurses and therapists who work in the emergency department to help prevent hospital admissions.

Head nurse Edgar Swart says the team rolled up their sleeves and helped their colleagues in other areas at the height of the pandemic: “A nurse from Early Supported Discharge, together with a paramedic and nurse from Rapid Response, supported our infectious disease team with community patient testing for Covid-19. STARRS also supported the anticoagulation and haematology teams with shielding patients. These were patients who would normally come to hospital to have their bloods taken for testing. We carried out more than 900 anticoagulation visits and 10-20 haematology visits. One of the STARRS paramedics also supported the occupational health team with staff testing for Covid-19.

AMU nursing staff redeploy to Ealing’s Covid wards

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n 24 March the Acute Medical Unit (AMU) at Ealing was temporarily closed in response to the pandemic. Mairead Sheahan, AMU Clinical Nurse Manager, explains what happened next.

“AMU staff were redeployed to the Covid wards where their skills were needed to care for acutely unwell patients and those needing Level 2 care such as Bilevel Positive Airway Pressure and Continuous Positive Airway Pressure.

“Between hospital avoidances and early supported discharges from Northwick Park and Central Middlesex hospitals, both teams worked and supported each other to ensure that patients were cared for safely in community.

“The team responded well in caring for severely ill patients who staff could see deteriorating right in front them.

It was also emotionally draining to see patients pass away without their relatives being able to be with them.

“Despite all the fears and anxieties, staff continued to carry out face-to-face visits, day and night, to ensure that patient care was never compromised.”

“I am very proud of how our nurses responded to the pandemic. They worked tirelessly throughout the crisis and never complained about having to work across different wards in the hospital.”

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Reflections from our rehab services

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rom the outset of the pandemic inpatient rehabilitation services needed to adjust their care requirements. Tricia Botten, clinical matron Robertson Ward, Willesden Centre for Health and Care looks back on that time. “The general rehab service at Central Middlesex Hospital quickly developed into a backup service for the acute medical beds and played its part in providing care to patients with Covid-19 in their acute recovery phase.

Our staff were accommodating and used patient monitoring skills that have not been required by them for several years, while still motivating patients to be responsible for their physical recovery and rehabilitation.

The staff were flexible across the service, working with colleagues from other divisions, to ensure safe and quality patient care.

The rehab service was halted in mid May as part of the plans to

turn the hospital into a Covid protected elective surgical site.

Staff have been temporarily redeployed across our Trust while long-term plans are worked through.

The neurorehabilitation service at the Willesden Centre needed to make key changes to service provision during the pandemic.

Any patient exhibiting symptoms of Covid-19 was transferred to an acute setting for treatment and monitoring for any deterioration in their well-being and clinical presentation.

During early April, 30% of patients had Covid on Robertson Ward. We closed to new admissions and the ward was treated as a home environment with all the patients self-isolating for 14 days.

This led to a feeling of family and staff engaged with patients as a family member would encouraging the rehabilitation programme to be maintained but also enabling virtual visiting calls to be made so helping

patients to keep in touch with their families. Unfortunately, a number of our staff were affected by the virus, with three members needing to be hospitalised. I am pleased to say that these colleagues are all now well into their recovery and have either returned, or are about to return, to work.

Business as usual has returned with the government guidelines being strictly adhered to. Visiting remains difficult and we are working with our senior nursing team to find ways to bring back face-to-face visiting in the garden at the Willesden Centre.

Both personally and professionally it was sad to see the changes we had to make to our service. But throughout the pandemic, the staff were amazing.

They went the extra mile to celebrate lockdown birthdays, and ensure that virtual visiting took place on these special days so our patients felt loved and appreciated.�

Business as usual has returned with the government guidelines being strictly adhered to. Visiting remains difficult and we are working with the Trust’s senior nursing team to find ways to facilitate face-to-face visiting using the garden at Willesden as outside space.

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Our Trust

Estates and facilities - recognising an extraordinary effort At the start of the pandemic, the key pressing issue for NHS hospitals was to ensure that enough intensive care beds and respiratory support wards were available to treat for patients with Covid-19.

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ur wards were transformed to meet the challenge. The estates and facilities team, supported by external contractors, worked tirelessly to ensure we were prepared for a national healthcare crisis. Below are some of the examples of the team’s extraordinary efforts.

wards. This work led to the development of a spreadsheet to accurately monitor the situation across the whole Trust.

Modifying dialysis equipment

The team also carried out daily inspections on wards to check what equipment was in use. Inspections and maintenance on the main VIE plant increased to seven days a week, up from once a week.

Estates and facilities assisted in modifying existing Renal Dialysis NX Stage medical equipment (believed to be a UK first) to provide lifesaving support to Covid-19 patients who were being ventilated and required dialysis.

Creating of clean & dirty zones 1,000 gauge polythene airlocks were created, with zip sealed accesses, to maintain air locks from Covid-positive areas, within almost every clinical/surgical department at Northwick Park and specific wards at Ealing.

Securing the oxygen supply Vacuum insulated evaporator (VIE) allows the bulk storage of oxygen for medical use. The high demand for oxygen in treating patients with Covid-19 resulted in the delivery pressure from the main VIE dropping, which had a knock-on effect to the secondary VIE. To compensate for this, the estates and facilities team increased the output pressure of the main VIE control panels.

Due to the high number of patients requiring oxygen, calculations were carried out on the pipe sizes and flow rates to each ward. This allowed medical teams to evaluate what equipment could be used for patient care on individual

As oxygen usage continued to rise extra pipework was installed to create additional flow. Oxygen usage was calculated each day to ensure supplies were maintained at optimum levels.

New signposting Estates and facilities brought over 5,000 Covid-19 signs to maintain social distancing and direct patients and staff. The signs were essential in helping to protect staff and patients.

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United in a single goal During the lockdown, to maintain our critical mechanical and electrical services, the estates and facilities team were often required to work longer hours that were well outside of usual shift patterns.

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o ensure support was available to keep clinical and surgical divisions operating, many staff took the difficult decision to isolate from loved ones.

Stewart Knights, Estates Projects Manager, isolated from his partner, son and daughter, who live in Norfolk, for over 14 weeks, he didn’t leave the grounds of Northwick Park for the first seven of those weeks.

Stewart shared his experience with Our Trust. “At the beginning of the lockdown the team was working 15-hour days to complete the Chaucer ward, children’s ward and ambulatory care unit relocation.

“Over 30 staff and contractors worked seven days a week to get the job over the line. One member of the team contracted the virus and was sent to a facility for NHS staff who tested positive.

“I was fortunate enough to have been given a box of my grandfather’s letters he had sent home to his parents during WW2, while serving with the RAF in North Africa. There were over 140 letters describing his experiences as a young man sent to a foreign place to serve his country.

“I used these letters to better understand the person who my grandfather was and, in a strange way, they began to give me the strength to keep pushing on when the physical and mental pressures began to take hold.

“My colleague, Peter Barton also isolated from his partner, who lives in the west midlands, for nearly three months. He stayed within the hospital grounds ready for when a call came through for our assistance at a moment’s notice.

Pictured left, Stewart Knights with Peter Barton, right “For many of us, there were times when the pressure of work and isolation from loved ones would begin to get too much.

But, as a result, we became even stronger and united as a team, knowing that we had each others’ backs when needed.

“We created new ways of working, improvising with shortages of building materials to achieve and develop the existing infrastructure across our sites.

The strength of our internal teams was reinforced by many of our building, mechanical & electrical contractors.

“All of those contractors who chose to return to the Trust, day on day, understood the implications this could have on their families when they returned home each evening.

“Their dedication and commitment deserve recognition. There are two people who deserve the utmost praise and thanks. John Harfield (VM Construction)

and Lee Dart (BOSS Plumbing) volunteered to enter any, and every, Covid-positive ward and department (including ICU and HDU) throughout the lockdown to deliver and install essential kit and equipment. Their efforts were essential in helping medical staff care for critically ill patients.”

“I am extremely proud of all my colleagues from estates and facilities, who put their job before their families and friends. I can honestly say that, having worked in the NHS for over 20 years, I have never seen colleagues so united to deliver a single goal - saving lives.”

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Our Trust

Ealing’s Rapid Response Team

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he arrival of coronavirus at Ealing Hospital saw A&E domestic cleaner Engelbert Camilleri reassigned to the Rapid Response Team.

took us about 30 minutes the first time.

The trickiest is theatres because there is a lot of equipment to clean and several side rooms off the main operating area.”

The 26 year-old was tasked with terminal cleans of areas where Covid-positive patients had been assessed.

“It was stressful to start with but you adapt and just get on with it like all the other staff. We’re a big family at the end of the day and we got through it together.

Engelbert said: “We had been training for several weeks including putting on and taking off PPE equipment we were naturally all a bit concerned about what to expect.

“I remember my bleeper going off one morning asking me to clean a room that had been vacated by a patient who was suspected of having Covid-19. I thought here we go.

Engelbert and his colleagues put on their protective equipment and went to work with the aid of chlorinated products.

All PPE and cleaning equipment was disposed of after each terminal clean to minimise the risk of cross contamination.

Engelbert describes his experience: “It

“I was always careful and when I got home from my shift and immediately put all my clothes in the wash.

The first thing my mum said was ‘wash your hands!’ It’s obviously worked because I haven’t been sick.”

“It’s been an experience but we got through it. We don’t know if and when a second wave will come but we’ve got through it once so know we can do it again.”

Physio’s fight against pandemic

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sports injury picked up playing rugby influenced Alexander Bereziuk’s decision to become a physiotherapist.

“I was out with dislocated shoulder and fractured elbow for several months so there was plenty of time to think,” recalls the 26 year-old who was one of many physiotherapists redeployed to help fight Covid-19 at Northwick Park.

Outpatients was one of the departments whose routine work was suspended to help reduce the potential spread of the virus.

Alexander started out delivering prescriptions to patients who were shielding. He later joined the proning teams in intensive care helping turn patients onto their chest to help them breath.

equipment coming in and out of them. We used a technique where you wrap the patients in their bed sheets to turn them over and then back again after several hours.”

To protect his flat-mate from the risk of infection Alexander moved out of home and in with a colleague who was also working in intensive care.

Alexander added: “It’s all a bit of a blur looking back on it but I’ve got to know so many colleagues that I wouldn’t normally have met. It was great to just see people from all over the Trust come together to do what needed to be done. There was no fuss. Everyone just got on with the work.”

The proning teams, which included anaesthetists, nurses and physiotherapists, were required to turn up to 16 patients a shift at the height of the pandemic in April.

He is now using his physio skills to help get patients with Covid back on their feet. With many so weakened by the virus they initially struggle to raise their arms or sit up unaided. Some of those are patients he helped turn while in intensive care.

Alexander said: “It’s hard work, especially in PPE equipment.

The patients were heavily sedated but they had a lot of

Many patients who are recovering have only a vague recollection of being in intensive care. A booklet has been written

by the senior physiotherapy team explaining to patients what they went through and what to expect on their journey to recovery.

Alex added: “The booklets help patients understand what happened to them and how they were looked after. A lot of patients have found them useful while processing the whole experience”.

Alex and his colleagues are now slowly getting back to normal and have been busy producing a series of short exercise and rehab videos for patients to use once they have been discharged.

Has the experience changed him?

“We’ve all been through something extraordinary together and it does teach you not to take things for granted.

“I haven’t seen my family for three months but plan to see them as soon as I can.

”I have my name down for the proning team if they need me again.

We’ve all been through it once so know we can do it again.”

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Always in our thoughts Remembering those members of #TeamLNWH who sadly passed away during the pandemic as a result of both Covid and non-Covid related conditions. We offer sincere condolences to their families and ask that their privacy be respected at what continues to be a difficult time.

Dr Erwin Spannagl Erwin was an integral part of the surgical department of Northwick Park Hospital for more than 16 years.

Erwin’s daughters said of their father: “He loved being a doctor and gave everything for his patients. For him, not offering help to those in need was never an option and he felt privileged to be able to heal people.

“Apart from his medical knowledge and technical skills it was his emotional intelligence and empathy which made him a great doctor. We miss him deeply, his kindness, his compassion and his optimism and feel so blessed that he was our father.”

Mr S. Tahir Hussain, Consultant Vascular and Endovascular Surgeon, paid this tribute to his friend and colleague: “I initially appointed Erwin in 2004 to work in general and vascular surgery and he was a key part of the regional vascular department for the last 7 years.

“Erwin was a popular and gifted surgeon who had a great deal of friends across many departments of the hospital. Some of us are still in shock that he is no longer with us and he will be missed. Personally, the loss of Erwin, my friend and colleague, is the most tragic event of this coronavirus pandemic.”

“Erwin was loved by his colleagues and by his patients. Many patients called him professor, and he would go the extra mile to make sure that they had the best possible care. He spent a great deal of time talking to patients and, even when he was not working, would visit them on the wards or phone them at home.

“He had recently won an academic prize at a venous meeting. He loved to teach medical students and nurses. Erwin was always willing to help others and his smile and humility were infectious.

Erwin (left) with members of the vascular team

Elma Cavalida

Shashi Dhingra

Abdulkadir Mohamed

Patricia Pinnell

Elma worked as a maternity assistant at Northwick Park Hospital, where she was a valued member of the day assessment unit team. She was known for her warmth, kindness and compassion, and for her true dedication to taking care of our future mums.

Shashi Dhingra, health records assistant, started working at the Trust in 2005 and this year marked her fifteenth year in medical records. Shashi was a wellknown and well-loved member of the health records team. She had a bubbly, energetic personality, and she will be missed by the team and colleagues across the organisation.

Abdulkadir Mohamed was one of our long serving security guards.

Employed

by Medirest, he worked at Ealing Hospital for 10 years. Dale Treharne, our Head of Security, paid him this tribute: “Abdul was a highly valued member of our security team who will be sorely missed by his friends and colleagues. He was a familiar face to everyone at Ealing Hospital and will be remembered fondly for his dedication, professionalism and good grace.”

Tricia Pinnell, a nutrition nurse specialist, was a much loved and respected member of the St. Mark’s nutrition team.

Lisa Knight, Chief Nurse, paid this tribute: “Those who knew Elma describe how she welcomed everyone who came into the maternity unit with a smile. She would do everything in her power to help others and nothing was ever too much trouble.

Elma was much loved by our mumsto-be and her colleagues alike, and she will be very greatly missed.”

Mr Omar Faiz, Clinical Director for St. Mark’s Hospital, paid her this tribute: “Tricia was an outstanding nurse, she was well-liked by patients and staff alike. Tricia was immensely kind and thoughtful, always had time for others and was always genuinely interested to know how everyone was. She would immediately take new team members under her wing, and we are still learning how much support she offered to our team. We have many fond memories of Tricia. She will not be forgotten. We have lost not only a dear colleague but a dear friend as well. May she rest in peace.”

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Community staff redeploy to hospital roles

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uring a pandemic, when you can’t deliver your speech and language therapy services in the community, what do you do? You volunteer to help your colleagues in hospital sites of course.

Ruth Perry, Elly Salmer and Rebecca Simmons volunteered to join the proning team in the Intensive Care Unit.

Catherine Simpson was redeployed to Northwick Park Hospital where she supported the pharmacy team by working on the ICU wards.

Edith Toledo and Celine Broad were redeployed to the mortuary team.

Lucy Stephens and Asma Azam redeployed to the patient property team set up in response to Covid-19.

Ruth Perry, Elly Samler and Rebecca Simmons Edith Toledo and Celine Broad

Lucy Steph ens and Asm a

Thanking the children of TeamLNWH During the pandemic nearly 1,000 letters were sent from Chris Bown, our CEO, to children of TeamLNWH thanking them for being so patient while their parents were busy helping other families stay together.

Olive, age 6 Lilly, age 6

Isabel, age 9, and Sian age

12

Azam