That was the week that was

Last week Cardiff was at the centre of the largest security operation ever undertaken in the UK. Leaders from 28 countries were in town to attend the NATO summit and anyone in and around Cardiff cannot fail to have been impressed by the sight of huge numbers of police officers from around the country patrolling the streets, many of them armed with automatic weapons.

NATOIn fact there were more than ten thousand officers deployed. It is a sign of the times we live in that these precautions are necessary, and at the end of last week there will have been a collective sigh of relief, mingled with some pride that Wales and Cardiff and Newport had done the nation proud.

We have all heard of VIPs – very important people and from time to time we might go to an event when one of these types is around. What do you call someone like the President of the United States, though? Well it turns out these are VVIPs, very, very important people.

As you can imagine planning an event like the summit takes many months of careful preparation and a great deal of collaboration with many organisations, both in government at UK and Wales level, security forces, the police and many more. One element of the plan was thinking through what might happen if one of the VVIPs were to be taken ill, or if there had been some other kind of larger scale problem such as food poisoning, or even the possibility of some kind of security incident.

Nations take very seriously the health and well being of their leaders as you can imagine. In the weeks leading up to the summit, our emergency unit, critical care unit and theatres were visited by a number of embassies and officials from countries attending the summit, along with a White House team. This is because UHW was the designated receiving hospital for the region during the summit. As is normal in these circumstances they wanted to assure themselves about was the standard of care their leaders might expect to receive in the event of a problem and the kind of facilities that would be available and whether a VVIP could be looked after securely.

The UHB's Angela Stephenson, Sharon O'Brien and Linda Donovan.

The UHB’s Angela Stephenson, Sharon O’Brien and Linda Donovan.

To say that they were impressed with what they saw would be a huge understatement, and we were delighted to receive a certificate from Dr Ronny Jackson, President Obama’s personal physician that reads:

“Your professionalism reflects great credit upon yourself and is in keeping with the highest traditions of medical care. Thank you for a job well done.”

NATO2It wasn’t just the VVIPs that we needed to think about though. What about all those police officers? What would they do if the needed medical attention? How about the protestors, what would happen if there was significant disorder and people go hurt? Our response to these challenges was lead by Angela Stephenson, the UHB’s Strategic Partnership and Planning Manager. Angela is clear that every part of the UHB played a role in the months of preparations for the summit, from operational service to staff in clinical boards. Angela is also pleased that the messages we relayed to the public about what we were doing were understood and we are grateful that the public played their part in minimising any disruption to our services.

Our primary care teams organised access for the police to their services for the duration – something that proved to be required when quite a few police officers suffered nasty insect bites as they searched undergrowth and bushes. Sharon O’Brien, the UHB’s Lead Nurse for Emergency Medicine, worked closely with the foreign teams to offer the reassurance that led to the endorsement from the White House.

She said: “During the Summit all the staff within the Emergency Unit were incredibly professional working with all the different delegations and embassy staff as part of the preparatory visits.

“I would like to thank all the nursing and medical staff who worked so hard to ensure that the Emergency Unit and the City Centre Triage and Treatment Unit were fully prepared and equipped for this Summit and I would like to thank Assessment Unit staff for their help in looking after the White House security delegation including the FBI whilst they were based in the Assessment Unit.

“All the staff were very proud that the White House felt able to endorse the EU and the care we offer and that the department could cope with such a massive event.

“We have shown that we are prepared for the major events and all this work has helped to reinforce that.

“I am very proud to be part of such a dedicated team and one that has won such prestigious, international recognition.”

Well I can’t do anything but agree – as once again we have done Wales proud and have shown as we always do that when the chips are down we deliver for those who need us, whether they are VVIPs or people like you and me. Congratulations, thank you and well done to everyone involved.

Keep well.

PICTURE CREDIT: UHB Media Resources, Ann Beswick

Crossing Continents

There is a lot of international attention on Cardiff this week because of NATO and I’ll say a bit more about what’s been happening behind the scenes next week. However, with an eye on international matters I’d like to share something about how people in our organisation are helping and supporting communities in Africa, who don’t enjoy the privileges of a Welsh NHS service that is both comprehensive and modern and which is provided in a society that has by comparison a high standard of living.

OLYMPUS DIGITAL CAMERAThe UN Millennium Development Goals included an ambitious target to halve global poverty by 2015. As part of the Welsh Government’s contribution to this challenge it supports an International Learning Opportunities (ILO) Programme, which aims to provide public and third sector workers the opportunity to work on development projects in sub-Saharan Africa. The current focus is on Uganda and Lesotho. The idea behind this programme is to enable those who take part to develop their leadership skills by sharing their existing skills and knowledge in a new and challenging environment.

One of our experienced mental health nurses, Simone Joslyn, took up the challenge and travelled to Mbale in Uganda between February and April this year to work at a health centre with a maternity unit. As you can imagine this provided her with an amazing opportunity to enrich and develop her skills and experience in a totally new environment.ILO1

Talking about her experience Simone says:

 “During my placement I was able to improve my communication and managerial skills, utilize change management and assist in the delivery of babies, something that I had never done in Wales. The people I worked with and met showed such grace and inner strength and I returned to Wales feeling humbled by the relationships I forged.

 

“At Bushikori Health Centre, where I was placed, the facilities were not what we are used to in Wales but the care and attention given to the patients was as good. I am in awe of their kindness and the care that they offer and learnt much to bring back to my area of work.”

I think it’s remarkable that we work with colleagues who are prepared to extend themselves and give so generously of their knowledge and skills to a part of the world that really needs international support. This is no holiday as Simone would confirm and the challenges are real.

It’s also wonderful that one of the values that I hope we all share, kindness, is something which really stood out for Simone during her visit. Surely this lies at the heart of any good health care organisation, and Simone’s reflections are a reminder that being kind to the people who need us, and to our colleagues we work alongside is something that really can change lives for the better.

I’m sometimes asked how I decide something is OK to do or not. This is because many people still feel that they will ‘get into trouble’ for having a go at something, or trying to make a change. I always say that if in doubt people should ask themselves three questions.

  • Is what I’m proposing to do safe? I might like to help shorten the waiting list for orthopaedic surgery by offering to do a few hip replacements – but that is definitely not going to be safe.
  • Am I going to be spending someone else’s money without their say so? Apart from being good manners, it is also important that we take good care of taxpayer’s money.
  • Will it make us proud? As opposed to something we would be ashamed of or make us look bad, or which wouldn’t fit with our values.

I reckon Simone has definitely made us proud through what she has done, and I’m guessing that working in Mbale has developed her confidence to work through a problem and make things happen. After all, if things can be made to work in Mbale, why not Cardiff?  I’ll leave the last word to her.

 “I’d urge anyone who thinks they could benefit from the ILO programme to apply. My time in Uganda was a fantastic experience and one that I will never forget. No other training programme that I know of offers this kind of exposure and opportunity and I feel honoured to have been involved and supported by Cardiff & Vale UHB. It enhances your practice and your values like nothing I have ever known.”

Keep well.


OLYMPUS DIGITAL CAMERA If you are interested in learning more about the Wales for Africa programme then visit
http://www.wales.gov.uk/walesforafrica

Hope

What will you be doing ten years from now? I’m not sure I know, unless I win the lottery – but then I’d have to start buying tickets wouldn’t I? If we think about what the next ten years might have in store for us here in the health board we might start with what we already know to help us understand what the future might look like. Let’s begin with the size of the population we will be looking after ten years from now.

Cardiff, the capital city of Wales, is booming and it has become one of the fastest growing parts of the UK with unemployment falling and output growing. In the education sector Cardiff University is strengthening its position as the only Russell Group University in Wales and the other higher education sectors are flying high too.

The contrast with other parts of Wales is quite marked as the population growth forecasts demonstrate.New Picture (20)

As you can see the population in our part of the world is going to grow at least twice as fast as the rest of Wales and much more than that in many cases. This is before we factor in the growth the city council have pencilled into the housing stock in Cardiff, with 47,000 new homes to be built according to the Local Development Plan.

10883720543_b4fd2aac29_zWhat will this mean for health care services? The obvious conclusion is that there is going to be significantly more demand for healthcare, and here we will be experiencing a trend line that moves twice as fast as anywhere else. We need to ensure that the external economic growth taking place in the capital is matched by a commensurate adjustment in the way that resources in the NHS are shaped overall. This is a complex area and there are many nuances and difficulties to overcome, but we are making the case that equity of access to healthcare must have some linkage to equity of resources to provide that access. I will keep you posted on this situation.

It looks like in future we are going to have to become really expert at helping our population stay well and we will also need to ensure that we get even better at selecting the right treatments for the specific problems patients have. To help us with this latter challenge, there is a new era approaching when we will be able to match an individual’s genetic signature to a treatment that is tailored to their individual characteristics, including the responsiveness to the proposed treatment.

Although all LHB’s are now designated University Health Boards, I like to think that there remains something distinctive about our organisation. As I have mentioned before, we contribute more than half of the entire Wales research output, and we have many internationally renowned staff who are leaders in their field. Our close working relationship with Cardiff University is one of our great strengths and provides us with one of the most important ways in which we will be able to meet the challenges ahead.

As an illustration, we know that today, lung cancer is a devastating disease and the UK’s biggest cancer killer. It accounts for more than one in five cancer deaths and is the second most common cancer in men and women in the UK. Working with Cancer Research UK, Rachel Butler and the Medical Genetics Team want to change these odds for people with lung cancer.

Genetic testing is already used to detect DNA changes in lung cancer that point to whether a patient will (or will not) benefit from a particular drug, this is known as Personalised or Stratified medicine. Stratified medicine identifies key molecular changes common to different people’s cancers. Patients can then be grouped based on these shared genetic faults, allowing some people to receive a targeted treatment matched to their group. The challenge has been developing targeted treatments that show a long-term benefit for patients while accommodating the cost of widespread molecular testing in the NHS.

Cancer Research UK are preparing to launch an ambitious UK clinical trial for non-small cell lung cancer (NSCLC) called the Matrix trial which tests multiple drugs in multiple groups of patients. Each treatment has been developed to target precise genetic faults, which we’ll be testing for using our specialised ‘next generation sequencing’ system developed specifically for the programme. Our All Wales Genetic Laboratory here at Cardiff and the Vale is one of just three UK laboratories that will be providing the specialist genetic testing that will determine which drugs the lung cancer patients will receive.

Recruitment starts during Autumn 2014 from across the whole of the UK – we expect to recruit 15-20 patients to each of the 16 treatment arms. Additional treatment arms may be added as new therapies linked to genetic markers become available. If a treatment shows promise, then there’s the potential for that arm to break off from the main trial and grow into a larger independent trial with more patients who share that genetic profile.

Early evidence suggests that this genetic approach to the treatment of lung cancer will have a significant impact on patient outcomes.

There’s hope for you.

Keep well.

Picture credit: Diego Torres Silvestre

Picture perfect

Thank you to the people who provide feedback to me via my blog page. I’m learning that you can’t please all of the people all of the time. In fact, that could be the subtitle of my job.

This week I’m going to cut to the chase and talk about someone excellent. Here’s how to spot him – spend a day or two lurking in the corridors of UHW and look out for a man carrying a gold cane and a diamond encrusted key. Easy.

DSC_2699The man is Paul Crompton and he heads up the Media Resource Centre here. What’s he done? Well, Paul was nominated by Professor Michael Peres of the Rochester Institute of Technology and Professor Norman Barker of John Hopkins Medicine for the prestigious Schmidt Award and was made a fellow of the Bio- communications Association for his “outstanding contribution to the progress of bio-communications.”

The award dates back to 1948 and Paul is only the sixth British person to become an award winner. Some of you might remember Professor Ralph Marshall who founded the Media Resource Centre and who was honoured in 1998. The winner’s get, you’ve guessed it, a diamond encrusted key and a gold headed cane – a traditional symbol of high achievement and honour, the latter of which they get to keep for a year.

This is an international award and Paul travelled to Minnesota this year for the annual meeting of the BCA. Paul says, “When it came to the actual Schmidt presentation, I was quite taken aback. Unbeknown to me, Professor Peres had gathered some video interviews with colleagues from Cardiff and the US, which he played whilst recounting some of the work I have done in the past 20 years.

“Being counted amongst the Schmidt Laureates, as they are known, is a real honour; many of the names being icons of our profession.

“One major thank you has to be the team I work with in Media Resources. I am nothing without them. They constantly rise to the challenges we face and support me with their skill, hard work and commitment in delivering the services we provide our patients and clinical colleagues.”

Congratulations and well done to Paul – another example of the excellence that, when we pause and a take a breath to look around us, we can find throughout the UHB.

On a final note I’d just like to pass my on-going gratitude to everyone who is working in our busy unscheduled care system, whether in CRTs, the wards, EU, doctors, therapists and every other member of this chain of committed people who work each day directly or indirectly to support the sick and the vulnerable. Your hard work and dedication is something I’m really proud of – and I want to let you know that I understand the current pressures you are working under and am working hard to find ways of getting some more resource to support the teams who are most hard pressed.

Keep well.

Stigma

It’s interesting how society places a value judgement on some illnesses. If you are unlucky enough to break your leg in a fall you are likely to find people sympathising with you and there is no question that you’ll seek out treatment and benefit from everything our health service can offer.

The same is true of cancer, heart disease and almost all other physical complaints. Sometimes there is a suggestion that people are contributing to their own ill health, by smoking for instance, and there is a debate to be had about the extent to which any health service should always be there for us come what may if we are not prepared to take some responsibility for own health.

This is a difficult area, but many people argue it is not unreasonable to expect that as patients we should make some contribution to getting better or preventing recurrence. Our own Optimising Outcomes Framework takes us a little in this direction by requiring patients who choose to have non-urgent elective procedures to participate in smoking cessation and/or weight reduction programmes before we agree to list them for a procedure. This is because there is evidence that some avoidable harm can be prevented if people take these steps and that the chances of a successful outcome can be improved.

In the world of mental health there is still a fairly widespread reluctance to acknowledge that mental ill health is just as much a part of the human condition as cancer or heart disease.

People do not choose to be mentally unwell, just as people do not choose to have cancer. Yet those who suffer may go unsupported or be unable to be open about the problem – which can compound a sense of isolation that can be a part of the disease process.

It’s not their fault and very few people actually want to be unwell – but still there is judgement and with it an implied projection of moral weakness or a failure of character in the person with the problem. Ridiculous!

In the physical world there are examples of this kind of judgement being applied, although it is much less common. Here are some facts for you about a disease that suffers from this sort of prejudice. It is:

  • The 8th leading cause of death
  • More prevalent than any one cancer, or HIV
  • Potentially lethal – two variants of this disease kill three people every minute – that’s 1.4 million in 2010 compared to 1.2 million who died from malaria.
  • Often silent and people may not realise they are infected – one in three people on the planet have been exposed to the virus.

Full team with Minister and AdamThe disease is hepatitis, which is a cluster of similar viruses that attack the liver. Hepatitis C is a real menace because the body is generally unable to clear the virus itself. Four out of five people develop a chronic infection, which may then lead to cirrhosis and liver cancer after 15-30 years. If you are infected you will face many challenges as the treatment is prolonged (24, 48 or even 72 months are required) and some variants of the virus are much harder to eradicate.

There is no vaccine and so it is vital that the risk of exposure is reduced. For those who are infected this is a major responsibility they have once diagnosed as this will help to contain the spread of the disease. It is possible to spread the virus through contact with the blood or other body fluids (i.e. saliva, semen, vaginal fluid) of an infected person, although it is unlikely to be contracted through kissing or the use of cutlery.

The virus is able to live outside of the body for a relatively long time, which means that the risk of exposure from shared razors, toothbrushes or other household articles is much greater. If you are a drug user then you can be infected by using the equipment for injecting drugs (not just the needle) or by sharing a straw or note if you snort cocaine. Unsterilised tattoo or body piercing equipment is another route for infection.

Unfortunately there is a degree of stigma associated with the disease which may prevent people who believe they may have been exposed from coming forward. As a society this is very harmful, and places us at increased risk as the virus doesn’t know who we are or what we do for a living and makes no judgement about whether or not anyone deserves to be infected.

This is why Delyth Tomkinson, Brendan Healy and colleagues from across the NHS in Wales have been at a stall in the Hayes in Cardiff centre this week. Delyth and colleagues from the Welsh Hepatitis Nurse Forum have been championing the cause of promoting access to testing and treatment for this disease.

Minister getting tested(web)This is particularly important as there are thought to be 14,000 people with undiagnosed disease in Wales. Getting a test is simple – talk to your GP or pick up a self-referral from the cashiers desk in the concourse at UHW and our team will take care of the rest. I think Delyth and the rest of the team are great ambassadors for the health board – and their powers of persuasion are not to be underestimated – just ask the Health Minister, Mark Drakeford who agreed to be tested to show his personal commitment to the cause.

On World Hepatitis Day our team were out there sending a very clear message that prevention is better than cure; that getting tested is simple and easy to do and will reduce the chance that the disease will spread by ensuring people who are infected know they are and so can ensure they protect those around them and of course get the treatment that may eradicate the virus for them.

If putting a value judgement on a virus isn’t nonsensical enough, the consequence of allowing stigma to persist is that those who like to judge are putting themselves and their families at greater risk by creating a climate where the very thing that would protect us all is less likely to happen.

I’d like to think that those of us who work at the health board believe we should never fail to challenge prejudice of any kind. Making value judgements about the health challenges people face is a world apart from a mature conversation between a health care professional and the patient about what they can do to help themselves.

Keep well

Matter over mind?

Summer is well and truly upon us. The heat of the July sun contrasts strongly with the same sunshine on a winter’s day. As the Earth tilts slightly towards the sun this tiny movement increases the sun’s power and we feel the difference. The margins are so small – if the Earth were only in a slightly different plane of space life might never have got going.

For the ancient civilisations this natural phenomena of the seasonal fluctuations warranted an explanation. Lacking the insights we have today, people found the answers in myths of gods – myths that were layered and developed over millennia, developing and changing shape as the civilisations themselves waxed and waned.

We know that between 1425 and 1200 BC, on the island of Crete there were a people that we now call Mycenaean. Archaeologists have discovered clay tablets with scratchings on them that turn out to be a development of an earlier Minoan language, known as Linear B. From these tablets it is possible to make out the first appearance of a goddess who would later be named Demeter by Homer.

DementerDemeter was the goddess of the harvest, who presided over the grains and the fertility of the Earth and from Homer we have the story of Demeter and her daughter Persephone, who was abducted to the underworld by Hades. Demeter searched for her beloved daughter ceaselessly, preoccupied with her loss and grief. While she searched, the seasons halted and living things stopped growing and then began to die. In time Zeus intervened and Persephone was returned to her mother, but only after she had eaten pomegranate seeds given to her by Hades. Having done so, Persephone was bound to Hades and must return to him for one third of the year – during which time nothing will grow – winter in other words.

Dementia is a Latin word derived from the word root mens or mind and de which means removal or separation – so dementia becomes ‘removal or separation of the mind’. The term was first used in 1861 to describe the symptoms of what we now know as dementia. Language just like mythology is layered and also changes shape and meaning over time as do memories.  Is there an echo of Demeter in the word dementia? I don’t know, but there’s something about poor Demeter frantically searching for her lost daughter and forgetting to undertake her duties that resonates with me.

Launch1(web)It certainly did last week when we launched our Three Year Dementia Care plan. At its heart it has three themes: prevent, delay and cope. There is no cure for dementia and the number of people with dementia is set to rise. Currently there are thought to be 45,000 people with the disease in Wales, and in our population the number of affected people is set to increase by 60% over the next 25 years.

We have worked together with people with dementia, their carers and the professionals who have expertise in this field to develop our plan. Clearly prevention and delay have to be key cards that we play in our battle with this disease.

Interestingly the prevention component of our plan draws on evidence that is locally derived. The Caerphilly Cohort Study led by Professor Peter Elwood OBE from the School of Medicine at Cardiff University, monitored the health habits of 2,235 men over a 35-year period. It found that five behaviours are integral to having the best chance of a disease free life: taking regular exercise, a healthy body weight, a healthy diet and a low alcohol intake.

Plan Cover EnglishThe people who consistently followed four or five of these behaviours experienced a 60% decline in dementia and cognitive decline – with exercise being the strongest mitigating factor – as well as 70% fewer instances of diabetes, heart disease and stroke, compared with people who followed none.

So let’s all enjoy the sunshine then and also make an effort to take some exercise. It might be easier to do so now while the days are long and warm, rather than when they shorten and the cold sets in. The evidence is clear that we can lay down the foundation of a healthier and more fulfilling older age for ourselves and those around us by taking a few steps now to modify our behaviour.

Keep well

Making it all add up

Bench2(sweb)

Families from across Wales attended the ceremony.

Last Friday saw the opening of a very special memorial in the grounds of UHW. It is part of a number of activities that marked Transplant Week as we thank those who have selflessly donated organs to help others. Families of donors from our health board area and across Wales were joined by staff from the hospital at the unveiling which commemorates the generosity that over the last six years has enabled us to contribute to 341 life saving transplants across the UK.

Bench4(web)

Some of those UHW staff who save lives with their organ donation work.

We have three specialist nurses for organ donation (Susie Cambray, Emma Bennett and Angharad Griffiths) working in the health board. Theirs is a challenging and very sensitive task, working as they do in our critical and intensive care areas, and our emergency department. Their role is to provide support and advice to staff and families to help ensure that every patient at the end of their life is given the opportunity to fulfil their wish to become an organ donor.  The emphasis is to provide families with the current and accurate information they will need to make an informed choice – and the right choice for them. Our team works with the broader clinical team to support families at this difficult time with whichever decision is made.

In Wales, the government has published a Transplant Bill which aims to change our system from opt in to opt out. This is something that has been done in other countries and is driven by a shortage of donor organs across the NHS. Working within this framework we would hope that in the years ahead it might possible to make organ donation a much more normal part of end of life care for the patient’s families.

Standing in the shoes of another can help us to understand things from someone else’s perspective. What would it be like perhaps to be a wife, watching her husband struggle with daily renal dialysis, or a parent of a child with a congenital and potentially fatal heart defect, or a grandmother who is no longer able to see her grandchildren playing in the garden? If we look at things from their perspective it is easy to see what a truly remarkable gift a donor makes.

A reminder about the centrality of family to a sense of who we are and our place in the world, at least for me, was provided a couple of weeks ago when we celebrated together as a family (with one or two important absentees) a 151st birthday. In all around a hundred friends and family came to our home to join in on our special day. My mother-in-law and her husband brought some of their oldest friends, our daughter invited a gang of her friends and my wife asked her best friends to be with her that day. Most of the wider family were there too, as you’d expect.

What was great to see was how well the generations got on together, sharing stories, playing ridiculous games, eating food and the odd (and maybe more) glass of wine or beer. Everyone seemed full of life and it was a really happy day, as judged by the pile of thank you letters, cards and emails we have received subsequently.

Reflecting on that day, I wonder what price I’d pay to ensure that those to whom I’m closest could enjoy another day like that? What would I do if I knew in advance I could help one of them enjoy more such days should some unforeseen circumstance befall me and I could help them? Well I know what I’d want – but I’m not sure everyone around me is as clear about this as I’d like. So in the days ahead I’m just going to gently talk this through so I make my wishes clear. Maybe that’s something we could all do?

Keep well.

PS 151 is a ripe old age but in case you’re wondering no I don’t belong to a family that has someone sitting in the corner with a face like a walnut who can remember Queen Victoria and the advent of electricity. No, the truth is that we were actually celebrating three milestones at once, 80, 50 and 21, which when you add it all up comes to 151.