Issue 3 / 2018

04 How our dentists are giving children their confidence back

08 Robodocs - Why robots are transforming cancer surgery

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Contents

04 Dazzling dentistry Why Ieva can’t stop smiling

10 It happened to me The power of speech therapy

12 A day in my life Tropical diseases? We’ll send them packing!

15 What’s on Key dates for your diaries

16 NHS 111 – much more than a helpline

08 Saving lives – with robots Inside the UK’s biggest robotic surgery centre

03 Welcome From our chief executive

Produced by: The UCLH communications team

Front cover photo: Consultant restorative dentist Steve Bassi.

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06 Against all odds The tiny baby that become a talented student

Front cover photograph by Adam Scott.

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WELCOME

When I’m in and around UCLH, I am greatly impressed by the way our staff live these values to deliver the best possible care. Modern healthcare, research and teaching is not an individual job anymore; I think everybody at UCLH appreciates the value of working together.

Sometimes you are part of a team that may be bigger than you realise. A good example is the care we deliver for patients who need immediate treatment. The traditional way of thinking is that it is the job of our Emergency Department (ED) and acute medical wards to care for these patients.

I am very proud to see the vast amount of work that is done every day by those teams, sometimes under tremendously difficult circumstances and extreme pressures. We have a very resilient ED team that delivers fantastic care (with the highest ratings for patient satisfaction in London) and they

are always looking at ways to improve. We have carried out major building work to extend the department and move the entrance to Gower Street, which opened in January. Improving is another of our values!

However, the number of very sick patients who come to UCLH every day is increasing and it is tough to adequately care for them all. Our ED can only flourish if all teams throughout UCLH pull together to make sure that patients are cared for on the right wards, at the right time. In this respect, we are one big team.

There are many ways we can work together better to benefit our acute patients. As you can see on page 14, our brand new electronic Coordination Centre will make things easier for us to plan and respond to the challenges of life in a busy hospital.

On a day-to-day basis we all have a role to play to free up beds for patients waiting to move out of our Acute Medical Unit and Intensive Care, so that these beds are available for new patients who need immediate care and attention. We need to discharge patients when they no longer need to be in a hospital bed and the majority of patients welcome the chance to go home.

We are all players in the team that cares for acute patients: let’s keep on living our values!

I am a firm supporter of our values (safety, kindness, teamwork, improving). They are the cornerstones of our culture and help us deliver our vision of top- quality patient care, excellent education and world-class research.

Marcel Levi Chief Executive, UCLH

Marcel Levi with the team behind the Emergency

Department development

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Ieva Prieskentye’s smile looks incredibly natural. But, in fact, it is the result of years of painstaking dental treatment.

Ieva is one of the hundreds of thousands of Britons who have hypodontia, a condition in which some teeth simply never grow.

Sometimes baby teeth don’t fall out – meaning they enter adulthood with rows of small, pointy, misshapen teeth.

And if the baby teeth do fall out, adult teeth may not take their place – leaving them with big gaps.

In severe cases, someone may only have four or five teeth in their entire mouth.

This can affect the ability to eat and speak – and have massive effect on self-confidence.

Priti Acharya, a consultant orthodontist, said: “The playground can be a cruel environment – especially in a world that is so driven by aesthetics and everyone has a smartphone with a camera on it.

“Patients tell us that they want to be able to eat and chew. They aren’t looking for a Hollywood smile, they are just looking to be normal.”

The hypodontia clinic at the Eastman Dental Hospital, which is part of UCLH, specialises in rebuilding such fractured smiles.

Orthodontists, restorative dentists, paediatric dentists and dental nurses work closely together to provide the highest standard of care.

Our orthodontists use braces to move the teeth the patient does have, closing gaps and creating a foundation to which implants, dentures and bridges can be added by our restorative dentists.

Prabhleen Anand, part of the paediatric team that treats patients up to the age of 16, said:

“Some patients first attend the clinic when they are as young as seven and don’t complete their treatment until they are in their 20s.

“Some will be missing a lot of teeth, others just one or two, but each tooth means a lot to each child.”

Healing broken smiles

Ieva Prieskenyte has had six years of dental treatment

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Looking to the future

In 2019, the Eastman Dental Hospital and the Royal National Throat Nose and Ear Hospital are moving to a new facility on Huntley Street, near University College Hospital. The nine-storey facility will match world-leading care with a state-of-the-art environment.

Consultant restorative dentist Steve Bassi said:

“There are lots of studies showing that people are judged on their smiles. For instance, someone with a nice smile is more likely to be successful in a job interview.

“But there’s a fine line between cosmetic dentistry – making nice teeth look better – and what we do. Our aim is to make a fractured smile look normal again.”

Ken Hemmings, a consultant in restorative dentistry, said:

“In severe cases of hypodontia, the patient’s jaw bone may not have developed enough for implants to be put in. We can do a graft to thicken it, sometimes taking extra bone from the hip, and working with the maxillofacial surgeons to put it in.”

Dental nurse Agnes DelMundo said:

“Ieva didn’t smile much when I first met her, now she can’t help but smile because she is so happy.”

IEVA’S STORY

When Ieva Prieskentye was little, the tooth fairy didn’t visit very often.

She said: “I remember that my sister was always putting teeth under her pillow and getting visits from the tooth fairy but lots of my baby teeth just didn’t fall out.

“My mum used to put money under my pillow anyway, so that I didn’t feel left out.”

As a teenager, Ieva didn’t just have lots of tiny baby teeth, she also had big gaps between the adult teeth that had come through.

She was teased by other children and covered her mouth when she laughed and ate.

Aged 15, she was referred to the Eastman Dental Hospital and now, six years later, her smile has almost been rebuilt.

Ieva, an English literature student in Swansea, said: “I used to be very self-conscious about my teeth. I never opened my mouth in photos and I remember it taking my boyfriend six months to persuade me to go out for a meal because I really didn’t like eating in public.

“The dentistry has made me more confident and allowed me to laugh and smile without worrying about what people think.

“I never thought I’d be so happy about my teeth. It’s lovely.”

Treating hypodontia: (left-right) Steve Bassi, Priti Acharya, Agnes DelMundo, Ken Hemmings

Each tooth means a lot to each child

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When Sam Ahern was born 21 years ago, she was the smallest baby our neonatal unit had ever looked after. Now an accomplished musician and fine art student, she has gone back to meet the team that helped her win her fight for life.

Delivered 16 weeks early, Sam was barely bigger than her grandfather’s hand.

She weighed just 480g (a touch over 1lb) – less than half a bag of sugar and an eighth of the weight of the average healthy baby.

Her lungs were so underdeveloped that she spent the first 15 months of her life in hospital.

Even when her parents were allowed to take her home, they had to take an oxygen cylinder with them whenever she went out in her pram.

Now, two decades later, Sam has returned to our neonatal unit, where many of the team that looked after her still work.

This includes Judith Meek. Now a consultant paediatrician, she was a junior doctor in 1996.

Judith said: “I was present at Sam’s birth and helped care for her in the months afterwards.

“We just weren’t used to such exceptionally tiny babies 21 years ago. Even today, we only treat a handful of such very, very small babies a year.

“The next time I saw her, she was five years old, taking part in a fun run and beating a lot of the other children.

LOOK AT HER NOW

A reunion with some of the staff from 21 years ago

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“For me, it was a real light bulb moment – the fact that you could be in hospital for over a year, go home on oxygen and yet run so beautifully.”

Despite that early success, Sam’s health was far from perfect as a child and she underwent a range of treatments, including speech therapy and physiotherapy.

She also has autism, which is more common in very premature babies than in the general population.

Now a happy and confident 21-year-old, the fighting spirit she showed as a baby still shines through today.

A talented guitarist and clarinettist, Sam has given talks to MPs, had two plays performed at a central London theatre and is making a documentary about our neonatal unit for her degree project.

Sam, who lives in north London, said: “My family still marvel at the fact that I was that small and still survived.

“And other people often say to me, how do you do so much?

“I tell them that I realised early on that many things are easier for others and so I have to stay two steps ahead to stop them from catching up with me.”

At just a day old, Sam is barely bigger than her grandfather’s hand

My family still marvel at

the fact that I was that small and still survived!

Sam Ahern

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THE NUTS AND BOLTS OF ROBOTIC SURGERY

• Our two robots are used for prostate, bladder and thoracic surgery.

• The four arms carry an internal 3D camera, scissors, scalpels and other customised instruments.

• In 2015, UCLH became a specialist centre for prostate cancer surgery, operating on patients that were previously treated at their local hospital.

• The tiny instruments can be passed through much smaller incisions than required for the human hand, resulting

in shorter scars and speedier recovery.

• A cancerous prostate gland can be removed in 90 minutes – half the time of conventional surgery.

• Robotic equipment can also be used in gynaecological, head & neck and orthopaedic operations.

• We have trained 10 surgeons from around the world in robotic surgery.

Pictures courtesy of London Evening Standard

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THE ROBOTIC REVOLUTIONWe performed more than 500 robot-assisted operations on men with prostate cancer last year – making us the UK’s biggest robotic surgery centre. Find out how robotic surgery is giving men their lives back.

It looks like a giant spider, with a tangle of arms hovering over a patient as he lies on the operating table. But this piece of equipment is a life-saver.

The tiny instruments wielded by the robotic arms can cut out diseased tissue with more control, precision and flexibility than conventional surgery – reducing complications and enhancing recovery.

At University College Hospital at Westmoreland Street, part of UCLH, robotic surgery has been a game-changer in the treatment of prostate cancer.

Professor John Kelly, consultant urology surgeon and clinical lead, said: “Conventional prostatectomy – removal of the prostate – is a major procedure taking three to four hours and involving a two to three night stay in hospital and a lengthy recovery.

“Although it removes the cancerous tumour, patients are left with life-changing after-effects like incontinence and impotence which can be devastating.

“Robotic surgery has changed that – it gives us the precision to remove the cancerous tumour preserving the tissues and functions around it.

“It gives men their lives back.”

The surgeon “drives” the robot with his hands and feet from a control panel up to 8 feet from the operating table.

A camera mounted on one of the arms provides a high-definition 3D view of the prostate and the custom-built instruments are moved in ways impossible with the human wrist alone.

The incisions required to insert the instruments are small and the surgery is extremely precise.

As a result, patients can expect to leave hospital the day after their operation and be back to their day-to-day lives in a fortnight.

Last November, our annual total for robot-assisted prostectomies surpassed 500, a national milestone that made front page news in the Evening Standard.

Professor Kelly said: “None of this would have been possible without teamwork.

“Everyone from our team of consultants to our clinical nurse specialists, theatre scrub team and admin staff has played a huge role in the service’s success.

“Our growing expertise means we can treat the most complex cases and the outcomes for patients are getting better and better.”

Consultant urological surgeon Greg Shaw told the Standard: “We are at the start of this technology. It’s only going to get better.”

Greg Shaw operating using a robot

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Around one in three stroke patients suffers aphasia, in which damage to the parts of the brain involved in speech leaves them struggling to understand others and to express themselves.

Barry Lampert is one of the 80 people who learn to speak again each year, with help from the highly-trained staff at the National Hospital for Neurology and Neurosurgery’s (NHNN) Neuro-rehabilitation Unit and aphasia outpatient clinic.

A gym-loving property landlord, Barry was just 55 when he had a stroke. His wife Lynda realised something was wrong when he didn’t come home one evening.

The next morning he was found slumped in his van at the side of the A1.

With vital brain tissue damaged by the stroke, Barry couldn’t walk or talk. Even something as seemingly simple as stirring a cup of tea was impossible.

Now, after six months of intensive rehabilitation at the

NHNN, part of UCLH, he is back in his north London home.

He has learnt to walk again and can even climb stairs – albeit slowly. He can also feed himself using his left hand, if someone prepares his food.

Lynda said: “The team at the NHNN – the doctors, nurses, healthcare assistants, physiotherapists, speech therapists, occupational therapists, social workers, everyone – is exceptional.

“It is clearly not just a job for them – their commitment and dedication is phenomenal.”

But while Barry has made huge progress, every word is still a struggle and some topics and conversations are just too difficult to follow.

In the documentary Speechless, Lynda, 55, said: “Barry was always a real people person, full of life, a bit of a lad.

“But if he can’t fully understand what people are saying and can’t find the words to join in when he does, he must feel very lonely, very isolated at times.”

IT HAPPENED TO ME

GIVING THE SPEECHLESS A VOICEThe work of our world-leading neuro-rehabilitation service was showcased in a recent BBC documentary, Speechless. Here we introduce you to patient Barry Lampert and his wife Lynda.

Lynda and Barry Lampert with occupational therapist Shauna Feeney (left) and physiotherapist Ellen O’Leary (right)

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How UCLH inspired me to change my life

Laura was so moved by what she saw that she applied to join them and now works at the NHNN’s Neuro-rehabilitation Unit (NRU) as a speech and language therapy assistant.

Laura, 28, said: “Helping someone directly and being there for them when they may be at one of the most difficult points in their lives is a real privilege.”

Laura moved into TV after studying biology at university and first became interested in aphasia when working on a programme about political journalist Andrew Marr and his recovery from a stroke.

Her curiosity was further whetted when she joined Speechless as an assistant producer.

Now, her work ranges from admin to doing one-to-one language drills with aphasia patients and helping run support groups for their relatives.

Laura, who hopes to do a Masters in speech and language therapy, said: “Seeing the speech and language therapy team and the work that they do really made me think that there was something much more important that I could be doing with my life.

“I really look up to the speech and language therapists in the unit - to have that kind of career would be an amazing thing.”

LISTENING TO OUR PATIENTS

Healthcare may be increasingly high tech but it’s often the small details that make a real difference to patients.

Christine Mackenzie is one of four governors who spent time talking to patients, often in their own homes, about their experience of the care they received in our Hyper-acute Stroke Unit (HASU).

“We asked them what could be improved and it is often the relatively little things that add up to the positive, bigger picture. Extra blankets, improved pureed food and clearer information to take home were some of their suggestions that can make a big difference.”

Using the governors’ recommendations, the stroke team is making several other changes too: a new care pathway is being designed to improve the care of patients who present to the Emergency Department with symptoms that mimic those of stroke, but are in fact, due to other neurological conditions.

The stroke team is also finding ways to help patients with their rehabilitation: carers and relatives are now invited to take part in physiotherapy sessions so they can help patients continue their exercises at home.

Lynda and Barry Lampert with occupational therapist Shauna Feeney (left) and physiotherapist Ellen O’Leary (right)

Laura Sunnucks

As an assistant producer on the documentary Speechless, Laura Sunnucks met some of the neurologists and speech and language therapists who help people with aphasia learn to speak again.

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SENIOR NURSE Lucy Eastgate

at the Hospital for Tropical Diseases

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parasites, including myiasis, a type of maggot that has grown under the skin. They have tiny hairs that grip onto the flesh and can put up quite a fight when we try to get them out! Some tropical diseases are not easy to identify but if you have strange symptoms after travel to the tropics you’ve come to the right place!

Words of advice…Road safety (or lack of it) is the biggest risk when you travel – so don’t be too relaxed. And always wear flip flops on tropical beaches. They don’t just look pretty – they can protect you against cutaneous larva migrans, a parasite in dog poo that gets under the skin – literally.

How I became a travel medicine specialist…I first became interested when I worked as a nurse in a high security prison and saw people with untreated tropical diseases. After studying tropical medicine, I worked in Cambodia, Uganda and Afghanistan in remote clinics.

After work…I like walking, rock climbing, playing with Olive and geeky things like playing Scrabble with my lovely husband John.

My day starts at…6.15am, courtesy of my 16-month-old baby Olive. We have a little chat – she’s such a cutie! I then take the train from the Buckinghamshire countryside to Euston.

On a typical day I…Triage and treat patients who’ve returned from the tropics. Our walk-in emergency clinic at Mortimer Market sees around 3,600 patients a year. They might say “Oh gosh, I swam in the Nile”… or “I slept in the rainforest and now I have a strange rash”. We can request tests for malaria and get the results back within an hour. If it’s a positive, it’s a judgement call whether we admit or prescribe medication and monitor them closely as an outpatient. I also give travel vaccinations and antimalarial medication.

The best thing about my job is…

It’s endlessly fascinating. Our patients are a lot of fun to work with and many have been to places I’ve never heard of and are always interested and curious about their diagnosis.

Anything particularly tricky?…One of our tasks is to remove

From maggots to malaria, holidaymakers can bring back all sorts of unwanted souvenirs. Lucy Eastgate tells us how she sends tropical diseases packing.

A DAY IN MY LIFE

HOSPITAL FOR TROPICAL DISEASES: THE FACTS

• It is the national referral centre for patients with infectious and tropical diseases such as malaria, dengue, typhoid and leprosy. It is also the home of the UCLH Infectious Diseases Service, covering a wide range of suspected or confirmed non-travel-related infections.

• Offers a 24-hour consultant-led emergency service.

• Provides travel advice and can dispense anti-malarial drugs and vaccines.

• Offers a specialist clinic for those travelling with diabetes, HIV, cancer or other complex health conditions.

• Sells mosquito nets, water treatments, health packs and other travel-related goods.

Some tropical diseases are not easy to identify but if you have strange symptoms after travel to the tropics you’ve come to the right place!

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Like air traffic control, it allows our team to plan, manage and co-ordinate the constant arrivals and departures so we can give the best care possible to our patients. With just a quick tap of a computer screen, large electronic whiteboards display the facts.

The centre’s advanced technology, provided by TeleTracking, uses a real- time locating system wristband for patients at University College Hospital, the National Hospital for Neurology and Neurosurgery (NHNN) and the Elizabeth Garrett Anderson wing. When a person is discharged and their wristband is removed, the system immediately triggers a message to the bed cleaning team so that the bed can be quickly prepared for the next patient.

Dr Richard Cohen, clinical director for the Coordination Centre and operational excellence, said: “With more information available to us about our patients in terms of their progress and treatment, the care we provide can be quicker and safer and the health outcomes much better.

“As the system becomes fully embedded into UCLH life we’ll be able to concentrate even more on our vision to provide top-quality patient care. In time we will be able to treat many more patients without needing to expand our current facilities.”

Porters are also booked through the system. Staff can see when a porter is on their way and when, for example, a task to move a patient has been completed.

Better care at the touch of a screen

Our new Coordination Centre is the heart of UCLH. Based in a small room near the main hospital campus, it provides minute-by-minute updates on hospital life: which beds are available, how many patients are being admitted to and leaving the wards, what equipment is available, and where.

Around 2,000 items of medical equipment have been tagged so it is quick and easy to check where they are located, to save staff time in looking for them.

So how is our brave new world?

The Coordination Centre is still in the very early stages, and like many major projects there are challenges, but already some of the benefits are being seen.

Kate Petts, deputy divisional manager at the NHNN, has responsibility for managing patient flow. She said: “It has been a big culture change but our teams are embracing it and we are beginning to see changes in the way we work.”

It’s also resulting in a calmer atmosphere on the wards because staff need to make fewer phone calls to arrange porters, cleaners or enquire about equipment. “It’s much quieter which is good for our patients,” said Kate.

The Coordination Centre programme (enabled by TeleTracking) is just one part of UCLH’s new digital strategy. UCLH is also working with Atos, our digital transformation partner, to improve our technology infrastructure and services, and Epic, the supplier of our electronic health record system (EHRS), to further improve patient safety, research and integrated care with external partners.

Wristbands helping us improve patient care

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If so, being a governor could be just the role for you! We are seeking eight people to join our Council of Governors to represent the interests of our public, patient and staff constituencies. Elections will be held for the seats and members aged 18 and over can nominate themselves to stand. We are seeking:

• 1 public governor

• 4 patient governors (3 London residents and 1 living outside London)

• 3 staff governors (1 nurses & midwives, 1 medical & dental, 1 non-clinical)

You do not need any particular skills or experience! We are looking for people with an interest in UCLH and who have the time, commitment and enthusiasm to help us deliver our vision and the views of those who have elected you.

Interested? Contact the Membership Office on foundation.trust@uclh.nhs.uk or 020 3447 9290.

WHAT’S ONWant to help make a difference?

Receive your copy of UCLH Magazine directly to your inbox! If you are a member of UCLH help us save money (and paper) by receiving your edition of UCLH Magazine by email instead of post. Just email your name to foundation.trust@uclh.nhs.uk

MembersMeets Members are invited to our next series of seminars on health topics.

Monday 26 March Monday 14 May Thursday 21 June

Visit www.uclh.nhs.uk/MembersMeet nearer the time or call the Membership Office on 020 3447 9290 for further details.

If you are not a member and would like to join or find out more, contact us.

Dates for your 2018 diary:New Year, new developments Wednesday 21 February: Come to our next Listening Event and find out more about exciting developments at UCLH – the new cancer and surgery centre, which includes proton beam therapy (opening 2020), and our new facility for the Royal National Ear Nose and Throat and Eastman Dental Hospital (opening 2019). We’ll also be discussing our strategic priorities for 2018. Register at: www.uclh.nhs.uk/getinvolved

Research open event Thursday 5 July at University College Hospital: You’re invited to a fantastic exhibition to showcase research and innovation at UCLH and to mark the NHS’s 70th birthday celebrations. Scientists will be hosting lots of interactive displays featuring the latest technology and techniques to tackle major health conditions. More information to follow – but keep the date free!

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ARCHIVEThis photo shows a little girl undergoing dental work in the main treatment room at the Eastman Dental Clinic. The clinic opened in 1930 and was the brainchild of George Eastman, a philanthropist who made his fortune from the Eastman Kodak Company. He believed that all children should have access to free dental care – something he had not had as a child – and donated money for the foundation of a number of dental clinics.

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Who are you going to call?

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When you need help but don’t need to go to A&E, call the free NHS 11 service.

NHS 111 is much more than a helpline. The NHS 111 team can put you in touch with a nurse, emergency dentist, or GP and arrange face-to-face appointments, if needed.

The service is staffed by fully-trained advisors who can assess if you need an ambulance, and if you do, one will be sent immediately.

NHS 111 is available 24 hours a day, seven days a week to ensure that you get the right care, from the right person, in the right place, at the right time.