A woman was sent home from Epsom General Hospital with a sliver of mango seed stuck in her throat, leading to an update of guidance around patients who have been eating soft foods. The 57-year-old went to Epsom hospital emergency department saying she was having trouble swallowing after eating mango pickle.
A doctor looked at her, but could not see anything obviously wrong, with the patient not drooling, still able to swallow and no foreign body visible on examination. The patient was sent home with the advice that it could be a scratch or gastritis, and told to return if she was more unwell.

A board meeting of the Epsom and St Helier hospital trust heard she then came back four days later unable to swallow at all and with a sore throat, but still nothing visible to doctors. On a slide titled “the deadly mango” in a learning from complaints presentation, board members heard how the hospital then discovered an oesophageal tear and air in her chest after a CT scan.

Documents show there was “low level of risk” given she had been eating soft food, and that sharp foreign bodies causing problems are usually only related to fish or broken bones such as in chicken, so this was not considered.
There are no guidelines either nationally or at the trust for this sort of situation.

After discussions with other hospitals, she went for surgery in Guildford, where a mango seed sliver was removed from her oesophagus and she stayed for a week on intravenous antibiotics. Luckily the patient made a full recovery, but did make a complaint against the hospital trust.

The board meeting heard that the unnamed patient had been informed of the investigation into the incident and how new guidelines had been drawn up at the trust, to look at the symptoms patients were suffering, and not just the foods they had eaten.

Dr Richard Jennings, group chief medical officer, said that from something ridiculously obscure and exotic and unlikely ever to happen again, the trust had created pragmatic and useful learning points. He added: “I was also very happy, having felt anxious reading the title, to find it was a “potentially deadly mango”.

The meeting heard that assessment of the patient was done correctly, though the investigation showed the patient probably should have been discussed with ear, nose and throat [department] if symptomatic
She also should have been told to return within 24 hours if there were no improvement.
A presentation said it was “very rare to have sharp foreign body injury following soft food and usually due to foreign bodies in them”, such as glass or plastic.
As well as new guidelines for staff, a discharge leaflet would be created for patients who were going home with this condition.

Age Concern Epsom and Ewell are fortunate to have many volunteers that give up their time to help provide various services to support members of the older community in the borough of Epsom and Ewell. One of these services is its well used transport service which takes clients to medical appointments across the borough and further field. To provide this service, they have a wonderful small team of volunteers who carry out around 1000 trips a year.

Stuart Kendrick (L) and Alan Carlson (R) and Mayor Clive Woodbridge celebrate long-service

Two of these drivers, Alan Carlson and Stuart Kendrick have each been driving for us for over ten years, and this month they will both have reached an amazing milestone of completing 2000 drives.

Alan, a retired special needs teacher, and previous mayor of Epsom and Ewell in 2001/2002, has lived in the borough most of his life. He started driving for Age Concern Epsom and Ewell in 2012, he’d not long retired and wanted to do something useful with his time and his large car! He appreciates that the transport service can help take away the anxiety that some clients feel and aims to provide calm reassurance when driving our clients to their appointments. He really enjoys meeting people and hearing their interesting stories and he’s been able to build up good relationships with many of them.

Stuart, a retired minicab driver, originally from South London started driving for Age Concern Epsom and Ewell following his retirement because his wife suggested he might like to go and do something useful! He really enjoys meeting our clients and gets a sense of fulfilment knowing that he is doing something that they really appreciate. His wife now often accompanies Stuart on his drives, and they all love the chats that they have on the way to appointments.

Age Concern is extremely grateful to all their volunteers but would especially like to thank Stuart and Alan for completing 2000 drives for Age Concern Epsom and Ewell and on 24th October held an informal lunch party for them with invited guests.

If you would like more details about the Age Concern Epsom and Ewell Transport Service, please contact Transport Desk, Monday – Friday 9.00am – 12.30pm on 01372 732 456.

Alternatively, if you would like to like to volunteer for Age Concern Epsom and Ewell, please contact Jane Hodgson, Volunteer Coordinator Monday – Wednesday 9.00am – 3.00pm on 01372 732 458 for an informal chat.

An NHS chief executive has never in her career seen employee relations cases of the “volume and a complexity” as at her current troubled ambulance trust. South East Coast Ambulance Service (SECAmb), the NHS trust which covers Surrey, is on an improvement journey, after an “inadequate” rating for how the service was led in June and a report this week which downgraded its overall rating.

The trust’s interim chief executive, Siobhan Melia, said though she was not happy with the pace of the progress on improving the culture at the trust, she understood why it was not moving quickly. She told a board meeting on Thursday (October 27): “I have never in my career seen a volume and a complexity of [employee relations] cases that we are dealing with.” She said she understood why limited staff resources and an “incredibly high case load” were contributing to this.

The meeting heard what progress was being made against two warnings given in the June report, which found a culture of “bullying, harassment and sexualised behaviour” at the trust.

A report published this week by the Care Quality Commission downgraded the trust’s overall rating, finding that staff were “burnt out”, working beyond their hours and not always getting breaks. But the area of “caring” was given a “good” rating in the latest report, with patients found to be treated with kindness and compassion.

Thursday’s meeting focused on the two warning areas of four highlighted in the June report, namely risk, clinical governance and quality improvement, and of a culture of bullying. The latest report will be addressed at future board meetings of the ambulance trust, which covers Surrey, Kent, Sussex and parts of Hampshire.

According to meeting documents, the trust’s planned outcome for concerns around culture centred on a “significant reduction in bullying and harassment”, and staff feeling empowered and supported to raise concerns.
The interim chief executive said there needed to be “absolute clarity” on there being zero tolerance on behaviours that did not align with trust values, and a “decisive position” taken that sexually inappropriate behaviour would not be tolerated.

She said the backlog of cases meant people were getting “frustrated” at the length of processes because the trust was “running to catch up”. Ms Melia said she had found herself “challenged” as a woman chief executive in 2022 to have taken a sexual safety workshop in the last week. She added: “I’m listening to the lived experiences of female members of staff at SECAmb, who are talking quite openly in that workshop about some of the things that are happening. So we simply have to get more decisive, more strong in the actions that we take and continually say: ‘We will protect you as we should when you’re an employee of SECAmb’.”

Saying decisions on sanctions in proven cases needed to be “much faster”, she added that the trust needed to “deliver the actions in a much more overt way” to match words and communications that were being put out.

The trust’s executive director of human resources and organisational development, Ali Mohammed, said that 25 per cent of employee relations cases involved bullying, harassment or sexual safety.

He said once the initial work had been done on meeting targets set out after the CQC report and clearing the backlog of cases, more of a “learning culture” needed to be brought in at the trust. But he said ultimately it would be the staff that would be able to tell leaders if things had changed for the better. He said: “Are we winning in terms of people feeling that there’s a different culture within the organisation? That’s the key thing in the end, asking the individuals themselves because they are the best judge of it.” He said there was an “individual and collective responsibility” on all board members, managers and “every single individual within the organisation” to push the same message and the same culture. He added: “This isn’t something one person could do in isolation. I think it’s a test we should hold ourselves to as a board, and as a senior management community, that it is something that we personally will be pushing forward.”

The board’s chairman David Astley said the trust needed to “root out” inappropriate behaviour. He said all staff needed to feel confident and safe at work, whether on the front line or in other areas. Mr Astley added: “They’ve got to feel safe, so they can do the best job they can for their colleagues, and more importantly, the patients.”

Surrey County Council must work closely with independent care providers to meet the challenges facing social care and continue to improve choice for residents, Surrey’s new director of adult social care has said.

In her first keynote speech to Surrey’s care sector, Liz Bruce embraced the need for a new working relationship between the council and providers of residential, nursing and home-based care to help build for the future of social care including planning for the biggest care reforms in decades.

As well as preparing for the reforms – which are set to usher in a lifetime limit on care costs of £86,000 – the care sector in Surrey is operating in an “unprecedented” economic environment and dealing with recruitment pressures and the impact of Covid-19, Mrs Bruce said.

Addressing the Surrey Care Association’s autumn conference in Dorking, Mrs Bruce said new relationships and “new thinking” would enable the council and providers, along with their NHS partners, to move “together ahead”. 

Forging a closer relationship would enable the partners to better shape services around the needs of residents and communities and enhance the choice of care and support options available.

Earlier this year, Mrs Bruce became Joint Executive Director of Adult Social Care and Integrated Commissioning working across Surrey County Council and Surrey Heartlands integrated care system.

She told the conference: “We need each other more now than ever. We’re stronger together and we’ve got more in common together – we mustn’t let people divide us. We’re far more powerful and influential to central government if we’re saying the same things.

“How we work together going forward is all based on relationships. We need to innovate together and to do that we’ve got to have a good relationship and have dialogue. None of us can do what we’re trying to do on our own so we need to come together and work in partnership. I’m optimistic we can do that.”

Areas where there are opportunities to work together include on shared issues such as workforce and training. A key focus for adult social care is supporting providers and residents with better information, advice and guidance to help the make informed life choices, especially when considering or requiring care.

The county council’s commissioning strategy for older people, covering the period until 2030 and drawing on input from providers and the NHS as well as residents and staff, aims to champion greater choice, quality and control for residents.

As well as supporting people to lead independent and active lives in their own homes and communities for as long as possible, the blueprint spells out how the council and partners will work together on ensuring intensive and personalised care options for people with more complex needs, in line with the council’s ambition to tackle inequalities in health so that no one in Surrey is left behind.

Mrs Bruce took up her new role in Surrey in May from the London boroughs of Richmond and Wandsworth where she was Director of Adult Social Care and Public Health. She has previously held senior positions at London’s tri-borough partnership – Westminster, Hammersmith and Fulham and Kensington and Chelsea – and at Manchester City Council and Warwickshire County Council.

Surrey County Council News

Gina Miller supported Epsom Rotary‘s fight against rising cases of Polio. Today is National Polio Day and on Saturday local Rotarians were raising awareness in Epsom’s Market Square. They raised £300 from the Borough’s generous public and that will be matched by the Bill and Melinda Gates Foundation.

Gina Miller with Peggy Rowell of Epsom Rotary in Epsom Market Square

With the news reporting Poliovirus has raised its ugly head, here in the UK, it is a reminder how important the Rotary International PolioPlus campaign is. Not since 1984 has there been a case of polio in the UK, which was declared polio free in 2003. Although, no cases have been detected or confirmed and the risk of someone catching polio in the UK is low, it has come as major blow to Rotary, that it has been identified, here, in the UK. The emphasis is being placed on trying to make sure that all children and unvaccinated adults have been fully immunised against the disease. This is because the poliovirus is opportunistic and will exploit gaps in population immunity.

The Rotary PolioPlus campaign was launched in 1985, becoming a founding member of the Global Polio Eradication Initiative in 1988. In this time, Rotary members, working with communities around the world, have contributed more that 2.1 billion US dollars and countless volunteer hours for the fight to end polio. Now polio is considered eliminated in most first world countries with Afghanistan and Pakistan being the only countries in the world where the infection is classed as an endemic.

The fight has to continue and as Rotarians we can play a key role in raising funds and awareness to achieve a polio-free world and ensure we protect the gains Rotary has worked so hard to achieve.

Polio Outbreaks 2022

Poliovirus (Poliomyelitis) has been confirmed in non-endemic countries in Africa, Asia, Europe, India, the United Kingdom, and New York in 2022. In recent years, polio-endemic countries of Afghanistan and Pakistan have reported polio outbreaks, according to the Global Polio Eradication Initiative (GPEI).

And on September 26, 2022, the U.S. CDC issued a global Alert – Level 2, Practice Enhanced Precautions, regarding polio outbreaks and poliovirus detections in various countries.

On September 13, 2022, the WHO added the USA to a list of about thirty countries where circulating vaccine-derived poliovirus (cVDPV) has been identified in 2022.This action is related to genetic sequences in July 2022 from a polio (Acute flaccid myelitis) patient in Rockland County, NY, and wastewater specimens collected in various New York counties, linked to poliovirus samples collected in Israel, and London, indicating multi-country, community transmission.

Our own correspondent

Epsom & Ewell Borough Council is installing 14 memorial benches across the Borough to commemorate all the lives lost in the Covid-19 pandemic. Metal benches have been placed at Alexandra Recreations Ground, Long Grove Park, Nonsuch Park, Shadbolt Park, Stoneleigh Broadway and The Grove in Ewell Village.

Mayor Clive Woodbridge, College Ward Councillors Julie Morris and Nigel Colin, Cllr Hannah Dalton and Elena Ciesco. Acting Borough Chief Executive Jackie King also attended.

More metal benches have been or are in the process of being installed at Auriol Park, Ewell Court Park, Mounthill Gardens and The Wells Centre. Wooden benches will also be placed at Epsom Common, Grandstand Road, Horton Country Park and Hogsmill by the steppingstones at a later date. Flowers will also be planted around the benches where appropriate.

Funding for the benches was provided via the Community Infrastructure Levy (CIL).

Councillor Hannah Dalton, who put forward the CIL bid, said, “The past two years have been extremely hard for everyone in the Borough, but more so for those who have lost loved ones. These benches are our permanent memorial to all those affected by the pandemic. “I hope they will bring comfort to grieving families, ensuring that their loved one will always have a place in and be remembered by our community.”

Councillor John Beckett, Chair of Environment and Safe Communities Committee, added, “While these benches memorialise the pandemic, they also represent a time for reflection within the Borough. I can’t think of a more fitting tribute to those we have lost, than to have something to remind us of and generations to come.”

One of the benches, for each of the Borough’s Wards, was the place of a moving speech by Mayor Clive Woodbridge on Saturday morning 22nd October. In Alexandria Park The Mayor spoke of the loss so many across the Borough have suffered during the pandemic. As of the week ending 7th October 2022 the UK Government funded LG Inform states that 474 persons have died of Co-Vid in Epsom and Ewell.

Mayor Woodbridge recognised how deep the bereavement is felt by relatives who came to the bench this day especially as he had this year suffered the loss of a son. As an example of the reality of loss he read a tribute to one Epsomian who succumbed to the virus.

“Luigi Ciesco was born in Italy in 1941 and at the age of 19 he moved to England in 1960 to start a new life. He met Vincenza his wife, at a wedding in Italy and soon after, they were married, settling first in Hook Road and then in Alexandra Road in Epsom for 45 years. They went on to have 4 children and 8 grandchildren and were married for 57 years. He was an amazing, fun loving and cheeky man, a real character and he was known and loved by so many. He loved his family, and he loved his Italian music and he loved to dance. He was an extremely hard-working man and worked in the NHS. He grew all his own vegetables and was an expert gardener and wine maker.

The Covid memorial benches mean a great deal to the bereaved families. The world seems to have moved on from Covid but they have not moved on, they are forever changed. The benches show the reality of how cruel this virus is and how it does not discriminate from young to old. We all hope that it makes people stop and think about our loved ones never to be forgotten.”

Epsom and Ewell based charities Love Me Love My Mind and The Friends of Horton Cemetery joined forces with Surrey County Council Youth Workers and others this week. In Epsom Market Square on Saturday 8th October local residents and visitors took part in the “Out of Sight, Out of Mind” Project. This Historic England supported project raises awareness of the Horton Cemetery in Epsom. There are buried 9000 patients of Epsom’s five now closed psychiatric hospitals. The largest asylum cemetery in Europe.

Borough and County Councillor Bernie Muir joined in the Market Square painting of memorial flowers.

The painting continued during a day of reflection and celebration on World Mental Health Day 10th October at St Barnabas Church in Temple Road, Epsom. Activities included a walk to Horton Cemetery beside Hook Road and a song and dance performance by students from Epsom’s Laine Theatre Arts School.

Mayor Clive Woodbridge joined the event and painted a flower. 900 ceramic flowers are being individually painted by young and old throughout the Borough over the year. Workshops will be held to discuss the significance of the Cemetery and the lives of those who ended up in this paupers’ graveyard. The aim is to plant the flowers near the Cemetery on Mental Health Day 2023. The site was sold by the NHS to a property speculator in 1983 and has been neglected ever since.

On Tuesday 11 October Surrey Fire and Rescue Service lit up Guildford Fire Station in a show of support for Binti, an international menstrual dignity charity based in Weybridge, Surrey. The service will be looking to supplement Surrey County Council’s ground-breaking initiative, as the first UK council to provide free period products across the county and eradicate menstrual stigma and taboo whilst normalising the conversation.

Surrey Fire and Rescue Service are to explore the distribution of Dignity Packs where needed when carrying out community engagement activities. 

The event at Guildford Fire Station was attended by representatives from the Service, including Acting Chief Fire Officer, Dan Quin, and Chief of Staff Bernie Beckett. They were joined by actor and Binti ambassador Nina Wadia, star of TV programmes including Eastenders, The Outlaws, Dr Who and contestant on last year’s series of Strictly Come Dancing.

The lighting up of Guildford Fire Station coincided with International Day of the Girl Child, which seeks to highlight the challenges faced by young females to their education, their physical and mental wellness, and the protections needed for a life without violence across the globe. 2022 marks the 10th anniversary of the International Day of the Girl, following its establishment by the United Nations. They note that over the past 10 years, there has been increased attention on issues that matter to girls amongst governments, policymakers and the general public, and more opportunities for girls to have their voices heard on the global stage. Yet, investments in girls’ rights remain limited and girls continue to confront a myriad of challenges to fulfilling their potential; made worse by concurrent crises of climate change, COVID-19 and humanitarian conflict.  

Surrey County Council initially worked with Binti to host collection and donation points at 35 Surrey buildings, including libraries and County Council buildings upon the launch of the partnership in May 2021. Since then, the initiative has spread to a total of 55 collection and donation points where people can take period products to enable Period Dignity. 

Other organisations in Surrey have also come onboard, including Morrisons branches in Woking and Weybridge, as well St James Church in Weybridge.

Commenting on their support for Binti, Acting Chief Fire Officer, Dan Quin, stated: “We are delighted to be supporting Binti. As a Surrey-based charity with a global impact, they share our passion to support and protect those in need. I look forward to seeing the partnership develop, and hope that our communities will benefit from our planned work with Binti, as they have from the scheme established by our colleagues in Surrey County Council, and in particular Surrey Libraries.”

Manjit K. Gill MBE, CEO and Founder of Binti commented, “We believe period products should be available like toilet paper is and Surrey County Council are leading the way to create this change. With the cost of living crisis impacting many the campaign has been designed to ensure everyone has free access. Surrey is having menstrual conversations every day and working with Surrey Fire and Rescue Service is so exciting because we think period stigma will become a thing of the past.”

Binti was the first period charity registered in the UK, they have offices in India, US and The Gambia. They have now opened a period charity shop the first of its kind in Walton on Thames. Girls can buy period products and discuss all things related to menstruation. Binti’s vision is to provide menstrual dignity to all girls, all over the world. This means facilitating access to pads to ensure menstrual health, educating girls about what menstruation is and what they can expect from it, and dispelling stigma, taboos, myths and negative perceptions around menstruation.

For more information on how to donate and collect and ways to get involved, visit Surrey County Council’s Period Dignity webpage or the Binti website.

Surrey County Council news

A council chief has called on select committee members to use their status as a “top Tory” authority to influence health spending at government level. Calling ambulances backed up outside hospitals “dangerous” and saying “we don’t want old people on trolleys in corridors”, one of the council’s health directors said it would take everyone working together to get through the winter.

Surrey County Council’s adults and health select committee heard on Wednesday (October 6) from representatives from Surrey Heartlands Integrated Care System (ICS), South East Coast Ambulance Service (SECAmb) and Frimley Health and Care ICS.

As the health organisations set out their plans for winter pressures, and commitment to working together to cope, members heard of current issues including Frimley Park hospital beds being nearly 100 per cent full most of the time and systems issues causing delays in ambulance handover times.

Liz Bruce, joint executive director for adult social care and integrated commissioning (Surrey County Council and Surrey Heartlands ICS), said she “absolutely agreed” that ambulances backed up outside hospitals was “high risk and dangerous to everybody else in the community”. She said: “We don’t want old people on trolleys in corridors, and therefore we’re all in this together.” She highlighted the importance of the “whole system” working together, saying improvements were “everybody’s responsibility”.

The director said: “What can this committee do to help us? A Conservative council, a top Tory council, you can help us by influencing government around funding nationally for hospital discharge and social care, and how we support sick people safely to go into hospital and come out again. Because we don’t want to see elderly people go into long term care when they don’t need to.”

While the government had announced £500million for health care over the winter, she said it was not yet clear how it would be allocated or if it was “truly new money”. Saying she expected the winter to be “extremely challenging”, she added: “It’s very obvious that we’re going into significant and stark problems in our system for people in discharge. I’ve asked [my team] to build, very quickly, a business continuity plan around with winter discharge.”

The meeting heard from South East Coast Ambulance and Surrey Heartlands representatives about what was being done to improve ambulance handover times. Moving towards electronic patient records, virtual wards and daily meetings were all hoped to help with delayed handovers which were made worse by sicker patients and “systems problems”.

SECAmb’s deputy director of operations Mark Eley said he was having to balance offering staff overtime, particularly in the current financial situation, with the risk they might “work too hard, wear themselves out” and go off sick. He said: “Staff are becoming very weary and worn from the last two years, so I’m not pushing too hard because as I increase my overtime, I can increase my sickness if I’m not careful.”

The issues with Frimley Park hospital beds being full “almost all of the time” were also said to be caused by not being able to discharge patients who were well enough to go home.

Our special correspondent shares his local experience.

In the good old days before Covid 19 you could visit the surgery to book to see a doctor, or instead telephone. You can do neither these days; now you have to fill an online form in and in a day or so the doctor will get back to you. If you are lucky, you will be able book a face-to-face appointment with the doctor provided you do not have a temperature or any other of the dreaded symptoms of Covid.

There is one exception to this; if you have an eye problem you book an appointment at SpecSavers as (at least in this area) they act on behalf of the NHS. They do an excellent job; for minor problems they will sort it out. If not, they will send you off to the eye hospital to be seen straight away as a lengthy wait to see a consultant may result in more damage.

I have been a type 2 diabetic for twenty-five years and because of this annually I have my eyes screened; photographs are taken of the back of the eyes. When I started this was done at Epsom Hospital. I got there by bus and the procedure was tiresome, as they put drops in your eyes which make your sight blurry. But it had to be done!  Then after a few years the technician gave me some good news; they had a modern machine and drops in the eyes were no longer needed. Absolutely brilliant. On top of that she would put your mind at ease and tell you not to worry.

Then someone in government decided to privatise the operation and accepting the lowest bid without having regard to anything else the service went into rapid deterioration. The new equipment was sold off and outdated technology returned. Years later, the privatised version of diabetic eye screening is still using equipment that became obsolete twenty year ago. Now you are advised:

*  plan how you’ll get to and from the test – do not drive, as you sight may be blurry for a few hours afterwards.

* you might want to bring someone with you or ask someone to collect you after the test.

* During the test you’ll be asked to read some letters on a chart first.

* Drops are then put in your eyes. This may sting for a few seconds. The drops make your sight blurry after about 15 minutes. After that you’ll be asked to look into a camera.

* After the test you will not get the result on the day. You will get a letter about your result within 6 weeks.

Screening can take place at various venues, such as community centres, as well as hospitals.

I could have my eyes screened at Epsom Hospital without spending a penny on transport as the 166 bus would drop me outside. However, I choose not to because I do not need to waste a few hours being unable to see properly. Instead, I have my eyes photographed at Steven Harris Opticians in Beckenham. I get there by train and tram, but if I did not want to spend any money, I could take the 166 to Croydon Bus Station and get another bus from there to Beckenham. They take a number of photos in each eye (not just one in each eye) and the consultant shows me these and what they mean; he says we are looking for consistency with last year. No drops and a fantastic service.

Of course, other opticians, including SpecSavers, have the latest equipment also.

I keep on being harrassed by Surrey’s Diabetic Eye Screening Programme (DESP). They insist that if I opt out it means I don’t have my eyes screened and they will inform my GP. They simply don’t understand that there are better services out there.

Anyone over 60 can have a full eye test, including a retinal scan FOR FREE under the NHS. Those under 60 can go privately and the same procedure costs around £45. In my view, such a fee is worth every penny.  After all, it would relieve the anxiety of waiting six weeks to know if there were a problem or not.

The NHS would save a fortune if they scrapped this privatised service and organised screening through qualified opticians.   

[Do you have a view? Write to us. Ed]