The Epsom and St Helier Trust board heard the complaint of a patient allergic to nuts given nut oil. LDRS reports:

A hospital patient with a peanut allergy and an epipen was given medication for a nosebleed which contained nut oil. The patient at St Helier hospital was told before going home that the A&E doctor “didn’t think” the cream contained nut oil, a hospital trust board meeting heard. But on returning home and reading the leaflet, the unnamed patient learned there was in fact arachis oil, or peanut oil, in the medication. The patient had gone to the emergency department after a nosebleed, having started on a medication to help reduce blood clots. The patient had told the nursing team on arrival at the hospital and the doctor who prescribed the cream for the nosebleed about their allergy.

On contacting the emergency department, the patient was told there was not an alternative medicine that could be prescribed.

Members of the Epsom and St Helier Trust board heard at a meeting on Friday (March 3) that the patient then contacted their GP for an alternative before making a complaint to the trust so the issue would not affect other patients.

The board meeting, held at Epsom hospital, heard from a registrar and a consultant in the emergency department what steps had since been taken to learn lessons from the incident. These included a safety alert being sent within the team and the individual doctor being spoken to, while board members also asked what more could be done at trust level to help in what was a “very, very busy” department.

Ruth Charlton, the site chief medical officer, said the emergency department was of the only in the trust to use a paper prescription method rather than electronic. She also said that because the emergency department was operating 24/7, and doing things very quickly, patients were not sent to pharmacy for medications, which would be “an extra checking mechanism in place”. She said an electronic system would flag allergens, such as cows’ milk, in a medication and then allow something else to be prescribed instead.

She added: “We need to take away this case and look at what more we could do to address the systems issues.”
The meeting also heard it was not clear what checks were made by the doctor about what was in the medication, or who the patient had spoken to when calling the hospital to ask about alternative medications.

Board chair, Gillian Norton, said the board was impressed with the “rigorous approach to learning” shown by the department and thanked the doctors for sharing the experience. She said: “Keep up the great work. “We are very conscious that you have done all this learning and thought about this while you have got this incredibly busy day job.”

Royal Surrey hospital trust bosses are beginning to plan for three days of junior doctor strikes which could have a “significant impact” on services. A national ballot is currently taking place of members of the BMA Junior Doctors union, which closes on February 20.

If members vote for action, it could mean a possible 72-hour strike taking place in March, a board meeting heard on Thursday (January 26). As yet the trust, which runs Guildford’s Royal Surrey County Hospital as well as the Haslemere hospital, has not been directly impacted by its staff striking, though ambulance strikes in December saw the hospital put measures in place.

Meeting documents said the junior doctors’ strike was more likely than others to meet the 50 per cent threshold needed for members to strike because a national ballot was being held. According to the BMA website, junior doctors have seen their pay cut by more than 25% to their salaries since 2008/09.

Bill Jewsbury, the trust’s medical director, said the three-day strike, which he thought “probably would” go ahead, would have a “significant impact” on various parts of running the trust. The meeting heard that other, more senior doctors, would need to “step down” into the roles, along with non-union members.

Dr Jewsbury added: “That then has an impact beyond that 72 hours because we then have to rest those people.
“What you’re looking at is a much longer period of disruption than just your three days’ of strike.”

According to the documents, a review carried out of the day of ambulance workers’ striking in December had identified one incident that was being investigated of the strike having an impact on patient care. The meeting also heard that the possible junior doctors’ strike would impact on its target to clear the backlog of people waiting more than 78 weeks, a year and a half, for treatment by the end of March, in line with national guidance.

Getting rid of all the people on the waiting list was described in documents as “the biggest operational challenge affecting the trust”, with a peak of 207 patients in the category at the beginning of October, falling to 161 at the end of November and to 155 in the first week in December.

Matt Jarratt, chief operating officer, told the meeting: “That is going to be a major challenge was going forward.”

A woman said she felt like her mum was “a prisoner” when she couldn’t take her home from a Surrey hospital.
The daughter, who we are choosing not to name, said it felt like the family was caught in a “never-concluding circle” when trying to communicate between NHS trusts to get her mum discharged.

Her mum was in hospital for five months, having been admitted to Guildford’s Royal Surrey County Hospital with pain following breast cancer, but the family living in West Sussex meant a lot of communication about release was across different NHS trusts.

By Colin Smith, CC BY-SA 2.0, https://commons.wikimedia.org/w/index.php?curid=9266476

She told a meeting of the Royal Surrey trust board on Thursday (January 26) that conversations about getting her mum discharged were “awkward” and “difficult” as she tried to negotiate her mum’s release from hospital and whether or not she needed a care plan in place.

Board members apologised for the patient and her daughter’s experience, which included time at Haslemere Hospital, and said the trust would address issues such as communication between themselves and neighbouring trusts. Alexandra Ankrah, NExT director at the trust, sympathised with the woman’s experience, saying she had been through similar with her own mother, though not at Royal Surrey.

Addressing concerns that her mother had felt like a “bed-blocker”, where people who are medically well enough to leave hospital cannot be discharged because there may not be the appropriate social care measures in place at home, she and others in the meeting agreed they did not like the term. Ms Ankrah said: “No one should ever be made to feel that they don’t have a right to our care and services.”

The daughter, who chose not to make a complaint against the trust, said: “I felt like my mum was a prisoner.”
The meeting heard that many patients were in similar situations regarding communication across county borders, and a meeting would be organised using the patient story as a basis to make changes.

The chief executive, Louise Stead, said it came up “every single week” with people caught in “an impossible little maze”. The trust’s medical director, Bill Jewsbury, said getting people home when they were well enough was “really important” because most people wanted to be at home and improved once there. He added: “If we are really honest with ourselves, we are incredibly risk averse around discharge planning.”

Dr Jewsbury said the story was “a classic example” of saying somebody needed a care package in place before they could be discharged but said it would be “quite a powerful driver” for the family to be able to take their relatives home. He said the trust should ask itself: “Have we had that conversation with yourselves as the broader family? [Have we] phrased and pitched it in such a way as: ‘There are going to be some risks involved in perhaps getting your mother home. ‘It isn’t without risk but we can get your mother home.’”

He said it would be “worth trying” and that the hospital could do more to work with families as well as outside groups such as charities and churches in supporting patients.

The hospital’s own virtual wards, where patients can continue to be treated at home and which started late last year, were also raised as one way of helping to tackle the issue.

The daughter told the meeting: “If somebody had presented me with a disclaimer for signing mum out of the hospital, I would have done that.”

Surrey County Council sets out its vision for the care and living of the older generation by 2030. In 2021/2022 Adult Social Care in Surrey spent £506 million to support older people. This money helped over 5,600 older people and their unpaid carers. Money was also spent with voluntary organisations that support people in their community too. Adult Social Care also ensures services for information, advice and guidance are available to help people understand their care options and to make good care-related decisions.

The county of Surrey has a population which is getting older with people living longer than in other parts of the country. These changes mean that many more people are likely to be living alone, without support from their family. By 2030, the number of people aged 75+ predicted to be living alone will have increased by 27%. National reporting states that the number of unpaid carers 65 years old and over will increase by 17% from 2016 to 2025.

Dementia is most common amongst older people and in Surrey it is estimated that between 2020 and 2030 the overall number of people with dementia could increase by 28%, from 17,700 to 22,672.

In building the 2030 strategy SCC stated “We spoke to over 750 people living in Surrey. We worked with many diverse groups of Surrey residents of all ages including unpaid carers, care providers, partners, and colleagues. This took seven months and included workshops and surveys. We wanted to know what works well, what does not work well, what could be improved and what is important to our residents.”

The plan sets out all the ways SCC, working with its partners in the NHS, care sector and districts and boroughs, will support people to live and age well in Surrey over the next decade. At the heart of the plan is a commitment to improving opportunities and care choices in local communities so that older people can be as active and independent as they wish.

The council engaged with residents and their families, as well as staff and partners, to draw up the strategy – and is now seeking input to help shape how it’s put into practice.

The plan is centred around three priorities. They are:

• Prevention – supporting people to lead healthy and independent lives in their local communities for as long as possible
• Living independently – enabling people to live in their own homes with care and support tailored to their strengths, including through planned new extra care housing
• Care homes – making sure that Surrey can offer the right mix of high quality care homes for those who need them

Further details can be found in the summary version of the plan at surreycc.gov.uk/livingwellinlaterlife.

Working with partners, including the NHS in Surrey Heartlands and Frimley, as well as care providers and voluntary organisations across the county, the council has already achieved some key milestones in its plan.

These include:

• signing a new contract for home care services so that people receive even better care in their own homes
• enhancing its reablement service for people needing short-term care, such as after a hospital stay, through linking with specialist care workers
• carrying out in-depth planning to help SCC and its partners meet the growing need for care home places catering for complex and challenging needs

The council’s keen to continue to gather residents’ and partners’ input as it works towards meeting the commitments in the plan. There will be opportunities to take part in workshops and surveys.

Anyone who has an interest in shaping services for older people can sign up via the web page or by calling 0300 200 1005, SMS (for the deaf or hard of hearing) 07527 182 861, text relay 18001 0300 200 1005 or BSL video relay.

Mark Nuti, Surrey County Council’s Cabinet Member for Adults and Health, said: “Our ambition here in Surrey is that no one is left behind – we’re committed to helping those who need us most, and improving quality of life for everyone. We want older people to be able to lead independent and active lives for as long as possible in their own homes and communities and, if they need extra support, to receive tailored and dedicated care. Our Living Well in Later Life plan sets out how we will continue to modernise our services and work with our partners over the rest of the decade to enhance the lives of older people in Surrey. If you have an interest in shaping services for older people, please come forward and help us put our plan into practice.”

Additional reporting from Surrey County Council news service.

Greg Culshaw of Toyota‘s Epsom Head Office (GB), has completed a gruelling 24-hour static bike ride, putting him on course to raise more than £40,000 for the Motor Neurone Disease Association.  Greg is the General Manager, Customer, Network and Quality Support.

Greg began his challenge at 10am on Wednesday 17 November and was joined by a number of colleagues, including Agustin Martin, Toyota (GB) President and Managing Director, who completed stints on static bikes alongside him, to give him encouragement. Paralympic cyclist, Jody Cundy, and Mark Chapman, Director of Finance of the MND Association, helped cheer him on at the start of his marathon.

Toyota (GB) is halfway through a three-year partnership with the MND Association and has so far raised more than £78,000 for the charity, which focuses on improving access to MND care, funding research and campaigning on behalf of the MND community.

Greg was inspired to take on the challenge in memory of a Toyota colleague, Rachel Rollason, who died from motor neurone disease earlier this year. He commented: “Rachel and I spent four years working together in the Customer Services Division and it’s fair to say that she made a lasting impression on me. Her boundless energy and devotion to getting things done were inspiring. She operated on ’no limitology‘ before I had even heard the phrase.”

He added: “This has been a brutal challenge, but at the same time I’ve been focused on completing it for Rachel and the MND Association. The idea started in a conversation with Rachel and in her last text message to me, she told me how proud she was of me for taking it on. She continues to inspire me and in turn, made me proud of her.”

To date, Greg has raised nearly £16,000 through his Just Giving page: https://www.justgiving.com/fundraising/Greg24hrBikeRide. This will remain open for donations until the end of November. 

Toyota (GB) has pledged to fund-match the total raised by Greg, which means the charity should receive around £40,000 to help it keep up the great work it does on its five key promises:

1.    To make MND treatable and ultimately find a cure.
2.    To ensure everyone gets the help they need, when they need it.
3.    To make every day with MND count.
4.    To ensure people with MND are heard
5.    To ensure that nobody with MND faces it alone

Mark Chapman, Director of Finance at the MND Association, commented: “Greg’s challenge is particularly poignant because he’s doing it in memory of his colleague Rachel. It’s brilliant to see so many staff members from Toyota rally behind him to honour her, knowing that every penny raised will make a huge difference to people living with and affected by MND.

Last year we provided £1.4 million of support grants for 2,479 people living with the disease.

The grants provided by the MND Association have helped people living with MND to maintain their independence and improve their quality of life, and we couldn’t do this without partnerships with companies like Toyota.”

Jody Cundy, eight-time Paralympic Champion (three swimming, five track cycling) commented: “It was a pleasure to join Greg for the first hour of his 24hour charity ride for MNDA. It was a tough challenge, but I hope my support and presence helped make it a little easier.”

Agustin Martin said: “Watching Greg complete this challenge while we went about our daily business has been humbling for all of us at Toyota.  We congratulate him for his for raising such a significant sum for the MND Association, our charity partner, and for helping to honour the memory of our much-loved colleague, Rachel Rollason.”

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