Meeting the teams rated 'outstanding' at Harrogate district NHS trust

Staff from the Community dental team L-R; Christine Harding, Team Leader Lydia Gall, Head of service for North Yorkshire, Lesley Horton, Oral Health Nurse Chris Batty and Specialist Consutant Caroline Graham
Staff from the Community dental team L-R; Christine Harding, Team Leader Lydia Gall, Head of service for North Yorkshire, Lesley Horton, Oral Health Nurse Chris Batty and Specialist Consutant Caroline Graham
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Breaking down the Harrogate and District CQC report by department, five teams were recognised for their particular efforts going over and above to provide the best possible care.

Community dental services

Staff from the Radiology team at HDFT with head of department Libby Watkins (bottom right)

Staff from the Radiology team at HDFT with head of department Libby Watkins (bottom right)

The community dental service at HDFT describe the service they deliver as being different because of the patients’ needs.

The specialist service, delivers dental health to both adults and children with special needs, learning difficulties and disabilities as well as individual medical conditions.

Lesley Horton, Manager of Community Dental Services explained these vulnerable groups often need a lot more time dedicated to their individual situations to make them comfortable.

She said: “Sometimes they just need a lot of time in talking to them, and settling them into the practice. If you think somebody who’s quite autistic if you go up to them you won’t get anywhere near them.

Staff from the outpatients team, L-R: Ruth Horne. Tracy Hird, Lynn Briggs and Heather McKenzie-Shore

Staff from the outpatients team, L-R: Ruth Horne. Tracy Hird, Lynn Briggs and Heather McKenzie-Shore

“You have to spend that time and build up that relationship and rapport with them to be able to be able to get anywhere near them let alone look in their mouth.

“I remember a staff member once going out into the carpark because the patient decided they couldnt even come into the building, they didnt treat them down there but they will see them down there because they’re so flexible but that’s what makes the service because the patients are unpredictable and you don’t know how theyre going to react.”

Lesley oversees the NHS community dental service run in four areas across North Yorkshire and York, but the service here which covers Harrogate District and Craven is led by Lydia Gall.

In the last few years during her time as team leader, Lydia has seen the service become much more specialist and developing from having one part time consultant to two specialist consultants dedicated to specific areas.

Specialist consultant, Caroline Graham, said of the result: “I think it’s tremendous it reflects the hard work that the team have put in and the hard work they put in every day to look after our patients because we deal with some of the most difficult and complex patients across the county.

“All the team have put in a lot of effort for the children and adults we see to make dentistry as easy as they can for them.”

One of the ways the team that the team, who are based in a clinic on Wetherby Road, have been able to help patients adjust is with the oral health education room.

Chris Batty is both a dental health nurse and oral health promoter who works at the clinic but also goes out into the community to deliver talks in special needs schools about the importance of dental hygiene.

One of Chris’ informal colleagues - Colin the crocodile - also plays a pivotal role in helping children feel more comfortable and getting a better understanding.

Chris said: “We purposely keep this room as friendly as possible because not only children but we have adults who are extremely nervous.

“We call it aclimatization where they can come in here and we can perhaps chat about toothbrushing and whats going to happen in the appointment, what they’re worried about and what we can do to make it better.

“The puppets come in handy especially with children because when you want them to take responsibility for looking after their teeth and brushing them themselves alot of it is tell, show, do.

“It’s a lot more fun and kids want to engage with that rather than being told ‘you will brush your teeth’. The only problem is that people don’t want to go back to their own dentist because we’re so nice to them!”

Radiology

The head of the Radiology department has made an unofficial request for her team which was rated ‘outstanding’ by the CQC to be dubbed ‘awesome’ instead.

Radiology Services Manager, Libby Watkins, made the quip explaining that she knew her team would get brilliant feedback for their ‘committed’ hard work.

She said: “I think its absolutely brilliant and absolutely right, we actually like the word awesome rather than outstanding, we want to say we’re awesome so if the CQC could change it...

“We do feel the staff in this service really own what they do, they’re dedicated they’re committed and they’re frankly a brilliant brilliant team, and it is all about a team.”

Nationally, Libby explained there is a shortage of young medical professionals coming into radiography or learning to become a radiographer.

But that hasn’t stopped the team here striving for excellence.

Libby said: “We’re very short of staff but those staff that we’ve got really work 100 per cent to support each other, everyone comes to work with the objective of giving 100 per cent and a lot of them stay extra and do more than what they should have to do, theyre a brilliant team of people to work with and I’m very fortunate.”

But while there might be a struggle to get people into this section of medicine, it seems those that join rarely want to leave...

Of the roughly 70 staff members who work within the department, the team recently celebrated for one of their colleagues who was hailed in the trust’s recent long service awards for her 25 years in Radiology.

Outpatients

The outpatients department at Harrogate and District Foundation Trust deal with nearly every medical procedure that a patient is not required to be admitted for.

And in recent years, the outreach department has grown considerably to reduce the number of people visiting the hospital who don’t have to.

The team now deliver a number of services at outreach clinics in different areas within and surrounding the district, so people living in places such as Yeadon, Ripon, Alwoodley and Wetherby don’t have to travel for their care.

Matron-in-charge, Heather McKenzie-Shore said: “It’s the ethos of taking care closer to home. The outreach has been a huge development for us, particularly in Alwoodley because they can get an x-ray on site so they don’t even have to come here, they get everything there. You see your GP, you get reffered, your consultant goes out there you get your tests out there, your results out there - it’s fantastic they dont have to worry about parking or anything.”

Those who still come to the hospital at Harrogate for treatment have been catered for and considered as well, and all-the-while the team have been capacity conscious.

Heather added: “We do more one-stop shops so the patient only has one visit to the hospital rather than coming for an appointment and then for a test or an xray or coming back.

“We also do a lot of procedures that people used to be admitted for so we’re freeing up beds and improving capacity because we now just do it all within the department.”

The department has placed ‘secret shoppers’ whereby volunteers sit in the waiting room acting in the role of a patient and give feedback on the running of the service.

The self-assessment initiative has allowed the team to get feedback about the impact of clinics running late and reflect on themselves to improve their work.

Heather said: “We need to know the warts and all in order to improve, we need to know what we’re good at - everyone needs that pat on the back as well and the assurance that theyre doing well but we also need to know where we’re falling down and what we can do better in order to improve.

Many of the team have worked within the outpatient department for well over five years.

Heather is one of the longest standing team members having worked at the hospital for 28 years and is closely followed by the current outpatients manager, Tracy Hird, who has been there for 14 years.

Heather said: “People really care - it’s a hospital that is small enough that everybody kind of knows everyone and can communicate with each other and it is a real family atmosphere, it’s very easy to access people, there are no walls to jump over and hoops to jump through.

Fellow outpatient nurse, Ruth Horner said: “ When you walk in, you all say hello to each other.

“If somebody is in difficulty, you stop and you make the difference, you go and get that wheelchair or go and get somebody a glass of water. We go the extra mile.

“It makes you feel proud that you’ve delivered a really good service and made a difference to somebody.”

Intensive Therapy Unit

The Intensive Therapy Unit (ITU) delivers some of the most critical care to patients described as being ‘in the worst days of their life’.

But in an effort to take away some of the unimaginable stress that patients in the unit experience, the staff here have started patient diaries to fill in the blanks they might not otherwise remember.

Dr Will Peat said: “Patients often don’t remember themselves being so sick so what they have to deal with is their mind coping with all the stress and that’s one of the biggest things that the CQC picked up on.”

Head of the department, Senior Sister, Linda Cross, explained why the ITU can be such a pyschologically damaging experience.

She said: “There are a lot of pyschological problems like flashbacks and nightmares of equipment and noises.

“We try to keep noise down, we turn the lights down low and try to normalise it. We have clocks with the date and time on to keep patients orientated.

“If they wake up a week or two weeks later they will have missed a lot of things.

“It might have been the world cup or something and everyone has written in their patient diaries so we feed that back to them so that when they leave here or when they go to the clinics they talk about that and that has helped pyschologically in the last few years.”

Nurse Gillian Hudson has worked in critical care for around 40 years, but she explained that sometimes the emotional nature of the job can take its toll on staff too.

She said: “We need support sometimes too if it’s been a really bad experience, we need time to sit back and reflect on it, because we all have families. Sometimes we do get upset but it’s very satisfying helping people.”

The ITU at HDFT has received emotional letters of thanks for their care and support and for Dr Peat, it is making that difference which is important.

He said: “It’s dealing with the sickest people and trying to make a difference for them when they are in the worst days of their life and having the ability to do something to help them.”

Adult community services

In the same week as the CQC inspectors visited the trust, the Adult Community Services (ACS) team became a ‘vanguard site’ for a new model of care as part of an NHS England project.

The project has seen the team undergo massive change and intergrate their services with a number of other organisations including charities, social services, and the local council.

Matron of the department, Lynne Boyd, said: “I am really proud of absolutely everybody and proud of our achievement because they went out with the teams and they asked patients what they thought and thats what matters really because the patients are at the centre of it and for us to get outstanding at a time of absolute massive change which there is at the moment is amazing really.

Similar to the outpatients outreach teams, the majority of staff in ACS are actually not based at Harrogate hospital, and sepnd the majority of their time taking care directly to the patient.

The department covers everything from podiatry, district nursing service, community rehabilitation, out of hours nursing, hospital admission avoidance and supporting early discharge to long term condition support.

The ACS have teams in Harrogate, Knaresborough, Ripon, Dacre and Boroughbridge but most importantly, many of the services are delivered in the patients own-homes.

Lynne said: “When you’re working with someone in their own home you’re more able to see the person in the patient.”

One of the nurses who works primarily in the fast-response team of ACS, Jackie Finan, highlighted how rewarding the job is.

Jackie said: “There isn’t a day when I go home and dont feel like I’ve made a difference and its not about me its about the patient, you’re a guest in the patients home and you are actually having to adapt and be problem solving all the time because obviously in the hospital they are in our territory, it becomes very clinical whereas we are working around their environment and there are so many issues to consider.”

In that very nature of problem solving, Lynne highlight a recent effort the Dacre team had made to adapt their service to the patients best needs.

She said: “A very small development would be that the Dacre team saw a need that somebody who had a problem with their kidney’s couldnt have Diamorphine so they developed the Entonox service (gas and air relief) that midwives would use but for doing really painful dressings.

“I think thats the beauty of community nursing and community therapy is that people see a need and they think about it and they work a way forward.”