This award is an opportunity for patients, families, visitors and Trust colleagues to say ‘thank you – you made a difference’ to a member of staff or a team for anything (however small!) that helped make their experience of our services better.

Our Winners for November 2020 are:

The Children’s Complex Care Team, Children’s Community Specialist Nursing Service, Cambridgeshire

Christine Thompson nominated the team for the wonderful support they showed to a family during their child’s end of life and after death care during the covid-19 pandemic.

Christine said: “The team requested the whole family’s Family Support sessions were extended with the service as their child’s health was deteriorating. Both the child’s siblings were not in school due to the COVID-19 pandemic. Mum informed me she was struggling to get Conti wipes for her child to wash her with and these were either sold out or extremely expensive due to the pandemic. We therefore agreed to supply these. The child’s junior sister was being supported by a Children’s Support Worker who raised concerns. She was therefore seen by the GP and referred to CHUMS due to anxiety, and offered a group course to attend. I also requested the hospice Art Therapist consider seeing the junior sister for support.

The child’s short break hours were commissioned for a care agency to provide, however, this had not been successfully established. Therefore on 20th March it was agreed with the CCG we could offer all free capacity during the day to support the child’s short breaks as her health began to deteriorate further. Both the Symptom Management team and a Consultant Paediatrician advised Mum she could stop using the saturation monitor if she wished; Mum was not comfortable to do this. I agreed with Mum to support her to lower the heart rate alarm threshold on the monitor and to increase the alarm delay to decrease the alarms and Mum’s anxiety.

“On 25 March the local hospice confirmed they were unable to provide commissioned care to the child due to the COVID-19 pandemic. On the 27 March 2020 the child was thought to be approaching the end of her life, her health having deteriorated further. The team therefore commenced one night a week short break care as the child’s Mum was evidently exhausted and Mum declined the care agency to proceed with ‘meet and greets’ with new staff. The local hospice also confirmed they would be likely unable to accept the child for end of life care at the local site due to the COVID-19 pandemic. Mum also confirmed she would not want the child to go to any of the other sites owned by the local hospice as these were further in distance to home which would have impacted the whole family and the staff did not know the child at these sites.

“I requested support for the child’s siblings from our Play Therapist as they were struggling to witness their sister deteriorate. On 1 April the child’s Mother decided she would like her child to be cared for at home during the end of her life and her body cared for at home after her death if unable to go to the local hospice. I asked my nurse colleague to enquire how to register a death currently during the COVID-19 pandemic.

On 3 April I asked for home improvement electrical works to be stood down as it was agreed these were inappropriate at this time. On 6 April the child commenced Diamorphine via syringe driver and on 7 April 2020 I requested our Play Therapists input as the hospice were not offering face to face support for therapy or memory making. The child spiked a temperature and I sought advice from their Paediatric Consultant, Infection Control Lead, Senior Management and the Medical Director regarding COVID-19 swabbing and PPE. It was agreed that we would support the wishes of the family in regards to PPE and adapted to an individualised risk assessed approach so as not to unnecessarily increase the child’s fear at the end of her life. It was confirmed the child would be unable to go to the local hospice after her death due to the COVID-19 pandemic.

“On 9 April 2020 I confirmed the local hospice was unable to offer a cooling system to the child to enable her body to stay at home after death as the family requested. On 14 April my team confirmed with the child’s funeral director they could provide a cooling system and support the child at home after death. The team continued to offer short break day care daily and x3 nights a week to the child as her health continued to deteriorate. On 17 April it was agreed with Mum that the child’s nebulisers could stop as they were causing her unnecessary distress. The Health Care Support Workers (HCSW’s) and I discussed with the child’s Mum the family’s wishes for her after her death. Mum requested support from our team to help wash, dress and care for her child after her death, and help create a music playlist for her child to have playing in her bedroom.

“On 20 April I liaised with the funeral director regarding the cold blanket they would supply, checks they would carry out, and out of hours support they could offer the child. On 21 April It was agreed that within ‘reasonable hours’ the family could contact the HCSWs directly to inform them of the child’s death so that they could attend the home to support the family with care of her body. The HCSWs spoke to Mum about switching off the saturation monitor when they were in the room with the child which she agreed. I discussed with the HCSWs and agreed a checklist of what they could do to support the care of the child’s body after she died. On 22 April it was agreed a HCSW would commence art sessions with the child’s twin as she had disengaged from art therapy with the hospice due to it being via video call and not face to face due to the COVID-19 pandemic.

“The child spiked another temperature and again it was agreed to respect the family’s wishes in regards to PPE. On 23 April I ensured the child’s Dad had received a supporting letter from their Consultant Paediatrician to provide to his work, explaining the need for him to have time off work during the end of the child’s life.

“The family purchased an air con unit for after the child’s death as advised by the funeral director. On 24 April we obtained a Dyson fan from a charity and money for the air con unit the family purchased and funds for ice for the unit. Mum stated she was struggling with conversations with various professionals who were ensuring she understood her child was dying. Mum stated she wanted to focus on the positives remaining daily for her child and the family and she understood her child was dying. I agreed to liaise with professionals in regards to Mums wishes. On 26 April the child’s father telephoned the HCSWs believing his child was going to die that evening, the HCSWs attended the home along with the Symptom Management team from the hospice and a Children’s Community Nurse and Senior Manager from our service.

“On 27 April 2020 at 17.10 I received a call from a HCSW informing me that the child had passed away. I was informed the HCSWs had just left the home following short break care and the child’s parents had called them stating the child had died. The HCSWs returned to the home to support the care of the child’s body. I contacted the appropriate professionals to inform them of the child’s death. On 28 April it was agreed with parents the HCSWs would attended the home twice daily to support care of child’s body. On 29 the HCSWs agreed with Mum they only needed to attend the home once daily to support care of their child’s body and they would contact parents daily to enquire if a second visit was necessary or not. The HCSWs removed equipment as requested by parents form the home and on 6 May the child’s body was taken to families chosen funeral home to be cared for. The HCSWs supported the family at this time and encouraged Mum out of the home as she became extremely distressed.

“On 11 May Mum informed me the family created a memory garden for child at home where they had spent a lot of time during the end of her child’s life, and the HCSWs, as a family creating positive memories. I discussed funeral arrangements and ideas with the Mother. Although as a team we do support children who are life limited and at times in end of life this is a rare occasion and usually the hospice would lead on this care. Due to covid-19 this was not the case in this instance and the team went above and beyond to support this family, in a truly child and family centred manner offering support that was not necessarily something we had done before.

“The team had daily contact with the family to support them and this was varied in delivery due to the pandemic, lockdown and some staff shielding. Difficult conversations were often needed with parents via technology. The care and support offered to this family was exemplary and the feedback from parents exceptional.”

What an amazing nomination showing the outstanding care provided by this wonderful team!

Other nominations this month included:

Anne Malanaphy, Rapid Response Staff Nurse, Rapid Response Night team, Luton
Anne was nominated by Halima Begum, Sue Laird and Annamaria Vayer on behalf of the whole team for working throughout the pandemic covering shifts for nurses who were shielding/isolating and still continuing to carry out extra shifts to ensure the service is covered. During her shifts she dedicated to provide the best care to patient and family members and always goes that extra mile. They said: “Patients and their relatives have verbally praised Anne for her dedication and hard work. Anne always comes to work with a smile on her face, never complains and has a positive approach to work. She is an excellent team member always ready to help her colleagues. Anne is a very valued member of staff for the night team, and we feel she deserves some recognition for her continuing hard work.”

Hazel Byatt, Manager of MOS Department, Mill House, Cambridge
Hazel was nominated by Pat Weller for her tireless hard work throughout the pandemic. Pat said: “She has always been an amazing hard worker from way back when she was a P.A. for our clinical director for many years. She choose this promotion to manager for the MOS dept., even though she was not clinical and knew the task ahead could be hard, but Hazel has always been driven by determination to do her job well and to make a success of all that she dose. She has shown this 100 % in her role as our manager with a happy team and a great working environment.

“To describe what made a difference and why I nominate Hazel, I have to say it’s been two things. Firstly it’s been the hard work and the hours she has put in during this pandemic and the support and understanding she has given each team member. If you need time off, help with your job or you need to speak to her about anything, she does her very best to sort this and make the time to listen and help. Even when she is extremely busy she finds the time to support her staff. This is very comforting for us all especially over this last 8 months when everyone's life has been turned upside down.

“Secondly it’s been the support Hazel has given me personally. After a long time off work she gave me the opportunity to work for her in the MOS dept. and her care and support have been second to none. So what's made a difference? Hazel's hard work, determination, positivity and her care and support for all the MOS team. Sometimes things just go unseen and I think Hazel's commitment to her role and staff needs to be recognised and awarded as she has worked for Brookfield’s for the last 20 years and has always given 100%.”

Elizabeth Taylor, Specialist Nursery Nurse, Child Development Centre, Community Paediatrics Service, Beds
Sarah Holmes nominated Elizabeth after receiving lovely feedback from a parent of a child with additional needs:  “Elizabeth is wonderful and amazing and we are very grateful for all the support we have received from her.” An example of the compassionate and committed care and support Elizabeth consistently shows towards the families she works with.

iCaSH Norfolk - LARC waiting list initiative
Ellen Ballantyne-Hough nominated the iCaSH team at Oak Street in Norwich for their outstanding work in managing the demand for LARC (Long Acting Reversible Contraception) post lockdown 1. Covid-19 as we know, affected everyone in March and April 2020, and iCaSH NHS services were deemed as essential, but they worked to a revised and reduced offer during the initial lockdown.

Ellen said: “We slowly began to increase our service offer within iCaSH in line with national guidance and activity and demand started to increase as lockdown restrictions were lifted. This summer, the iCaSH services found themselves with a large cohort of women whose LARC procedures were cancelled during lockdown, due to the reduction in face to face clinics and the temporary remodelling of essential service delivery. Services began recovery planning in the GU, Contraception and HIV elements of care delivery.

“Demand for LARC increased, coupled with the ‘backlog’ of women whose appointments in March, April and May had been cancelled. In August 2020 it was decided to trial a waiting list initiative, where callers were placed onto a waiting list for a pre-assessment appointment. This saved ringing endless times for the next available pre-assessment, and in turn helped with phone line capacity, meaning the patient and call taker experience immediately began to improve. The waiting list grew and grew and soon after starting, there were over 600 women waiting for pre-assessment clinics, often waiting in excess of 5 weeks for the initial pre-assessment.

“The team have worked incredibly hard since August and now are able to offer in excess of 100 pre-assess appointments each week, matching 100 LARC appointments also offered each week, mainly due to the commitment of staff, and many working excess and additional weekend hours. The management and delivery of this initiative is like a huge complicated jigsaw, with many staff playing very different, but all equally important and integral parts. From the idea of the list, to designing the system, to call taking, staff co-ordination, appointment making, through to the pre-assessment and end procedure clinics, everyone has a valuable part to play.

“To date, since 5th August 2020, the Norwich team have pre-assessed and LARC fitted over 1,070 women, and the waiting list that stood at over 600 in September and early October, has now decreased to 238. Weekly call volumes have decreased, from 140 at the peak, to fewer than 70 a week now, allowing us to provide capacity in excess of demand, which is helping to reduce the waiting list. Women now are waiting no longer than 3 weeks for a pre-assessment following initial contact and procedures are usually offered within a few days the team are aiming (and hoping!), that by Christmas, call takers will be able to book directly into pre-assessment slots and the waiting list will no longer be required.

“The initiative has been replicated across our iCaSH services, using the Oak Street model as a basis for similar iCaSH hub LARC waiting list initiatives. I am so proud of how the team has handled this immense project. What seemed unachievable and daunting just a few months ago, has turned around to become something they can be proud of, and shows the strength, commitment and diligence of the team, made up of call takers, administrators, clinic assistants, clinical nurse specialists, medical staff and operational managers. You have made the impossible, possible. Thank you!”

Fantastic nominations this month, well done to everyone who was nominated!