Examination of Witnesses (Questions
120-139)
MS JULIE
MOORE AND
DR DAVID
ROSSER
21 JUNE 2007
Q120 Mr Jenkins: I am going to stick
to this question. I would like to know, do I send a message to
the Taliban asking them just how big and ferocious their attacks
are going to be in Afghanistan because then we would have a degree
of certainty. I asked you the simple question of what is the cut-off
point where you would have to say, "We can handle no more,
they must be diverted somewhere else". Have you worked out
or thought of a number?
Ms Moore: If we know with certainty
what the number is we can plan for that. If we were told that
the numbers are going to continuously go up, can we continue,
yes, if they were to increase 20 per cent, 50 per cent, yes, but
what I do not know is whether that is the plan to continue, that
we will be the sole receiving hospital at the moment. If we were
told, "You are going to be it", then we would like to
build in capacity to flex up and down which, indeed, we are doing
at the moment. We could take, and have taken, anything we have
been asked to take by the military and the MoD and we will continue
to do so. A degree of certainty that they are going to continue
to do that would just be helpful.
Q121 Chairman: Would you expect there
to be any change in these arrangements when super garrisons come
on-stream? For example, if there were large numbers of personnel
based around Colchester, and hospitals are therefore used to dealing
with military personnel there, would you expect any change in
these arrangements as a result of that?
Ms Moore: Not in aeromedically
evacuated patients. Prior to the recent conflicts we were seeing
very, very small numbers of inpatients, sometimes none and the
maximum we ever got up to was about four, six or eight before
that, so very small numbers in a 1,200 bedded hospital. The real
difference that has been made is soldiers posted overseas in conflict.
Q122 Mr Jones: Can I ask a question
of Dr Rosser. We were in Afghanistan two months ago and we met
the medical personnel at Kandahar and were very impressed by not
only their dedication but also the change of emphasis in putting
doctors on the frontline, for example, rather than after med evacuation.
What feedback or professional contact do you actually have with
the people on the frontline who are treating these young Servicemen
as they are actually wounded? Is there an exchange of professional
expertise or any lessons you could learn or vice versa?
Dr Rosser: A number of the people
who go out are actually based with us so the contact we have with
them is great because they are colleagues when they are back in
the UK. We have learned a number of lessons about communication
essentially and how important it is that there is personal conversation
between doctors on the frontline, particularly for the major injuries,
particularly chest, head and neck injuries that surgically are
very complicated. We have done quite a lot of work with General
Lillywhite and have arranged a number of different communication
channels and regular telephone conferences to discuss issues in
principle: maybe we are not using the right dressings, maybe we
should approach something slightly differently. The surgery at
the front end is about saving life, as I sure you know, really
stopgap surgery, and reconstructive surgery is what we do when
people get back here but clearly you cannot entirely separate
those. There has been a lot of communication really fine tuning
that interaction: "Perhaps if you did it a little bit differently
the reconstruction results would be better". We have also
done a lot of work on opening up communication channels so there
can be direct communication about individual patients on the way
back because theoretically one should be able to put the necessary
details on a handover sheet. To quote one of my surgical colleagues,
"If you are going to have to put both hands inside somebody's
chest it is very reassuring to know exactly what your predecessor
did and found". We have recognised the importance of that
and opened up better channels.
Ms Moore: The Army are looking
at putting digital links in so that images are being fed directly
back to our consultants for views as well, and also to have web
cams to look at wounds. That is something that 24 hours a day
will give access to surgeons that they have not got on the frontline.
Chairman: We saw something pretty similar
to that in the Shaibah base in Iraq last year.
Q123 Mr Havard: As I understand it,
that process is going to be extended further in the new hospital
arrangements that are coming along.
Ms Moore: That is right.
Q124 Mr Havard: Therefore, a lot of this
stuff is being planned to be developed in that. This comes back
to a point that you made earlier about certainty and planning
and the question that we asked about financing and contract arrangements
and so on and the certainty of something remaining here and developing
here. As I understand it, you, the NHS Trust, contract with the
MoD to provide certain things. That is presumably, what, a 12
monthly process. Can you explain to us whether or not there is
a 12 monthly contract between you and the MoD that deals with
the current process as is described and running, and how the contracting
arrangement is being negotiated about future development and your
point about certainty and planning?
Ms Moore: The contract is negotiated
12 monthly. At the moment there are two processes going on, there
is a routine 12 month contract and there are two contracts, one
for treatment and one for the training and personnel placement
and, secondly, we are having discussions with the MoD about what
facilities they want exactly in the new build. We have got capacity
to expand the military presence in there but we do need to know
about that fairly soon. With a PFI build there is a timescale
you have to meet, so the deadline that I have asked for is that
they will let us know by August about what they want in the new
hospital.
Q125 Mr Havard: So the new hospital
is a PFI build.
Ms Moore: Yes.
Q126 Mr Havard: And you are in the
process of contract negotiations now?
Ms Moore: Yes.
Q127 Mr Havard: So when you say the
near future, are we talking about 18 months, 12 months, six months?
Ms Moore: No, six weeks.
Q128 Chairman: The new hospital is
to be finished in 2011?
Ms Moore: We start moving in in
2010 and we finish the whole process in 2012. We have got an 18
month moving in process so you were right, somewhere in the middle.
Q129 Mr Jenkins: If I can take you
back once again, because I like to learn from our mistakes if
possible. There was a time when we first started out when we did
have some problems in the treatment of injured personnel, and
I think you would accept that as a justified criticism. As you
put it, there were some "inevitable teething problems".
Did you log those teething problems? Did you in any way keep a
profile of how you overcame those teething problems? If we need
it I want to be sure that we can pass that on to another trust
so we do not undergo the same problems in the future. Did you
do that?
Ms Moore: We did do that. We have
regular meetings with the military where we go over issues that
are learning points. Some of those have been clinical issues because
some of the injuries we have not seen and people have not been
trained in for some time and a lot of that expertise has been
shared. Others were some organisational issues but they were minor
compared to some of the clinical elements at play.
Q130 Mr Jenkins: It is the clinical
side that I am interested in. I think anyone who has spent any
time looking at this problem will realise that there are men and
women now alive today because they have come to Selly Oak. It
would have been extremely challenging for our military medical
teams to have shown the same degree and level of skill. Will you
take it from me back to your staff and say thank you for all the
work you have done, all of the hardships you have overcome, all
of the teething problems you have overcome and everything else
to provide that service.
Ms Moore: I will be very glad
to do so. Thank you.
Q131 Mr Jones: Would you recognise
one of our witnesses last week described the situation in Selly
Oak in the early days as—the actual words used were—"confused
and shameful"? Do you recognise that as a fair criticism?
Ms Moore: No, I would not. The
focus has always been on providing the utmost clinical care. I
think those words may have been applied to some other aspect but
certainly not to the clinical care that was given then. I would
be on record as saying that the staff of the Trust take a very,
very high degree of pride in the care that they provide to the
military. They are distressing injuries, the staff have a degree
of empathy with the military casualties coming back, and I have
no problem at all when we have an aeroplane landing that has got
six coming into critical care that staff will come in at a moment's
notice on their day off to look after the soldiers. Around clinical
issues, no, I would not recognise that at all.
Q132 Chairman: Clinically, clearly,
you are quite excellent, and if I may take this opportunity, on
behalf of the Committee, I would like to thank you for that because
I think the care that you give is outstanding.
Ms Moore: Thank you.
Q133 Chairman: I suspect we all think
that. When you say that around clinical issues you would not recognise
that phrase, would you recognise it about any other aspect of
the care which was provided by Selly Oak in the early stages?
We have clearly moved on now but in the early stages would you
recognise that?
Ms Moore: I think in the early
stages where casualties were coming back people were not so used
to casualties arriving back in the middle of the night or whenever
and there may have been some organisational issues. There was
never anything that we investigated from the Trust's perspective
that gave great cause for concern as far as we are aware. There
were some complaints that came through about some of the follow-on
care afterwards once people had gone.
Q134 Mr Jones: I just have a follow-up
to that in terms of complaints, either about medical care or the
way people dealt with it. How many complaints have you received
from Armed Forces personnel who have been through Selly Oak, or
their families in, say, the last 12 months? What type of complaints
have they been?
Ms Moore: Since we have had the
military there we have treated nearly 40,000 patients and we have
had seven complaints; two last year and there have been five this
year.
Q135 Mr Jenkins: What was the nature
of those complaints? Were they about medical care or welfare care?
Ms Moore: There were a variety
of issues. One issue we could say was about clinical care but
the rest of the issues were more peripheral issues, if you like.
The one medical issue Dave is familiar with so I will ask him
to answer that.
Dr Rosser: The one which you could
say is a half clinical thing which we picked up in one of the
complaints was around a drug error when a short acting version
of a painkiller was given instead of a long acting painkiller.
That in itself poses no major risk but clearly it is not acceptable
for drug errors to happen. Having said that, to put it in context,
we administer 147,000 drug administration events per week in our
organisations, so realistically, however hard you try and however
hard your policies are for dealing with drug errors they will
happen, when you are dealing with that many events it is inevitable.
Q136 Chairman: Do you know how those
sorts of statistics compare to other NHS trusts in the United
Kingdom?
Dr Rosser: The complaints statistics
or drug error statistics?
Q137 Chairman: The complaints statistics
I was asking about, but the drug error statistics as well.
Dr Rosser: The drug error statistics
I do not really know how it relates because we are running a very
advanced electronic prescribing administration system in our organisation
which is unique to us. I can trot out those figures because I
get weekly reports from that system, I suspect most of my medical
director colleagues around the country would not have those figures.
I think Julie knows the figures on complaints better than I do.
Ms Moore: In terms of general
NHS complaints 0.1 per cent of patients in the NHS complain, the
statistics for the military is 0.02 per cent, so five times lower.
Q138 Chairman: A final question on
this and then I will turn over to Kevan Jones again. If this system
is so good at administering drugs, why is it unique to you?
Dr Rosser: It was developed by
us in partnership with the university and it has not spread throughout
the NHS largely, I guess, because the NHS is waiting for similar
products to be devolved through Connecting for Health.
Ms Moore: We will be looking to
sell it in the near future!
Q139 Mr Jones: One of the debates,
certainly in Parliament, has been about the idea, and one of the
arguments is, we should have separate hospitals altogether for
military personnel. Obviously even the Opposition have now conceded
that is not clinically advisable. The emphasis now is on the creation
of military-managed wards and we saw this morning when we visited
it is perhaps the best way of treating military, not just in terms
of the care but also people being together with a military ethos.
Where are we at with that at Selly Oak and also what challenges
does it set you as the Trust in terms of managing the military
unit with all the other responsibilities clearly for the provision
of care for the people of Birmingham?
Ms Moore: I think you are right,
it provides the best of both worlds. We have got the skilled NHS
staff who are able to teach the military staff and it also provides
a high degree of military staffing for the wards so that the soldiers
are nursed by large numbers of military nurses on the ward, which
you saw this morning. The challenges it presents are that military
nurses are not trained in running NHS wards so they have to get
familiar with whole new jargon and I think the NHS have to get
used to whole new jargon from the military as well. Both sides
use acronyms like there is no tomorrow. In bringing the teams
together there has been a positive benefit for both sides to learn
from each other. There are not great challenges in that there
are problems with it, they are all nurses, they are all doctors
and they are all looking after very sick patients. We do recognise
that the military environment is a different environment and having
military people looking after you is good.
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