Articulate Autumn 2012 - Royal National Orthopaedic Hospital NHS
Transcription
Articulate Autumn 2012 - Royal National Orthopaedic Hospital NHS
a 2 articulate To connect by a joint, to speak distinctly 3 Autumn 2012 - Issue 105 Olympic volunteers Operational bed meeting 11 Getting a head start 13 Shoulder Unit represented at international event 14 Lasers see us in a different light 17 Surgeon rewarded for bravery in New Zealand earthquake 19 Record year for Buttercup Walk 20 Scat 22 Fond farewells 24 Christine’s corner SIDE IN 9 2 A message from Rob Hurd Contents 3 4–5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 E-pathology has gone live! RNOH staff volunteer at the London 2012 Olympic Games RNOH staff put on their dancing shoes for Olympic opening ceremony RNOH wins prestigious award Prosthetic Rehabilitation Unit greets Rob Hurd Operational bed meeting Travel scholarship Getting a head start Paediatric and speech language therapy praised Shoulder Unit represented at international event Lasers see us in a different light Colloquium for the retirement of Professor David Marsh Children’s ward holds Jubilee party Surgeon rewarded for bravery in New Zealand earthquake With grateful thanks… The RNOH Charity Scat London Sarcoma Service supports sarcoma Awareness Week Fond farewells News in brief Christine’s corner Editorial team Anna Fox Communications Manager Extension 5349 Jackie Stephen Head of Learning and Corporate Affairs Extension 5651 Dipti Pisavadia Communications & Foundation Trust Administrator Extension 5750 Christine Bows Clinical Nurse Specialist Extension 5279 Welcome to this long-awaited issue of Articulate! We’re in the midst of a very busy period for the Trust – whilst treating ever more patients, we are also accelerating our journey towards Foundation Trust status. I hope that you will read our leaflet “Shaping our future – with your help” which outlines our reasons for becoming an FT and how our Council of Governors will be configured. At the same time, we are making good progress with the bidders who are working on the design of our new hospital and many of you are involved in projects aiming to transform our services. Enjoy this issue – a flavour of what is going on in the Trust. Rob Hurd, Chief Executive New bank management system A new, improved bank management system was implemented in September BankStaff will: ✓ Enable managers to book and view bank and agency staff ✓ Send alerts about available shifts to SMS ✓ Enable bank workers to complete and submit their timesheets online for approval ✓ Enable bank workers to view their pay and enhancements before they get paid ✓ Enable effective management of agency costs and processing ✓ Provide comprehensive audit trails of bank usage ✓ Be fully synchronised with ESR, avoiding duplication of entry ✓ Allow individuals to flag their availability, view unfilled bank duties and book themselves directly on to a shift BankStaff went live for all day shifts on 27 Sept ember 2012. All shift requests from 27 September must be book ed via BankStaff. For further information, please contact Gill Foun tain on extension 5291 or Tracey Ward on extension 5773 . articulate To connect by a joint, to speak distinctly E-pathology 3 has gone live! This new system (Pathology Electronic Requesting and Reporting) enables clinical staff to issue and administer pathology requests electronically and view results. What is E-pathology? How does E-pathology work? Staff will no longer need to spend time writing pathology requests, worrying if the required forms are available, whether they used the right forms, if requests get collected from the “RED BOX” by the right people or if the sample has been taken and sent to the laboratory for analysis. The pathology service is provided by Royal Free London NHS Foundation Trust (RFL); the Trust ICE system will be securely connected with the RFL pathology system. This will enable the electronic transfer of pathology requests and test results between the two systems, for viewing by RNOH clinical staff. The new system will enable clinicians and clinical staff to administer and follow up the progress of each request. They will also be able to view the results of pathology tests online using the ICE system. Staff will be able to issue pathology requests and print bar-coded labels, containing test and patient information, for placement on the pathology sample containers. Who can use E-pathology? Where will E-pathology be used: There are two parts to E-pathology: E-pathology will be implemented in all areas where pathology test requests are originated - all wards, Theatres, Stanmore and Bolsover Street Outpatients’ Department, pre-admission, metabolic and pain clinics and occupational health. Pathology laboratory staff will also have access to the e-Pathology system. 1. Test requests: All clinicians and some clinical staff who are authorised to issue pathology requests will be able to create and update pathology requests 2. Test results view: All clinical staff who are authorised to create pathology test requests will be able to view test results. In addition, access to test results will be given to all clinical staff and medical secretaries who need access to pathology results What are the benefits of E-pathology? • Faster pathology requesting process • Less clinicians’ time issuing requests • Improved quality of pathology requests • Traceable test requests • Elimination of errors caused by manually issuing requests • Closer links between requests and results • Improved monitoring of test results • Fewer duplicate requests Training is available for staff on how to use the system articulate To connect by a joint, to speak distinctly 4 RNOH staff volunteer at the London 2012 Olympic Games Dr Roger Wolman (consultant in rheumatology and sport and exercise medicine), Emma Levy, Hannah Mills (physiotherapists) have dedicated their time to volunteering at the Games. They share their experience of participating at an event that has been described as a roaring success and the best Olympics ever staged. Dr Wolman worked at the polyclinic in the Olympic Village, which provided accident and emergency services, primary care, physiotherapy, podiatry, dentistry, radiology and sports medicine. “I worked in the Sports Medicine Department where we provided a walk-in service for the athletes from 07.00 until 23.00 every day. The clinic was beautifully designed, providing space and natural light. To deal with injuries, we had access to two MRI, one CT scanner and three Ultrasound scanners. “The athletes were usually seen within 20 minutes of arrival and scans were usually done within two to four hours. They had the benefit of a multi-disciplinary approach with sports medicine doctors, physiotherapists, podiatrists and radiologists all working together. This created a very positive experience and one that was appreciated by the athletes. “The sports medicine approach to managing the Olympic athletes differed in several respects to the NHS sports medicine clinics at the RNOH. We saw injuries at the very early stages and the athletes often had scans within a few hours of injury. This sometimes made interpretation difficult. Virtually all the athletes chose to receive any treatment that would allow them to compete in this once-in-a-lifetime opportunity. “An athlete in one of the combat sports ruptured the main ligament in the knee (anterior cruciate ligament) during the semi-final bout, which the athlete went on to win. A few hours later, with the knee swollen and heavily strapped, the athlete decided to compete in the final. Unfortunately this resulted in defeat. By the time the athlete attended the polyclinic (a few hours after the final), there was severe pain and limitation of movement and evidence of damage to other structures in the knee. On three occasions, I gave injections 24 – 36 hours before competition to help control pain and inflammation, which allowed the athlete to compete. “Working in the village was an exciting and positive experience and I believe the team gave a very good account of sports medicine expertise in the UK.” articulate To connect by a joint, to speak distinctly 5 Hannah Mills, physiotherapist volunteered at the Olympics for two weeks and was based in the medical polyclinic. “Within the clinic there was a vast pool of expert knowledge and talent, spanning a wide range of multi-disciplinary team members. I was one of many physios recruited to work at the Olympics, to provide medical care for the athletes who did not have access to medical provision themselves. This was a truly amazing experience. “The Olympic Village was like no place I’ve been before. It was beautifully designed and held an air of both calmness and anticipation. Integrating with the athletes in their “home” made all the hard work and dedication that they have had to endure to get to compete at the Olympics so clear. “On a physiotherapy level, we would treat whoever walked through the door: whether country officials, members of the IOC or athletes. “Clinically I have gained so much experience through treating the athletes and working with highly skilled clinicians. I feel that I will be able to transfer what I have learnt into my work here at the RNOH and further in my career. This was an unrepeatable experience; I am so pleased that I was given the opportunity to be a part of it.” Emma Levy volunteered as a physiotherapist at the Olympic weightlifting competition, which was based in the Excel Arena. Emma worked twelve shifts during the Olympic period, initially covering the training area before the competition started. She said the common injuries in training were the expected sport injuries, such as muscle strains and muscle tightness. “As some athletes do not have access to a physiotherapist in their home country, we were also managing old ligament and joint injuries. One of the biggest difficulties was the language barrier with athletes, because, as you can imagine, it is not easy to ascertain where someone’s pain is originating from if they cannot easily converse with you,” she said. “We managed with our sign language skills and occasional use of Google Translate! Once the competition started our role slightly changed and we also had the responsibility of covering the warm up area and ‘Field of Play’. We worked with the medical team to assist athletes off the weightlifting platform following serious injury and carried out quick medical assessments before triaging their care to either the Olympic polyclinic for scanning or to the local A & E Department for more serious injuries. As expected from weightlifting, we had to deal with a number of serious elbow injuries which occurred when, in the heat of the moment, the athletes or their coaches loaded up the bar beyond their apparent capabilities.” articulate To connect by a joint, to speak distinctly 6 RNOH staff put on their dancing shoes for Olympic opening ceremony d Finley act the L-r: Craig Binch and Richar ng ceremony part in the Olympic openi Following 15 weeks of rehearsals and 150 hours of training, Craig Binch, discharge and clinical patient pathway lead and Richard Finley, admissions coordinator, were selected for the volunteer NHS segment of the opening ceremony. Craig Binch said participating in the opening ceremony will be a memory that will stay with him forever. “It was such a fantastic opportunity and experience,” he said. “Our part was nicknamed ‘Swing out Sisters’ - SOS - and we rehearsed through wind, rain and bright sunshine – the gruelling hours were definitely worth every second! “The dance was a combination of lindy-hop, swing and contemporary dance. “We were both so proud to represent the RNOH, NHS, London and the UK. “Behind the scenes, the atmosphere was electric, the show was amazing but it was over far too quickly, if you blinked you would have missed us. “I was dancing next to the bell on what was nicknamed the M25, Richard was on the main field of play in spell out - he was in letter ‘S’ in GOSH and ‘S’ in NHS. “The after parties finished off a wonderful, epic evening that we will remember forever.” Richard concluded: “We had the privilege of meeting Danny Boyle who was a genuinely down-to-earth and nice person, along with hundreds of great people who will now be lifelong friends.” Olympic Torch causes a stir The arrival of the Olympic Torch at the Stanmore site has caused mass excitement among staff and patients. The Torch was taken to the Coxen and Adolescent Unit and the London Spinal Cord Injury Centre but was stopped numerous times on its travels! The visit was organised by Loretta Jenson, nurse on the Short Stay Unit, whose partner, PC Dave Walters, had access to an Olympic torch. PC Walters was one of the Olympic planning officers responsible for planning police resources around the Royal Artillery Barracks. “Every torch bearer was given the opportunity to purchase a torch and the one I took to the RNOH wasn’t purchased so it was donated to the Police,” he said. “The torch will eventually go to the police museum in Hendon. “Providing staff and patients with an opportunity to see the torch was a privilege, particularly as it gave those who wouldn’t normally be able to be part of the Olympic experience to get involved. Anna Fox, communications manager, would like to thank Loretta for organising the visit and for PC Walters for his time. “Without Loretta, the visit would not have happened,” she said. “Having the Olympic torch on site lifted patients’ and staffs’ spirits – it was a great experience!” t on the PC Walters meets a patien Centre ry Inju London Spinal Cord PC Walters meets patie nts on the Coxen and Adole scent Unit articulate To connect by a joint, to speak distinctly 7 RNOH wins prestigious award The Trust has received a patient safety and care integration award for its enhanced recovery programme, supported by Medihome in the community. The Care Integration Awards, organised by the Health Service Journal and Nursing Times, recognise and reward the outstanding efforts of staff to achieve integrated pathways of care to meet the needs of patients with long-term conditions. The RNOH was presented with the award for musculoskeletal care at a ceremony held in Central London on 04 July 2012. Lynn Hill, deputy chief executive and director of operations and transformation and Jonathan Miles, consultant orthopaedic surgeon, Joint Reconstruction Unit, accepted the award on behalf of the Trust. Lynn Hill said "We are delighted to be recognised in this way. We created an integrated patient pathway, which delivers improved pre- and post-operative care and has transformed our patients’ experience. It is an excellent example of collaboration and integrating care solutions to maximise the potential of helping our patients to leave hospital more quickly, receive care in their own home and regain their independence" Nominate your colleagues for an award! Complete a form on the RNOH Web or contact the Communications Department for a form Closing date for nominations is 26 October 2012 Awards ceremony on 11 December 2012 For further information, please contact communications on extension 5750/5349 articulate To connect by a joint, to speak distinctly 8 3 Prosthetic Rehabilitation Unit greets Rob Hurd A fitting prosthesis for “In June, I spent an enjoyable and illuminating morning in the Prosthetic Rehabilitation Unit. All the staff and patients that I met were extremely positive about the nationally recognised work that the unit carries out for patients and service users from around the region and beyond. There is no doubt that this is a fantastic service. “Until a few years ago the service was managed by North West London Hospitals but moved to within the remit of the RNOH to continue on the Stanmore site. The unit has, however, undergone a difficult period with its temporary relocation out of the L – r: Christophe Cointet, prosthetist and Rob Hurd, chief executive Outpatients’ Department to the Louis Fleischmann building as a result of the decanting needs of our new hospital development. “As with everywhere I go within the RNOH, space is at a premium and difficult compromises have had to be made. There is always a lot to learn from how this move took place that will inform future similar projects. “I was joined by Phil Sones from our patient group and I am particularly grateful to Christophe Cointet for the time he spent with me describing the work of the unit and the role of the prosthetists. I was particularly interested to observe the interaction between the prosthetists and patients and saw first hand the technology that supports the fitting of prosthetic limbs – this is a highly skilled activity that is focused on enhancing the quality of life of the users and patients of the service. The RNOH is proud to have this unit as part of its portfolio. “Work to improve the service for our Prosthetic Rehabilitation Unit patients is on-going to ensure that the service operates from the one unit, which will encompass therapies, psychology and counselling.” Charlie Treatment for bone cancer has been performed on one of the youngest patients in the world at the RNOH in collaboration with a specialist surgeon from the Netherlands. Two year old Charlie Hewson underwent a modified Van Ness rotation plasty, which consisted of the removal of the femur and most of the thigh muscles, then articulating the tibia with the remnant of the hip joint (the acetabulum) after rotating the leg by 180 degrees. What a wonderful recovery, considering the massive physiological, surgical and clinical rehabilitation hurdles Charlie had to overcome with his family. Christophe Cointet, prosthetist, said the complexity and rarity of Charlie’s case made it hard to predict an objective functional outcome. “After the design and development of a range of prostheses to assist his rehabilitation, and the amazing hard work and dedication by Charlie and his parents, we were delighted to see him stand and take his first steps independently,” he said. “Due to Charlie’s young age, we are constantly having to make him new prostheses to keep up with his rapid growth and changing abilities. His recent prosthetic fitting coincided with the London 2012 Olympics, and since Charlie is a big supporter of Team GB, it was fitting to personalise his new socket with the team’s logo.” articulate To connect by a joint, to speak distinctly 9 Operational bed meeting A new meeting has been established, which supports the bed management process and improves patient flow from admission through to theatres and on to a safe discharge. The operational bed meeting was set up in March 2012 following an increase in bed pressures, influenced by the temporary closure of the Jubilee Rehabilitation Centre (JRC). Craig Binch, discharge and clinical patient pathway lead, said this accumulated in actions being taken to look at current systems. “The meeting was to be a snapshot of the current bed situation, forecasting and problem solving for the following day,” he said. “The timescale is intended to be around 15 minutes, with each member of the multidisciplinary team giving their update, generating actions to be taken forward to resolve issues at an early stage. The operational bed meeting has been well received. It has been extremely positive and productive, generating a number of benefits including: Joined up thinking “A dual approach to bed management, improving communication between general and service managers, theatres and the admissions and discharge team. “The meeting has brought together a focused group of professionals to help work through issues together. Escalation processes “The meeting has developed a distinct pathway to escalate problems as they occur, allowing us to mobilise individuals to take actions as required. This helps us to resolve problems promptly, allowing us the luxury to plan ahead. “During times of extreme bed crisis, there is now a strategic channel to highlight the situation early. Emergency transfers “A sub group has been developed, which analyses the emergency transfer process, aiming to streamline the necessary steps defining the pathway and escalation process. This will be incorporated in the revised admissions and discharge policy identifying specific time limits for transfer. Communication “Communication between departments, particularly the admissions and discharge team and theatres, has been extremely encouraging. Now the channels are open, we should continue to see improvements and strive to work together to achieve our goals and develop our service. Tablets to take away “A major achievement is the drive to completing patient discharge summaries 24 hours before discharge. The group recognised that this was a large influencing factor in relation to problems surrounding bed management. The main reason for limited success for the 11.00 discharge project was lack of tablets to take away (TTA) completion in advance, to enable us to discharge our patients in a timely manner. “As a group we have all spoken to individual medical teams and explained the situation, encouraging their participation. The pharmacy team, service managers and myself have been particularly on board. Between us we have kept records of compliance and monitored progress. We are pleased that there have been vast improvements and we would like to thank the junior doctors in particular for their input. This has had a visible positive effect on our patients’ experience and long delays awaiting discharge medication are now minimal. “We now have an established spreadsheet from the ward pharmacists, which highlights outstanding TTAs on a daily basis to articulate To connect by a joint, to speak distinctly escalate at our meeting if required. “I have also been trained on how to utilise iCS to track TTA progress. Infection control “We’ve also discussed patients’ infection control status. Although the issue is being looked into more formally by the director of nursing, we have established a link with infection control who have developed a spreadsheet identifying patients’ infection control status. Medihome “We have worked alongside Medihome to encourage utilisation of their service and we now have a structured daily update in relation to current Medihome patients. We have successfully achieved our goal of having a live, current status for all of our Medihome patients and plan to continue this into the future. Complex admissions “The meeting has allowed us to identify complex admissions and highlight adults at risk as a multidisciplinary team, enabling us to provide the optimum experience for those patients, thus raising awareness throughout the different disciplines. Continued on page 10 10 Estimated discharge date “Another success relates to patients’ estimated discharge date (EDD). The length of stay group is looking at this in greater detail, but we have also had valuable input. “The adult matron and I have relaunched the EDD beside the patients’ bedside and now all current inpatients have a visible date beside their beds. “The operational bed meeting has proved to be particularly valuable to the admissions and discharge team. The meeting still has room to develop and is in its early stages, but I am confident that we can continue to improve our service. I would like to take the opportunity to thank all the multidisciplinary team who have been involved in developing the meeting, in particular Louise Reiterbund, service manager for specialist surgeries and Patsy Spence, deputy director of operations and transformation. Support has been much appreciated and their input in particular has been invaluable.” The following attend the meetings: n Discharge and clinical patient pathway lead n Discharge liaison sister n Theatre coordinator n Allocated service manager n Deputy director of operations and transformation n Inpatient pathway project lead n Medihome representative n Therapy lead n Service manager Travel scholarship Natalia Vásquez, clinical research associate working on the London Spinal Cord Injuries Centre (LSCIC), the Functional Assessment and Restoration Service (FARS) and the Neurospinal Research Centre at the RNOH, was awarded the travel scholarship in 2011. Natalie shares her venture. “In July 2011 I was awarded the RNOH’s travel scholarship for the project titled “Developing collaborative research into strategies for the promotion of neuroplasticity for therapeutic benefit after spinal cord injury (SCI) in Colombia, a country with a high incidence of the condition. “The costly rehabilitation programmes used in affluent countries are not extensively available in developing countries such as Colombia, my home country (L. H Lugo et al, 2007). However, before coming to the UK in 2007 I had the privilege to spearhead the design of an efficient rehabilitation environment for patients with spinal injuries in Arcángeles, a rehabilitation centre in Bogotá, Colombia. Today, Arcángeles is a well-established multidisciplinary centre, renowned nationally and internationally for their programmes based on the paradigm of integral rehabilitation and Activity Based Restorative Therapies (ABRT). “This experience, having being awarded a masters degree in clinical neuroscience at UCL and having started a career in clinical research in one of the best specialised spinal injuries units in the UK, has motivated me to pursue this project and initiate collaborative research to promote clinical neuroscience and to drive the beginning of high quality research into this topic in Colombia. My aim is to strengthen current rehabilitative interventions being used in Colombia and the UK and to develop new strategies for the promotion of neuroplasticity after a SCI, initially aimed at the restoration of pelvic floor function in the SCI population. “With the purpose of initiating the diffusion of knowledge and setting up the research unit in Bogota we have developed a multidisciplinary research team that brings together an international group of collaborators from five institutions: Professor Michael Craggs from University College London and the LSCIC/RNOH, Professor Peter Ellaway from Imperial College and LSCIC/RNOH, Professor Martha Torres in Rosario University and Juan Pablo Salazar in Arcángeles Rehabilitation Centre in Colombia. articulate To connect by a joint, to speak distinctly 11 , Sharnice L-r: Andrew Wills, Kishan Badiani Begum sha Aye and nn Qui Zoe Atherton, Getting a head start “The funding awarded from the RNOH’s travel scholarship will allow me to travel to Bogotá Colombia in the next few months to introduce new concepts regarding strategies to promote neuroplasticity and objective assessment protocols for the restoration of pelvic floor function in SCI patients. These concepts will be presented in an academic seminar among the rehabilitation and research teams from Rosario University and Arcángeles Rehabilitation Centre. Additionally, I will facilitate the recruitment of a visiting student and observational internship at the Functional Assessment and Restoration Service from the Spinal Cord Injuries Research Centre at the RNOH in 2013. “I look forward to developing this project further and facilitating bilateral collaboration into a broad range of aspects related to SCIs. I would certainly encourage people to apply to the travel scholarship award. It is a great opportunity to pursue not only professional but personal advancement of their careers.” A new scheme which encourages school leavers or those exiting further education is well underway at the RNOH. 27 apprentices have taken the opportunity to develop and learn while they are earning and getting a nationally recognised qualification. Leanne Chaney, learning and development officer, said if you’ve just left school or further education, it’s a great opportunity to get work experience. “I have placed apprentices in human resources, productive ward, IM&T, IT, medical records, business and administration and healthcare assistants on the wards,” she said. “For managers it is a good way to develop new or existing staff and consequently improve productivity and patient experience.” Zoe and Sharnice who started on the RNOH apprentice scheme in October 2011 have said the following about their experience so far… “The chance to start this scheme at a well-known, well respected, very successful hospital with some of the greatest specialists world-wide is amazing. Members of staff are articulate To connect by a joint, to speak distinctly friendly and welcoming and make you feel very comfortable within your work environment. Zoe said: “The RNOH has been highly rated by friends and family so it is a privilege to be working here. “So far on my apprenticeship, I have learnt new skills as well as improving skills I already had. I have learnt to adapt to new job roles and duties in addition to developing ideas suitable to my working environment. “I thought this would benefit me more than just learning the skills at sixth form and would help me to get a secure job.” Their future career ambitions include becoming a HR professional and a successful project manager. Leanne concluded: “Overall, apprenticeships are good for business and good for supporting employment in the local community and young people. They develop productive, enthusiastic and loyal people in the workplace. 80% of businesses who employ apprentices agree that they make the workplace more productive and add real value.” For further information visit: www.apprenticeships.org.uk 12 (England’s Left to Right: Jean Gross, for Children), Communication Champion hie Scott Sop Siew-Lian Crossley and ists) rap The ge gua (Speech and Lan Paediatric speech and language therapy praised for their work supporting children and young people’s communication Paediatric Speech and Language Therapy at the RNOH has been praised for their work supporting children and young people with speech, language and communication needs in the Shine a Light 2011 Hello campaign awards. Run by The Communication Trust and Pearson Assessment, the Shine a Light awards are the flagship initiative of the Hello campaign (national year of communication). At the awards ceremony, hosted by Vanessa Feltz, the Speech and Language Therapy team, which includes Sophie Scott and Siew-Lian Crossley (speech and language therapists) and Alison Rake (speech and language therapy associate practitioner), were highly commended in the Team of the Year. Sophie Scott said: “This is a relatively new service aimed at providing quality support for children, families and the staff working with children with complex communication issues admitted to acute medical care. “It was wonderful to be highly commended for our work in the Shine a Light awards. We are really proud of our achievements. Given that we work to empower the wider multi-disciplinary team to communicate with our patients, we feel that this really is an award for the whole paediatric team at RNOH.” Shine a Light was designed to honour individuals, teams, projects, communication-friendly settings and communities that have demonstrated excellence in supporting the needs of all children and young people’s communication, including those with speech, language and communication needs (SLCN). Students welcomed to Radiology Department Nine A Level physics students have visited the scanning and X-ray Departments at Stanmore to demonstrate how MRI, CT, nuclear medicine-ray and ultrasound work and the physics behind each modality, including how images are produced and reported on. The students from St Margaret’s School in Bushey were full of praise for their visit and said they learnt a lot, particularly how different scanning can work together to help doctors make a better diagnosis. Antony Turner, imaging manager, said the event was a huge success. “We are hoping to provide students with regular opportunities to visit the Trust to gain better insight into the work that goes on within a Radiology Department,” he said. articulate To connect by a joint, to speak distinctly 13 Shoulder Unit represented at international event The RNOH’s Shoulder Unit will be represented at the European Society of Shoulder and Elbow Rehabilitation (EUSSER) in London in October 2012 Anju Jaggi, clinical physiotherapy specialist at the RNOH and vice president of EUSSER, said EUSSER is the only Europe-wide society that connects healthcare professionals with an interest in shoulder and elbow dysfunction. “The objective of the society is to provide the highest standard of information and education to enhance patient care,” she said. “The RNOH’s shoulder unit has been at the forefront of managing shoulder dysfunction and instils a strong multidisciplinary team approach. Mr Ian Bayley was one of the co-founders of the British Shoulder and Elbow Society (BESS) and emphasised the importance of rehabilitation in addition to surgery in managing shoulder dysfunction. His enthusiasm and encouragement has allowed this philosophy to be adopted by BESS and now EUSSER. "I was keen to organise a stimulating conference with international speakers to discuss the challenge of rotator cuff disease. Shoulder pain is now the third highest musculoskeletal complaint in the UK and is set to rise, given the increasing needs of a growing elderly population. Current treatment concepts range from exercise therapy through to surgery, but lack common evaluation criteria.” The day will cover: epidemiology, clinical assessment, injection/therapy and surgical management. The afternoon session will include discussion of clinical cases studies utilising the expertise of the faculty. The event is applicable to therapists, physicians and surgeons. For further information regarding the London Shoulder Symposium, please visit www.welbeing-cpd.co.uk The shoulder team at the RNOH is particularly keen to develop this collaborative approach and encourage evidence based practice. The unit also plans to run one of the first randomised control trials investigating the management of shoulder instability in collaboration with Professor Ginn and Professor Funk. articulate To connect by a joint, to speak distinctly 14 Lasers see us in a different light A clinical study of Raman spectroscopy as a non-invasive assessment of human bone quality is under way at the RNOH. The exciting new project is looking at ways to use lasers for diagnosing bone diseases. This leading research is funded by the Engineering and Physical Sciences Research Council (EPSRC) with a grant of £1.7m and builds on a collaboration established with the UK’s Central Laser Facility (based at the Rutherford Appleton Laboratory (RAL). Shining the laser in nt me onto the patient tru ins RS SO The Pavel changes the light’s operation: L-R: Professor colour; this colour Matousek, Professor Tony ns, Parker and Dr Jemma Ker change can be setting up the instrument analysed to find out wearing their laser safety what is present. The glasses technique, known as Raman Spectroscopy (after the Nobel prize winning Indian scientist who discovered it in 1928) is widely used for chemical analysis but recent advances in technology, namely spatially offset Raman spectroscopy (SORS), have widened its applicability in medicine. We all know about lasers in science fiction but the power of light provided by the lasers at the RNOH is only the same energy as laser pointers in classrooms. The project is at a crucial stage and we are calling for volunteers: people diagnosed with osteoarthritis, osteogenesis imperfecta or osteoporosis and people free from bone diseases for comparative measurements. Research goals: Research will be based at the Institute of Orthopaedics and Musculoskeletal Science (IOMS), University College London (UCL) and patient recruitment and assessment will take place in the Stanmore Clinical Research Centre in the patients’ centre at the RNOH. RAL will be developing improvements during the study, as the results are analysed. Professor Allen Goodship, professor of orthopaedic science, IOMS, UCL, who is leading the project said: “Raman has potential as a routine screening tool.” Dr Richard Keen, consultant rheumatologist at the RNOH and co-chief-investigator on the project said the study may help them diagnose and treat people with bone disorders better in the future.” Those involved The research is a collaboration between individuals from three world leading institutions, The Rutherford Appleton, UCL and the RNOH. Their aims are to produce research, which advances knowledge and technology which benefits patients. Risks What are the possible risks of taking part? The risks are negligible. Raman spectroscopy does not involve any ionizing (i.e. damaging) radiation and is a noninvasive technique. How can you help? This is a great opportunity for patients, relatives and friends alike to get involved in the research happening at the RNOH, which will hopefully progress better diagnoses and our understanding of bone disorders. Another way you could help is by donating your teeth or your children’s that have fallen out or been removed by a dentist and would otherwise be thrown away. These would be useful for us because the dentine that fills the inside of teeth is very similar to bone and we may be able to scan it with the Raman instrument. articulate To connect by a joint, to speak distinctly 15 Colloquium for the retirement of Professor David Marsh Dr Helen Birch Dr Ian McCarthy Iva Hauptmannova Jackie Vinton Dr Richard Keen Mr Panagiotis Gikas Professor Adrienne Flanagan Who do I contac t for further informat ion? For more informat ion and to volunteer, plea se contact: Professor Allen Goodship (via his secretary): 020 89 09 5535, Dr Jemma Kerns: 020 8909 5746/07517 101 977 or Mr. Panagiotis Gika s: 07958 342989 articulate To connect by a joint, to speak distinctly A Who’s Who in academia, politics and orthopaedics gathered at the Royal College of Surgeons to celebrate the retirement of Professor David Marsh. At the meeting, entitled, “Academic orthopaedic surgery and the Royal National Orthopaedic Hospital: the future”, 15 esteemed speakers addressed the audience of more than 150 guests covering science and the orthopaedic surgeon, national trauma and fragility fracture issues; internationalism and training and the future for the UCL Institute of Orthopaedics and Musculoskeletal Science and the Royal National Orthopaedic Hospital NHS Trust (RNOH), in the context of a world leading musculoskeletal programme for UCL Partners. The UCLP programme can address musculoskeletal care across primary to secondary and tertiary care for a population of up to nine million people in North Central London. Chris Moran, Professor of Orthopaedics from Nottingham, said: “Changing the NHS is not easy. It takes a man with a vision, to build a network, attract political will and find the money to change process. “Professor Marsh did this with the National Hip Fracture Database, which subsequently informed the Best Practice Tariff at the Department of Health." National Trauma Tsar for the Department of Health, Professor Keith Willett, continued: “Professor Marsh’s actions have driven one of the most successful cost saving initiatives in the NHS to date and has led to vast improvements to patient care and saved thousands of patients’ lives." Professor Karsten Dreinhöfer, from Berlin said: “Professor Marsh’s international ambassadorship for the Bone and Joint Decade has made an immense contribution to global orthopaedics." The event was summarised by Rob Hurd, Chief Executive, who formally thanked Professor Marsh for his contribution: “Professor Marsh, has brought to the RNOH research infrastructure and governance, translational teams and helped to establish wide networks across UCL and afar." He continued, “David has made an outstanding contribution to both UCL and the RNOH and has taken us from an era of major uncertainty five years ago, to one of clear vision, direction and a bright future. 16 Children’s ward holds Jubilee party Double celebrations for Rehabilitation Ward Children at the Trust embraced the Diamond Jubilee celebrations by holding a party on a bunting-adorned ward. Zoe Keates, senior play specialist and organiser of the celebration, said not only does the party mark a great occasion, but it also aims to lift the spirits of our patients. “Children designed and produced Jubilee celebration cards, all of which have been sent to the Palace,” she said. To coincide with the celebrations, Gail Burgess, head teacher and Zoe Nine year old Alex Chaston Keates invited Lynn Hill, and his mum enjoy the deputy chief executive and Jubilee celebrations director of operations and transformation and Patsy Spence, deputy director of operations and transformation to judge a competition, which saw children produce a Jubilee stamp. “The fun continued with games and a buffet and culminated with everyone singing the national anthem – it really was a fun-filled afternoon!” and L – r: Patsy Spence, deputy director of operations tive execu chief ty depu Hill, transformation and Lynn judge and director of operations and transformation a design a stamp competition Lynn Hill, deputy chief executive and director of operations and transformation and Camilla Wiley director of nursing, officially open the Jubilee Rehab Centre with staff Staff and patients officially open the Jubilee Rehab Centre Following extensive works to the Rehabilitation Ward, it has cause to celebrate – not only have the facilities for patients improved but it is now operating under a new name! The Jubilee Rehab Centre reopened in June after four months of closure. The ward has undergone major changes particularly a new infusion suite which caters for metabolic intravenous infusions and other clinical needs. Also, the traditional wood flooring has been removed and replaced with a far more modern one. Lewis Kendall, ward manager, is really pleased with the outcome. “Patient feedback, particularly from those who have stayed on the ward in the past, is really positive,” he said. “Patients have expressed that it looks like a new unit, which is great. “We wanted to change the name of the ward particularly as it was having an overhaul. We thought it was pertinent to include Jubilee in the name as the improvements were made during the year of the Diamond Jubilee and Stanmore is at the end of the Jubilee tube line. “I would like to thank the Private Patient Unit for accommodating our patients while the ward was closed. The teams worked well together, which made the journey smoother for our patients. Thank you also to everyone’s efforts while we were closed. “Also, we have looked at the way we run the service and have now set up a hotel based programme, which runs alongside the inpatient programme, increasing the numbers of patients we treat.” articulate To connect by a joint, to speak distinctly 17 Surgeon rewarded for bravery in New Zealand earthquake A consultant urologist at the RNOH has been awarded a medal for his bravery during the New Zealand earthquake last year. Mr. Julian Shah was a guest speaker at an event in Christchurch when the earthquake struck in February 2011, killing 185 people. Mr. Shah rushed to the town centre along with two junior doctors to see if they could help. He found that the cathedral and press building had been devastated. As he made himself known to rescuers as a doctor, he was ushered with a hard hat to the building’s top floor, where he helped a woman with a broken arm as she lay trapped by a concrete beam crushing her legs. Despite saving the woman’s life, Mr. Shah found himself in danger when an aftershock threatened to destroy the building he was in. Already four storeys high, he had no option but to jump two metres onto the roof of an adjacent building, where he then navigated his way down a dark staircase using a torch app on his phone, before assisting the woman to hospital. Mr. Shah received his medal at the Urological Society of Australia and New Zealand’s annual dinner in Darwin, Australia. Mr. Shah said the award ceremony was “fantastic”. “It was preceded by a presentation about the earthquake and I was almost moved to tears but I had to pull it together to go on stage,” he said. "The whole world saw the devastation caused by the Christchurch earthquake. It was a terrifying experience for many people, and one that will live on in my memory.” Our Trust values We have refreshed our values and we will be incor porating them into everything we do including induction, appraisal, objective-setting and traini ng. Patients first, always Excellence in all we do Trust, honesty and respect for each other Equality for all articulate To connect by a joint, to speak distinctly With grateful thanks 18 Donations for Coxen and Adolescent Unit A patient on the Coxen Ward has raised £500 for the ward. Addie Brady, who had a tibia replacement at the RNOH last year, received support from her school friends and teachers via a fundraising campaign, where a number of her friends/teachers shaved their hair in support of Addie's chemotherapy treatment. Zoe Keates, senior play specialist, said the money will be spent on DVD players, which will be attached to bedside cabinets to help distract the children. “We are so grateful for this money and can't wait to get the whole ward kitted out with DVD players; I have wanted to do this for some time now.” L – r: Mrs Brady, Addie Brady, Zoe Keates, senior play specialist, Sam Bowie, fundraising officer and Sheila Maurer, healthcare assistant Zach’s gift Parents of a three year old boy are so appreciative of the care their son received on the Coxen Ward that they wanted to give something back to the ward. Steve and Nikki Lavache, whose son Zach has already had three operations at the RNOH said they are very grateful for the wonderful care and medical attention Zach received at the RNOH. “We have recently married and instead of asking for gifts we asked if donations could be made to the ward,” Nikki said. Michelle Sicheri, play specialist, said they have raised £320 and the money, at the request of Steve and Nikki, will be spent on providing entertainment and distraction for the children on the ward. “I would like to say a huge thank you to Nikki and Steve for even thinking of such an idea, but also to their family and friends who so generously supported them and in turn us,” she said. Motorbike challenge raises funds for Coxen/ADU Three new specialist chairs have been funded via a £2,000 donation to the Coxen and Adolescent Unit. Following Jasmine Day’s diagnosis with scoliosis, Mr Molloy and his team performed a full spinal fusion to correct her spine. Jasmine’s dad said he was very grateful to the RNOH and the amazing staff who took care of their daughter and, by way of thanks, wanted to raise money for the ward. “I set myself a challenge of riding my motorbike, a Yamaha Fazer, 3,500 miles, covering the four furthest compass points of Great Britain in one week, to raise money for this amazing hospital,” he said. The money raised has funded three spinal chairs, which will be used by scoliosis patients after their surgery. L – r: Mark Day, Jasmine Day and Clare Kehoe, lead nurse, children’s services John Lewis donates a gift to the admissions lounge The newly refurbished admissions lounge in the Outpatients’ Department has received a welcome donation from John Lewis. Craig Binch said the admissions lounge was in need of a TV so he contacted the RNOH Charity for some advice. “Within a day of speaking to the RNOH Charity, John Lewis made an offer to donate a TV, which was fantastic news,” he said. “The TV has been gratefully received and will make a huge difference to our patients’ experience.” Rosie Stolarski, head of fundraising, said she is very grateful to the Watford branch of John Lewis, who not only donated the TV but also £1,560 to the Redevelopment Appeal from their Community Matters Programme. L – r: Craig Binch, discharge and clinical patient pathway lead, Pearl Robson, community liaison coordinator for John Lewis and Richard Finley, admissions coordinator articulate To connect by a joint, to speak distinctly N 19 HO SPITAL THE ROY AL IC AL ORTHO PÆ ION D AT Red al to l tot pea Ap 00 15,4 £2,3 ent opm evel Record year for the The Buttercup Walk, celebrating its 10th anniversary, was attended by more than 600 people, including walkers, their families and friends, making it the best attended fundraising event in the RNOH Charity's recent history. Rosie Stolarski, head of fundraising, said she and everyone else who helped on the day received extremely positive feedback from entrants. “Everyone got into the spirit of the day - despite the occasional downpour,” she said. “The record amount of funds raised this year will enable the RNOH to make numerous improvements to its service, which wouldn’t otherwise be possible. “Patients return year after year to attend the walk, and it is always so encouraging to see how many of them have progressed following their treatment at the hospital. We are very grateful to Max Milner for stepping in at very short notice to officially open the Walk and draw the raffle. His attendance was warmly welcomed by a lot of young fans.” Although this year’s Buttercup Walk was hit by sporadic rain showers – the heaviest of which, very unfortunately, began at almost exactly the moment the walk began – the wonderful spirit of the participants and their friends and families, shone through. Everyone at the RNOH had hoped beforehand that the walk’s anniversary year would be its most successful ever, and thanks to the incredible dedication of our supporters we weren’t disappointed. Rosie concluded: “Our thanks to everyone who helped to make the day so successful – we very much hope to see you again next year!” articulate To connect by a joint, to speak distinctly : date More than £40,000 has been raised following this year’s Buttercup Walk, by far the highest amount raised in the history of the walk. Redevelopment Appeal is officially launched On 26 April we marked the official launch of our £15 million Redevelopment Appeal with an event at St. James’s Palace, hosted by Their Royal Highnesses The Duke of York and Princess Eugenie of York. The event brought together a number of high-profile supporters of the hospital, including Damon Hill and his family, who saw the ‘premiere’ of our Redevelopment Appeal film and heard a number of impassioned speeches about the RNOH’s work and the importance of the appeal. The Duke of York, Patron of the RNOH, underlined his enthusiasm for, and commitment to the appeal. Princess Eugenie, who was treated for scoliosis at the RNOH as a child, used the opportunity to announce her patronage of the Redevelopment Appeal. Shortly after the event, the Princess took part in a 100km sponsored cycle ride, raising almost £10,000 for the RNOH Charity in the process. We have already received a number of major donations - amounting to almost £100,000 – and pledges from people who attended the appeal launch, providing new impetus for our campaign to raise an initial £5 million for the funding of the hospital’s new family accommodation unit and spinal injuries rehabilitation centre. For further information about the Redevelopment Appeal and the RNOH Charity, please log on to our new website, www.rnohcharity.org 20 Live life to the full … Edward Holt for Team GB A Lloyds TSB Local Hero has benefited from a specialist wheelchair thanks to Scat’s Live Life to the Full campaign. The campaign offers support to those who have suffered an amputation as a result of bone cancer, so that they achieve maximum mobility post treatment. Edward Holt, who is 19 years old, had a below-knee amputation due to osteosarcoma in 2009. Edward, who has been playing tennis since the age of eight, is now working to fulfill his ambition to Edward playing wheelcha compete in the 2016 Rio Paralympics. ir tennis Following extensive chemotherapy and two further operations, Edward is now at Leeds Metropolitan University studying sports performance and training hard with a serious tournament plan for this year. Edward in his new day chair Trish McEntee of Scat said the campaign has funded a special ‘day chair’, which facilitates Edward’s mobility that I didn't know existed but I'm willing to make the when not playing tennis. most of it. Losing my leg and playing wheelchair tennis “Edward now uses this chair for his studies at university has enabled me to meet a variety of people and inspired and also when he goes to his wheelchair tennis me to make the 2016 Paralympics.” tournaments as his stump swells after a game and it Funding from the Live Life to the Full campaign ranges becomes very difficult to put his prosthetic limb on,” she from the provision of the best technology available in the said. manufacture of artificial limbs to special wheelchairs and Edward said: “I have found myself in a parallel world crutches. When the going gets tough… the tough gets going! A team of ardent Scat supporters have taken part in the Tough Guy Challenge in memory of Ellis Clark. Sloppy Seconds (Sloppy because the challenge is mud and then some more mud and Seconds because two of the team have embarked on the ordeal before) endured hypothermic temperatures while being plunged into ice encrusted lakes and rivers. Gareth Pickard, team captain, said the team endured burns and scalds while leaping through burning bales of straw and had electric shocks while crawling through semi submerged sewer pipes. “We sustained cuts and bruises from the barbed wire and truly gargantuan obstacles that we had to overcome and all throughout an eight mile cross country run on extremely arduous terrain,” he said. “I couldn’t think of a more fitting challenge to honour our memory of Ellis.” Ellis Clark will always be remembered for facing every challenge during her battle with bone cancer. She inspired everyone who knew her or was involved in her care at the RNOH. r takes part in A Scat supporte allenge the Tough Guy Ch articulate To connect by a joint, to speak distinctly 21 London Sarcoma Service supports Sarcoma Awareness Week The London Sarcoma Service (LSS) has participated in a 5km run to support Sarcoma Awareness week, raising more than £500 for the charity. Abby McCarthy, physiotherapist, said: “When we discussed the idea that LSS would run the 5km in Finsbury Park, London, there was concern that the heat may wilt their running efforts. “We needn’t have worried as some members of the team donned beanie hats and long sleeved running tops to try and keep warm! That said spirits certainly weren’t as damp as the weather and all embraced the challenge.” Representatives from across the disciplines including oncologists, occupational therapists, physiotherapists, surgeons and a huge effort from histopathology led to a squad of 20 runners participating. L-r: Chetna Viyas, Debbie Nye, Andrea Lee and Noreen Galvin As part of our Wellbeing at Wo rk programme, we invited Livi ng Streets to lead a series of lun chtime walks around the Sta nmore site before autumn breezed in! Livi ng Streets is a charity that sup ports and encourages safe walking to, and at work. There was a sponsored lunch for those who participat ed on the day. articulate To connect by a joint, to speak distinctly Diane Unw in, nurse on the stay unit an d her husban short d Paul take part in a long dista nce rally Team effort in long distance rally A nurse on the Short Stay Unit and her husband have completed one of the most gruelling long distance rallies in the world. Diane Unwin and her husband Paul started the challenge from Big Ben in London and finished in Cape Town. Paul said Diane is an experienced rally navigator and got us all the way without getting lost. “We drove up to 700 miles a day at speeds up to 100 miles per hour,” he said. “The competitive car rally took just 29 days to complete and passed through 12 countries in three continents. This rally has made rally history and it is unlikely that such a rally will be undertaken again. “Diane and I drove one of three MG ZR cars that were modified to meet the 9,000 mile challenge.” For further information about the rally, visit / http://www.londoncapetownrally.com 22 Fond farewells Gloria Hance retired as a senior clinical coder earlier this year, following three and a half years in her role. However, her first stint at the RNOH dates back to 1978, where she was a staff nurse at Bolsover Street. Gloria said that she has so many good memories of the RNOH, from the seventies and more recently at Stanmore. “I feel very proud of my extended RNOH career and proud of working as a highly specialised orthopaedic senior clinical coder,” she said. Gloria is committed to continue helping the Trust in the future with fundraising activities. Hance Gloria Eve Hunter Following 22 years at the Trust, Joy Rendell, occupational therapist, has taken a career break and has embarked on a travelling expedition. After 42 years at the RNOH, Eve Hunter retired in early 2012. Eve started her career as a nurse at the RNOH and she then went on to be a medical secretary for Miss Sarah Muirhead Allwood. Staff have bid a fond farewell to Wayne Buttigieg, head of ICT, operations and applications. He will be sorely missed by his team and throughout the Trust as he made a number of substantial changes during his time at the Trust. articulate To connect by a joint, to speak distinctly 23 News in brief Talking of the old Bolsover Street building The RNOH plaque and statues of children which were part of the old Bolsover Street building have been moved and installed outside our current outpatient assessment centre in Bolsover Street – a link to the past! Half a century on Bikers stop-off at Jubilee Rehab Centre The Jubilee Rehab Centre has welcomed three members of the Traumatic Brachial Plexus Injury Group (TBPI) as they journeyed from John O’Groats to Lands End on their motorbikes to raise funds for TBPI, visiting peripheral nerve injury centres on their way south. L – r: Rob Hurd, chief executive, Paul White, supervisor in the instrument shop (Orthotics Department) and Professor Goldstone, chair of the RNOH Congratulations to Paul White, supervisor in the instrument shop, Orthotics Department, who recently celebrated 50 years at the Trust! As a way of thanking Paul for his length of service, Rob Hurd, chief executive, and Professor Anthony Goldstone, chair, took Paul for a celebratory lunch. Paul said he has seen many changes at the RNOH over the last 50 years. “I’ve thoroughly enjoyed the past Ed Barnes, who was one of the riders, has been a peripheral nerve injured patient at the RNOH since 2006. More than twenty five of the therapy and nursing staff were able to join them for lunch and fund raise a further £60 for the charity. 50 years at the RNOH,” he said. “I think back on all of my memories with great happiness and I really do think that the people I have been working with have kept me at the RNOH for such a long time.” Thursday 8 November 2012 Fireworks start at 19.45 on the lawn behind the Orthotics Department Bolsover’s Bon Voyage Staff at Bolsover Street enjoy a daytrip to Lille, France. Where next? articulate To connect by a joint, to speak distinctly Food and drinks served from 18.30 A 50p food voucher is available on the RNOH Web 3 News in brief Why is mycar clever? mycar is a fantastic benefit provided by the RNOH. It is a low cost, hassle free way to run a new car. It includes: n Scheduled servicing and maintenance n Fully comprehensive motor insurance (subject to acceptance by the insurer) n Breakdown cover n Accident management n 1000s of new cars at low monthly rates n No deposit n No second hand value risk n No dealer negotiation n No unexpected bills – fixed cost motoring (terms and conditions apply) n Costs taken from gross salary make tax, National Insurance and pension savings For more information please visit https://www.mycar-leasedrive.com (company code NHSSS09). Christine’s corner In this edition of Articulate I am interviewing staff nurse Beverley Commodore who works at Bolsover Street. Beverley has been a Trust employee for over four years and worked on the bank before that time. Beverley originally worked in the old outpatients’ centre, next door, and says although she has now got used to the new building, she does miss the old one as it had a lot of character. Q. If you were on ‘Come dine with me’ what would you cook your guests? My starter would be steamed yellow tailed snapper with a homemade seasoning, followed by lamb chops with spinach rice and caramel cheesecake to finish. Q. If you could be on any reality TV show, which would it be and why? It would have to be Big Brother, but I’d worry that all my dirty linen would be washed in public and there’s a lot! Q. Tell me something about you that no one else at work knows I’m very sensitive and cry at anything sad or emotional on TV. Q. If you were a drink, what would you be and why? I’d be a brandy and Baileys, a mixture of strong and smooth, all quality and in a posh glass. Q. Who has most influenced you? It has to be Judge Judy. She speaks her mind, is a strong woman who is fair but firm. Q. Tell me about a hobby you enjoy and why. I enjoy jogging, it’s relaxing, helps me lose weight and it’s free. Q. What music do you like? Congratulations to Maggie Evans, ward clerk for Ward 4 and administrator for the Tissue Viability Department, who recently celebrated her 50th Birthday. I love Reggae music. My favourite singer is Beres Hammond, the lyrics to his songs are really nice. Q. If you won the lottery jackpot, what would be your first few purchases? I would buy a four bedroom house in London and a block of apartments on Dominica in the Caribbean. I could rent them out or use them for when my family come to visit. Q. What do you like to do at the weekends? I like to hang out with my partner, he cooks me fancy meals which I love. The RNOH cannot accept responsibility for any loss, injury or inconvenience caused by reliance on material provided by third parties. Q. If you could come back as an animal in the next life, what would it be? A pampered top class house cat.
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