Examination of Witnesses (Questions
140-159)
MS JULIE
MOORE AND
DR DAVID
ROSSER
21 JUNE 2007
Q140 Mr Jones: So as a Trust you
welcome it?
Ms Moore: We have always welcomed
it. We did have a military-managed ward up until the deployment
at first conflict. The problem with that was in times of conflict
the military clinical staff are needed so they were deployed and
we were given 24 hours' notice of the ward staff being removed.
We have to be quite careful, we have got contingency plans because
obviously when there is conflict the military clinical staff are
busy elsewhere rather than in Britain.
Q141 Mr Jones: That gives you flexibility,
does it, in terms of if staff are then deployed on operations
you can still cover a military-managed ward with your NHS staff?
Ms Moore: We make sure we have
a core of NHS staff on the ward as well, yes.
Q142 Chairman: This issue has been
put very strongly in certain quarters, so strongly, in fact, that
some people say it is a breach of the military covenant to have
a young man just serving in the military next to an elderly lady
who has just had a stroke. How do you answer those criticisms
that this is going on and that it is a breach of the military
covenant?
Ms Moore: I would say the overriding
factor that is most important is getting the soldiers to be in
the most clinically appropriate place with staff who are skilled
at saving lives and saving limbs. Occasionally soldiers have been
nursed alongside patients of the same sex—we do not mix
patients of different sex inside the bays, we have entirely single
sex bays—in other bays. I do not believe that is the most
important factor, I believe the most important in all of this
is the skilled care given by the doctors and nurses who are skilled
to look after those patients. Whenever possible we put military
patients together but if you have a head injury you want a neurosurgeon
looking after you and if you have got a chest injury you want
a cardiothoracic surgeon. Those injuries are very, very few in
number, so we are not ever going to have enough to fill a ward
or even a bay with single patients on there.
Q143 Mr Havard: My understanding
of this is the Military Services Department have said that they
would like to have a situation where a trauma ward could be established.
From the business of managing it, it would appear there are not
military nurses with the relevant qualifications to actually manage
a ward and the idea is to get up to 70 per cent military nurses
as the component in such a ward. We have not got to that situation
yet. As I understand it, there are training activities and plans
to try to get to that position, that is the idea. Currently, the
situation is presumably managed by one of your NHS, I do not know
what they are—
Ms Moore: Ward sisters.
Mr Havard: This is England and I come
from Wales, so there is a different set of problems down here.
Q144 Chairman: You would never have
been able to tell!
Dr Rosser: I had not noticed,
no.
Q145 Mr Havard: It is that Grand
Slam tie you have got on! It is 2005, by the way. How do we get
to that situation? Is that what you are trying to move towards?
I am concerned about the contractual arrangements from the point
of view of knowing what the timetable is to advance this programme
if this is what the programme is going to be. Is that where we
are going to get to? As I understand it, you are not going to
be in that position next month and next month was the original
target date. Where are we?
Ms Moore: The military did have
some ward managers but, as I explained before, a lot of them have
been deployed and it does take time to skill somebody up for that.
We do have a military nurse as part of the leadership team on
the ward. There is a senior sister and there are junior sisters
on the ward. There is a senior military nursing presence on the
ward and that has been proved to be beneficial both to the casualties
and the rest of the nursing team. The military nurses do require
training up to be able to take full control of the ward. Some
of them have been outside the NHS environment for a long time,
have been out in the frontline in Afghanistan and Iraq, and they
do take time to pick up their skills. I do not believe that the
lack of that is causing any detriment to the people on the wards
whatsoever.
Q146 Mr Havard: I was not suggesting
that at all.
Ms Moore: No.
Mr Havard: I was asking if these are
the parameters we are trying to get to, where are we getting in
terms of progress towards it.
Q147 Mr Jenkins: With regard to our
military ward and the military nurses because of deployment, and
when they are on a six month deployment they are entitled to so
much leave, they do not come back for a while, what difficulty
is there in being able to rotate your staff to a level where they
can get their training? You have to mix these with your NHS nurses
but what problems have you had to overcome? I know it is necessary
to train them because they have to go out to theatre and then
come back home but have there been any major problems in these
rotas for nurses?
Ms Moore: We are very fortunate
to have some very skilled nurse managers who are used to managing
rotas that you could only describe as 3-D rotas at times. I would
pay tribute to the head of nursing in the division of the senior
nurses who has done an absolutely fantastic job in managing the
nursing situation.
Chairman: Moving on to welfare issues,
David Crausby, the Vice-Chairman.
Q148 Mr Crausby: Thank you, Chairman.
In our evidence session last week with representatives of families,
there was a general acceptance about clinical excellence and the
British Legion, for instance, said: "at the moment healthcare
is extremely good". One of the criticisms which the British
Legion made to us was that you were better at looking after patients'
clinical needs than dealing with wider welfare issues. They made
the point that charities are having to step in to provide basic
essentials like clothes and toiletries when people are separated
from their possessions. How do you respond to that? Is it appropriate
that Service personnel and their families in these circumstances
should depend on a charitable organisation?
Ms Moore: I am very glad of that
comment because we are aiming to be excellent clinically and the
comment did say that. The welfare of the military patients is
purely provided for by the military but I would say I thought
the comment was referring more to visitors than to patients. We
have a full range of toiletries, pyjamas, slippers, towels, anything
anybody might want when they come into hospital, because it does
not just apply to the military who arrive without their things.
Q149 Mr Crausby: She said there were
essential things like toiletries and clothing for people who have
been separated from their possessions. I think it was aimed more
at families but, even so, is it appropriate in these circumstances
that charities should deliver this need? After all, people are
sometimes quite proud about having to make appeals to charities.
In circumstances like this should they be put under even more
stress by having to ask for assistance with travel, for example?
Dr Rosser: We would answer no,
it is not appropriate. We have very clear responsibilities as
part of providing a high quality of clinical care to ensure that
families understand what is happening clinically with their loved
ones. The provision of welfare, travel, support and accommodation
is not provided through us as the NHS, it is provided through
the RCDM, so it would be unfair of me to comment too deeply on
how that is provided.
Q150 Mr Jones: This morning we visited
some of the flats that are made available for families to stay
on site when they are visiting very seriously ill relatives. Can
you just talk us through what actual support is given on site
for relatives and also what the interface is? You say it is the
military but one of the key things is what is the interface between
yourselves as the clinicians and the actual next of kin? This
morning we saw some very difficult examples where there were divided
families and other things and who do you deal with as the next
of kin, so I can accept it is not easy in some cases. Can you
talk us through what is the impact and interface with the next
of kin and what support is given to them?
Dr Rosser: As I said, from our
perspective the interface with the next of kin is around communicating
clinical progress, prognosis, making sure people are aware of
what the plans are, trying to keep people up to speed as clinical
plans change because in difficult complex injuries clinical plans
do change as things evolve. As I said, provision of accommodation
and the other aspects of welfare are not provided through us.
That accommodation is on our site but it is provided by the RCDM.
Q151 Mr Havard: As I understand it,
that is then partly delivered by the Defence Medical Welfare Service—another
set of initials!
Dr Rosser: Yes.
Q152 Mr Havard: They are contracted
to the MoD to do that.
Dr Rosser: Correct.
Q153 Mr Havard: So it is not just
the charitable sector that gets involved in that activity.
Dr Rosser: No.
Q154 Mr Crausby: As Kevan said, we
saw some good facilities this morning, we did not see them all
of course, but the real issue is, is there more you could do or
more you would like to do?
Ms Moore: I think Selly Oak is
two pints in a one pint pot and there is very limited life left
in the site and in three years' time we will not be using it any
more. In order to make sure that there is suitable accommodation
nearby the RCDM have taken over some local flats to rent for relatives
coming in. It is sub-optimal; we would like people to be on site,
but in trying to make sure that there is accommodation available
they have really tried hard to get accommodation nearby.
Chairman: I want to move on now to media
coverage of the issues that we have been discussing.
Q155 Linda Gilroy: In your memorandum
you are very critical of the effect of negative media coverage,
and I will ask you in a moment about the effects of that. First
of all, can you say how you think it came about?
Ms Moore: I am afraid I have thought
long and hard about that and I do not know why the negative stories
were picked up in the way that they were. We have given very good
news stories that some of the media have run with and we have
done some world first type surgery at the hospital and we were
very proud to publicise that but it was not picked up so much
as some of the stories that did do the rounds.
Q156 Linda Gilroy: We have your written
evidence, of course, but for the purpose of this evidence session
can you tell us what effect the media coverage has had and how
you and the hospital as a whole, but particularly the staff involved
in the wards, have been affected by it and reacted?
Ms Moore: Perhaps if I tell you
a comment from one of the nurses on the ward who looks after the
military casualties. She said: "I don't like coming to work
on Sunday morning any more because I never know what I might be
going to read" as they are looking after the soldiers and
what the soldiers might open up in the newspapers. We went through
a period when there were a lot of sudden stories that we had no
warning were coming arising in the press that staff found quite
puzzling because the work they were doing and the feedback they
were getting from soldiers and their families was not reflected
in the articles they were reading.
Q157 Linda Gilroy: So it had an impact
on the staff. It was quite a sustained period that it happened
over. Have you had to offer support to the staff to try and cope
with that?
Ms Moore: We have offered support
to staff. We have offered them additional support to go in and
talk to them about their experiences and I am pleased to say that
the staff are so dedicated and pleased that they are looking after
the military that they are still there, they are still wishing
to provide the high level of service, and are viewing it as a
nasty period in their lives that now, hopefully, is over. I think
they are glad today that we have got the opportunity to tell you
and put on record the kind of care that they have been giving.
Q158 Linda Gilroy: I think my colleague
is going to come on to some of the urban myths in a moment but,
before we move on to that, we have received a submission from
the four Birmingham MPs expressing concern because they have had
good contact with you over the period that the media coverage
has led to measures being taken that were driven by motives other
than clinical need. They are also concerned that the desire for
a military-managed ward might override proper clinical considerations.
How would you respond to their concerns?
Ms Moore: The most important point
is the last one and I think I would say that we retain clinical
responsibility for that ward and would not let anything get in
the way of providing excellence of care. Our main focus has solely
been to provide clinical care that saves lives, saves limbs and
rebuilds and preserves as much function as possible. Neither I
nor Dave, as Medical Director, would let anything get in the way
of that. The MPs have been exceptionally supportive, they have
visited, they have been round the wards, talked to the casualties,
they do know what is going on there and they have been as puzzled
as we have—as MPs you probably deal a lot more with the
press than we do anyway—as to why these things happen.
Q159 Linda Gilroy: Before passing
over to my colleague to deal with the myths issue, can I say that
we are hardened as far as media flak is concerned. Finally, can
you tell us the scale of activity you had to put in place to respond
to what has emerged from the media interest? Even though we are
battle-hardened to these things, I must admit I was quite shocked
at what you described in your memorandum.
Ms Moore: Some of the things that
caused most concern were people posing as relatives, posing as
visitors, taking photographs on phones, phoning the critical intensive
care unit saying, "This is the on-call manager, just run
down the military patients". The staff have had to have their
senses heightened to be aware of what is going on. We have got
additional security around the place, and I do not think I should
go into all that we do at the moment, but we have had to become
extra-vigilant to watch out for this. We have had some excellent
reporting and some excellent news stories as well, and some people
have reported extremely well. I must say it is a small minority
and it is disproportionate in how the press has represented it
in that way. The small stories, the urban myths, have spread whereas
the good stories that have been well reported have not.
| 
