City at heart of the matter (From Oxford Mail)

City at heart of the matter

6:20am Thursday 20th August 2009 in Search By Reg Little

Were the proverbial Martian to land in Headington, a brief glimpse of the city’s main hospital would surely have his antennae twitching madly with positive vibrations.

The Oxford Radcliffe Hospitals Trust may be beset by severe financial pressures but, on the face of things, the city’s main hospitals have never looked so impressive.

The Nuffield Orthopaedic Hospital has been transformed, the new west wing and children’s hospital are up and running at the John Radcliffe while the £109m Cancer Hospital at the Churchill recently welcomed its first patients. The finishing touches are being made to another world-class health facility at the John Radcliffe, with the long-awaited new Heart Centre to open in October.

Costing almost £30m, the new unit will be housed in a new five-storey building. It will provide five state-of-the-art catheter labs, for diagnosing and treating heart problems, a cardiac intensive care unit and more space for patients.

For all its reputation for valve surgery and electrophysiology, heart patients at the John Radcliffe still find themselves being put into mixed-sex wards. These will soon be gone, replaced with 50 single en-suite rooms over two wards, with the new centre including 16 day-patient beds, five recovery beds and four intensive care and high-dependency beds. There are also new family rooms, a gymnasium and purpose-built teaching and conference facilities. When it comes to treating cardiac patients timing is everything. And there can be no doubt that Oxford is fortunate that the millions were secured from the Department of Health and the Strategic Health Authority before the recession came into view, bringing rising Government debt. The new centre may stand as one of the final monuments to the NHS’s years of plenty, before a return to cost-cutting strategies, job threats, deficits and ward closures.

But the opening of the new centre is timely too, because it comes as we enter a new era in the way cardiac patients are treated, with Oxford at the forefront of advances in life-saving treatments.

The John Radcliffe was one of the hospitals to pioneer angioplasty, which involves inserting and then inflating a small balloon into blocked coronary arteries, leaving a stent to effectively scaffold the artery and restore blood flow to normal. Now the JR is leading with another groundbreaking procedure known as TAVI (Transcatheter Aortic Valve Implantation), which also avoids open-heart surgery and prolonged deep anaesthesia. Instead of having to open up a patient’s chest, this remarkable keyhole procedure involves inserting a new heart valve (made up of a stainless steel tube and biological material taken from cows) through the patient’s leg. Only about 20 such operations have been performed so far in Oxford. Consultant cardiologist Dr Adrian Banning, chairman of the cardiac directorate, said: “It is amazing how changes in health care happen so quickly. Back in 1995 when I came here, Oxford was the only hospital between London and Bristol using stents.”

But while the quality of care has been of the highest standard, the accommodation for heart patients has been lacking. At the same time, lack of space has remained a problem. At one stage he leads me into a small shabby side room, crammed with six members of his team. “What these guys do 24/7 is look after people who are dying,” he said. “That is where they have to go for coffee and then it’s back to it again. It is not only patients who get to feel better from having an improved environment.”

The number of beds will ultimately increase by a third, with extra specialist staff needed. But the present financial pressures mean there will be no immediate increase. Dr Banning said: “We will not be opening at full capacity. We will have to make a transition between what is affordable in the current climate and what we will ultimately be able to do.”

Because the specialist heart centre will be a regional facility, taking in patients from outside the county, the demand on its services will remain high. “This hospital, as a research institution, sees the most difficult cases. We have to look after the sickest patients. We have to do the most risky operations.

“We have the problem of people from Cheltenham, Gloucester and Swindon having to wait to come here. Ultimately, we will be able to get them in quicker, which if you have a heart problem is vital. Twenty-four hours makes the difference between not having to wait any more. The other thing is the high number of elderly people living in Oxford. Elderly people bring their own challenges. Twenty years ago, if you were 85 and had angina, you might be prepared to accept it and change the things you did. Well, people are not prepared to accept it any more.”

Leaflets supporting a £2m Heart Centre campaign, launched to fund “extra items beyond the normal resources of an NHS hospital” say: “To put it simply more lives will be saved.” Dr Banning has no doubt this will be the case. “The ambulance entrance is just 15ft from the catheter laboratories. That is the beauty of the design. it means when you have a heart attack, instead of being pushed around the hospital in a trolley you are dropped off right there, bypassing A&E, bypassing everything.”

In cardiac departments the crucial performance measure is “door to balloon time”, the time it takes to open the blockage after the patient’s arrival, with speed essential to reducing the damage to heart muscle and relieving pain. While Oxford already has one of the best records in the country, the new centre will see further improvement.

Ruth Titchener, Matron in cardiac medicine, said : “From the nursing perspective, it is the single rooms and new facilities provided for patient comfort that is pleasing with all the services close together. It was important that patients were involved in the designs.”

The woman responsible for the interior design of the centre is herself a former heart patient. Hannah Warner was born with a narrowing of the aortic valve and has been treated at Oxford by consultant cardiologist Dr Oliver Ormerod since she was 15. When the baby she thought she would never be able to have was born in June, she gave her baby the middle name Oliver in his honour. Ms Warner, a trained interior designer with the architects Nightingale Associates, said: “I know what it is like to lie in a hospital bed and stare at the curtains, the ceiling tiles, the bare walls, day after day. I knew I could make a real difference and also knew that one day I may well be in the Heart Centre as a patient again.”

The new centre will be “almost unique” in having a dedicated space for research within an NHS building, says Keith Channon, professor of cardiovascular medicine. Heart research was a key component of the successful Oxford bid, in partnership with Oxford University, to become a Biomedical research centre, one of only five in the UK. Now we are to see more benefits. The increase in capacity and the state-of-the-art equipment will enable us to participate in cutting edge research much more. For the first time we have a building that incorporates at its heart the infrastructure to support research, in addition to the routine daily work load of service procedures.”

A share of day case beds will be given over to research, meaning patients can be admitted for research studies without having to compete with NHS patients for space. Key areas of research will include inherited cardiovascular conditions, to identify underlying genetic causes of some heart diseases, taking on groundbreaking work in Oxford led by Prof Hugh Watkins. The centre will also see advances in cardiac imaging and diagnostics screening, with a £11m Acute Vascular Imaging Centre being created beside the new heart centre, with the powerful 3-Tesla state-of-the-art magnet. Prof Channon added that much of the research, involving blocked arteries, would ultimately lead to improvement in treatments for stroke patients as well.

The fact medical advances mean people with congenital heart disease are living longer has only added to the demands on specialist heart units, because it means there are more patients needing more support. In the 1950s, only 20 per cent of children born with a congenital heart defect lived until adulthood. Now 80 per cent of children survive to adulthood and need treatment, not least when they go on to need extensive care giving birth to their own children, like Hannah Warner.

The centre’s links to the university go right to the top. For Oxford University Chancellor Lord Patten is an active supporter of the appeal and will be attending a fund-raising dinner at Keble College on October 2. Lord Patten said: “Speaking as someone who had angioplasty 17 years ago it is perhaps not surprising that I am a strong supporter of the Oxford Heart Centre. The centre does great work and I am happy to give it all the encouragement that I can".

The first patients will soon be arriving, with the official opening not taking place until next year. Maybe it would not be such a bad idea to wait until President Barack Obama is next over, to give Americans a glimpse of British healthcare. But then who knows what state the NHS will be in by then.