Health Education West Midlands
Local Representative: Dr Oscar Nolan
Training Programme Director: Dr Vinay Bhole
DIANA, PRINCESS OF WALES, BIRMINGHAM CHILDREN'S HOSPITAL NHS TRUST
Birmingham is a progressive, modern city offering pleasant accommodation and excellent civic infrastructure. There are good road, rail and air links and easy access to the countryside. The International Convention Centre, Symphony Hall, National Indoor Arena, the Birmingham Museum and Art Gallery and several theatres are centrally located. There are excellent schools and the Universities of Birmingham, Aston and Birmingham City offer a wide range of educational facilities and other activities.
The Birmingham Children's Hospital NHS Foundation Trust
Birmingham Children’s Hospital NHS Foundation Trust is one of only four NHS Trusts in the country specialising exclusively in the care of children and young people. It provides both local general hospital and mental health services to the residents of Birmingham and much more highly specialist care to a wider population of 5.5 million in the West Midlands and beyond.
The Trust provides care for over 200,000 children and young people a year from all over the UK and Europe and is one of the leading paediatric teaching and research centres in the country. We employ more than 2,700 wte staff and welcome in the order of one million people through our doors every year. The Trust is a leading teaching and research institution and partner of all the city’s universities.
The Trust moved to its city centre site on Steelhouse Lane, in May 1998. Whilst many of the original features have been restored and maintained, this landmark Victorian site has been transformed internally with over £40m invested into state of the art facilities.
A 31 bedded Paediatric Intensive Care Unit with an ambitious expansion project on track
A centre of excellence for children with cancer, cardiac, liver and renal disease
280 inpatient and day-case beds including Child and Adolescent Mental Health Services
50 Specialties and supporting departments
An Emergency Department dealing with over 45,000 patients attendances a
A new Paediatric Assessment Unit
9 operating theatres
A new laparoscopic surgery theatre
An endoscopy suite
A hybrid cardiac theatre and catheter laboratory
A state of the art intervention cardiology suite
A second interventional radiology room with anaesthetic facilities
3 MRI scanners
A CT scanner
We have developed a number of partnerships over the last few years, including one with Wellcome and the Birmingham Children’s Hospital Charitable Trustees which has enabled the Trust to establish the only paediatric research facility in the country at a cost of £4.8 million.
Other successful partnerships include:-
A 60 room parent accommodation facility on site funded by Ronald McDonald House Charities - £7 million.
A bespoke environment for adolescents with cancer funded by the Teenage Cancer Trust - £3 million.
Renal Ward part funded by British Kidney Patients Association - £2.7 million.
There are significant estates plans for the immediate and medium term future including an additional 6 cardiac services beds and further likely theatre and PIC expansion.
Longer term plans are being drawn up for further new developments, either within the existing footprint or a new build on the University of Birmingham site.
EDUCATION AND RESEARCH DIRECTORATE
The Trust is one of the leading paediatric teaching centres in the country, with international research and development in areas such as:
Childhood cancer studies
Infection, inflammation and immunity
Molecular genetics of childhood conditions
Nutrition, growth and metabolism in childhood
Efficacy, safety and optimisation of drug use in children
A Directorate of Education and a Directorate of Research have been established in order to consolidate and support education and research initiatives within the Trust.
The Directorates include the Professional Development Team, Organisational Development and Training, Medical Education and Research and Development.
The Research Directorate is led by the Director for Research and Development, Dr Bruce Morland. The Research and Development Department manages research in the Trust and is responsible for research governance, including research ethics issues. This includes managing research finances, ensuring drug trials are carried out to international standards and co-ordinating laboratory involvement in research. The Department also co-ordinates an R&D education programme within the Trust and provides guidance for developing and registering research projects, research design, statistical advice and data analysis, including laboratory co-ordination of samples and pharmacy support for clinical trials.
The University of Birmingham:
The University was founded in 1900 by the citizens of Birmingham who wanted their own university to train and educate the people who would create and manage the burgeoning businesses and industries of the Midlands.
It was natural, given the nature of Birmingham's industry, that the University should, from the start, teach the major scientific and engineering disciplines. It was also the first UK University to establish a Faculty of Commerce and incorporate a medical school. The modern University is equally distinguished in the humanities, education, social sciences and law.
September 2000 saw the launch of ‘The Black Country Strategy’, to expand links with NHS partners to address concerns over the shortage of doctors in the West Midlands and also inequalities of health and healthcare in the Black Country. It has enabled medical students to have further opportunities to develop clinical experience in a district hospital setting. The ‘Black Country Strategy’ presented an exciting development in the training of future doctors. By September 2003, the Medical School increased its annual intake by an additional 159 students. The project extends clinical training beyond Birmingham into General Practices and District hospitals in the Black Country and Worcestershire providing unparalleled clinical experience for its students in both urban and rural settings. The expansion programme allows access to clinical teaching and research on patients drawn from a population of 5 million that is remarkably diverse in its socio-economic and ethnic make-up.
Academically, the University is organised into five Colleges, one of which is the College of Medicine, Dentistry and Health Sciences. This college is headed by the Professor Lawrence Young and is administratively split into Schools. The School of Clinical and Experimental Medicine covers the whole range of pre-clinical and clinical subjects. Interdisciplinary research is encouraged, as are links between the clinical and basic science departments in other faculties. The College is justly proud of its library and reference facilities and has good working relationships with Trusts and Health Authorities.
Academic Paediatrics at Birmingham Children’s Hospital:
Research infrastructure on the BCH site include The Wellcome Trust Clinical Research Facility, a 6 bedded inpatient and outpatient ward for children participating in experimental medicine studies and clinical trials; this incorporates a DXA body composition scanner and metabolic/exercise facility. In addition there is an NIHR 3T
MRI and spectroscopy scanner.
The West Midlands Medicines for Children Research Network is based at BCH, together with NIHR paediatric studies group facilitators, Childrens' Cancer Research Network nurses, NIHR CLARC, and many UK Charity supported researchers.
BCH also hosts several Clinical Academic training posts at ACF, RTF and ACL levels.
Current academic paediatricians:
Professor Timothy Barrett,
Leonard Parsons Professor of Paediatrics and Child Health
Professor Tauny Southwood, Professor of Paediatric Rheumatology
Dr Nils Krone, Senior Clinical Research Fellow in Paediatric Endocrinology
Dr Stephen Murphy, Senior Lecturer in Paediatric Gastroenterology
Dr Janet McDonagh, Senior Lecturer in Paediatric Rheumatology
Dr Andrew Peet, Reader in Paediatric Oncology
Dr Pamela Kearns, Reader in Paediatric Oncology
Dr Carole Cummins, Senior Lecturer in Clinical Trials
Dr Andrew Ewer, Senior Research Fellow in Neonatology
Dr Frank Mussai, Senior Lecturer in Paediatric Oncology
Undergraduate medical education:
Medical students attend The Children’s Hospital for 4th and 5th year ‘student selected activities’ attachments and their final year module in Paediatrics and Child Health. Teaching is delivered through lectures, small group clinical and classroom teaching, and by involving students in the clinical work of the hospital. The Trust has developed a paediatric clinical skills teaching session for all final year medical students and the Trust organises and hosts these sessions eight times a year. The teaching fellows and registrar are responsible for organising and teaching on the clinical skills teaching sessions. Facilities for students include an NHS Base library, student common room, on call rooms in student residencies, private study room and the Education Centre.
There are eight rotations of students each academic year. At any given time there are 25-30 final year students present at The Children’s Hospital, the students are, divided into one of five teaching teams and the remainder doing a 5 week Student Selected Activity. The teams rotate through week long ‘themed weeks’ in acute paediatrics, emergency paediatrics, paediatric surgery and paediatric intensive care/cardiology/cardiothoracic surgery.
Assessment is continuous and the trust is one of three sites which hosts the final year objective structured clinical examination (OSCE) three times a year (including the final year resit examination). The teaching fellows and Registrar in Medical Education play a major role in the running of these exams.
Medical educators in the trust have major interests in methods of mentoring, teaching and learning and assessment of clinical competence and are involved in research and development at local, regional and national levels.
There a number of elective placements available for students throughout the year and we receive requests from both national and international students.
Clinical management in the Birmingham Children's Hospital NHS Foundation Trust is directed through five clinical directorates. The Chief Medical Officer is Dr Vinod Diwakar. The Chief Operating Officer is Mr Tim Atack and for the Directorate of Specialised Services the Clinical Services Director is Dr Gill Derrick and the Associate Service Director is Mrs Amanda Baugh. Each Directorate team has the support of an Assistant Directorate Manager, a Head of Nursing, a
Finance Manager and an HR Manager.
There are regular Directorate Operational Management Team meetings, with the Clinical Service Directors holding monthly Directorate meetings for Clinical Leads who, in turn, are expected to arrange regular meetings (ideally, each month) for senior staff within the speciality (i.e. doctors, nurses and other staff as appropriate). The Clinical Leads for cardiac services are Mr David Barron and Dr Ashish Chikermane, who are responsible to the Clinical Director for the implementation of all aspects of Trust policy and Clinical Governance or Quality initiatives within the speciality.
The appointee will be expected to participate in all aspects of the Clinical Governance structure developed by the Trust to monitor, maintain and develop review and amendment according to the needs of the clinical area, changing circumstances and service development the quality and effectiveness of care. The Trust is committed to the development of medical staff through individual professional development a framework for which has been systematically introduced in 2001. There is an expectation that all staff are involved in audit of personal clinical practice as well as the involvement in departmental/speciality reviews; that they should meet the requirements for Continuing Medical Education defined by the relevant Royal College (and for which appropriate study leave support will be available); be aware of professional standards, the responsibility to undertake safe and ethical clinical practice and the importance of responding promptly to any circumstances which may result in increased clinical risk or adverse outcome. Funding is available for approved study leave as defined in the Trust’s study leave policy.
The appointee will be expected to play a role in postgraduate medical education and the training of other relevant staff groups. An honorary University title may be offered in appropriate circumstances.
The appointee will be expected to facilitate research undertaken within his/her department and elsewhere within the Trust, and to be aware of current Research and Development initiatives in relation to clinical service development.
The appointee will be expected to take part in the delivery and development of clinical services within the Trust's Service and Financial Framework and in line with the Trust's clinical strategy.
Arrangements should be made to ensure that local and Trust wide matters are communicated and discussed via appropriate means i.e., team meetings, written briefings etc.
The Paediatric Cardiac Service comprises of the departments of Cardiology, Cardiac Surgery and its facilities. These include a dedicated Out-patient Department separate from the main hospital outpatient department, a non-invasive Heart Investigations Unit, two Wards (Wards 11& 12) with a total of up to 35 staffed in-patient beds, a Homograft Bank and offices with secretarial facilities. It works as an integrated unit and managerially forms part of Specialised
There are advanced plans to develop additional capacity for outpatient facilities and Heart Investigation Unit in view of the increasing workload, along with a dedicated cardiac day-case unit in keeping with the modern changes to clinical practice.
Dr. O Stümper
Dr. P Miller
Dr. R Dhillon
Dr. A Chikermane Dr. T Desai
Dr. C Mehta
Dr. A Seale
Dr M Chaudhari
Dr V Bhole
Mr. WJ Brawn
Mr. DJ Barron
Mr. TJ Jones
Ms. N Khan Mr P Botha
Paediatric Cardiologist Paediatric Cardiologist Paediatric Cardiologist Paediatric Cardiologist Paediatric Cardiologist Paediatric Cardiologist Paediatric Cardiologist
Paediatric Cardiologist Paediatric Cardiologist
Paediatric Cardiac Surgeon
Paediatric Cardiac Surgeon Paediatric Cardiac Surgeon Paediatric Cardiac Surgeon
Paediatric cariac surgeon
5 Specialist Registrars in Paediatric Cardiology
1 Specialist Registrar in General Paediatrics (Rotating)
2 Staff Grade/Specialists in Paediatric Cardiology
3 Clinical Fellow in Paediatric Cardiology 5 SHOs (based in Cardiac Services, in hospital@night shift system)
Cardiac Surgery: 4 Specialist Registrars :
2 on West Midlands rotation
1 rotating with Great Ormond Street Hospital
1 visiting Registrar
1 Research Registrar
There are two wards. One is for infants (Ward11) and is staffed for 16 beds and the other for older children and adolescents (Ward12) and is currently staffed for 18 beds. Occasionally patients from other services have access to these beds. Ward 12 has purpose built adolescent facilities. Both cardiac wards have areas designated as High Dependency Units for cardiac care with appropriately trained nursing staff.
Intensive Care Unit
The Hospital has a Multidisciplinary Intensive Care Unit which is currently funded for 31 beds with an expansion of HDU facitlities. The Cardiac service utilizes approximately 50% of ICU days. A collaborative approach in the management of patients is expected and encouraged between Intensivists, Cardiologists and
Cardiac Liaison Service
There is an excellent liaison service covered by four full time senior nurses, who help patients and families cope with the difficulties of congenital heart disease. They undertake Community visits, support the Fetal Cardiology Service and run a monthly pre-admission clinic with the outpatients’ staff. The service works closely with a dedicated social worker.
The bank is based at Birmingham Children’s Hospital and has two full time technicians. It provides valves for the West Midlands and beyond. The Trust has invested in new facilities that became operational in May 2004. The bank has a managerial team chaired by the Clinical Lead with a Consultant Surgeon acting as Medical Advisor.
Cardiac Catheter Theatre
The cardiac theatre complex provides the setting for state of the art invasive cardiology for which the department is acknowledged as a leading centre. It is situated in the main theatre complex. A new, state of the art biplane cardiac catheter laboratory was opened in April 2011. All the latest software including rotational angiography and CT overlay are incorporated. The room is designed to full theatre specs to enable biplane hybrid procedures such as the hybrid Norwood stage I. In Oct 2011 a specially designed single-plane angio cardiac surgical theatre with laminar airflow system was opened, which now serves as the principal cardiac surgical theatre. This purpose built theatre will be instrumental in improving patient care by enabling the provision of pre/post-operative angiograms at the time of the surgery. There are currently 8 funded cardiac catheter sessions each with anaesthetic cover and dedicated theatre staff, and this is expected to increase, in keeping with the developments in catheter procedures.
Procedures undertaken in the catheter theatre include diagnostic cardiac catheterisations and the full range of therapeutic interventions. These encompass balloon valvoplasty and angioplasty, insertion of occluding devices, stents, pacemakers and defibrillators, electro physiological studies and pacing. The catheter suites are supported by fully trained cardiac physiologists for the complete range of invasive work including invasive electrophysiological procedures, and pacing.
Heart Investigation Unit
The Heart Investigation Unit is adjacent to the heart outpatients department. Fully trained technical staff assist in providing a comprehensive range of non-invasive investigations such as ECG’s, exercise ECG’s, Holter monitoring and echocardiography to support the out-patient clinics (including regular pacing clinics), and inpatients – cardiac as well as from other departments. Cardiac physiologists based here also provide support to the cardiac catheter laboratory for a full complement of cardiac procedures.
The department is also recognised for training.
Electrophysiology and Pacing
The centre is a recognised centre of excellence for electrophysiology and pacing. Dr V Bhole leads the service, with support from Dr. R Dhillon for pacing. The activity is supported by a team of cardiac physiologists trained in all aspects of EP and pacing. The department has also got the Carto® system to support ablation procedures.
The department undertakes routine trans-venous pacemaker and ICD implantation and CRT devices.
Fetal cardiology clinics are held at Birmingham Women’s Hospital in collaboration with the University Department of Fetal Medicine. Diagnostic and therapeutic procedures are undertaken. Fully trained sonographers and nurses/midwives assist in supporting the scanning and counselling. A new position has been created to support the existing fetal cardiologists due to increasing workload. Dr P Miller leads the service and Dr T desai and A Seale are the fetal cardiologists who run the service with him.
Low risk scans are undertaken by the fetal sonographers, which are then reviewed by the fetal cardiologists, and they currently scan, and counsel high risk patients. The department currently undertakes 1100 scans annually. We are currently supporting fetal activity in one of the level 3 obstetric units in the region, and there are plans to increase this activity across the region.
There is a single plane angiographic suite in the radiology department to support the increasing interventional radiology workload and the lines lists. There is a Trust and region wide PACS system which allows review of radiology images throughout the Trust.
Within the Radiology Department are facilities for performing MRI and Spiral CT scans, as well as Radionuclide studies. There are two MRI scanners, with dedicated cardiac software for a full range of cardiac imaging. In addition, a new 3 Tesla magnet has been operational since April 2012 which is used for clinical diagnostic and research purposes.
Cross sectional and non-invasive imaging
In the last 7 years, we have established a cardiac MR programme and have regular sessions. We are have recently increased to 4 CMR sessions a week with one anaesthetic session a month, and are expecting both the CMR sessions, and the anaesthetic cover to increase. We currently use a Siemens 1.5T Magnet for clinical work in cardiology.
We work very closely with the radiologists to provide a seamless cover for cardiac MR, and the increased CMR activity is evenly split with 2 sessions being covered by cardiologists and the other two by radiologists. As a consequence of this increased activity, we have recently appointed a paediatric radiologist who started in September 2012 and will be a part of the cardiac MRI programme. This current position in cardiology is the second part of this expansion.
The department has a well-developed CT programme to supplement cardiac ultrasound, and cardiac MR for structural lesions. We currently limit this service for information regarding extra-cardiac structures only, and we are expecting this to change with the acquisition of a new generation CT scanner in the near future.
We have started a programme of assessing myocardial contractility using newer modalities such as doppler myocardial imaging (Tissue Doppler), and 3-dimensional reconstruction. The department has undergone a complete refurbishment of its ultrasound facilities with state of the art equipment acquired in the last 3 years. We have a fully digitalised service with dedicated workstations for a complete complement of analysis for advanced echocardiography, both structural (3D) & functional. With the development of non-invasive posts, we are aiming to support a consultant led TOE service for selected catheter interventional procedures.
Cross sectional imaging is supported by Dr A chikermane and Dr S McGuirk, Consultant Paediatric Radiologist. Non-Invasive imaging is performed by Dr Chikermane who leads the service and supported by Dr A Seale.
Adult Congenital Heart Service
Full time consultants: Dr. S Thorne
Dr. P Clift
Dr L Hudsmith
Dr S Bowater
Five consultants support the service for adults with congenital heart disease, based at the University Hospitals of Birmingham NHS Foundation Trust (UHB). Drs. Stümper and Mehta currently provide support for the interventional cardiology aspects of this service, and the cardiac surgeons from the Children’s hospital provide the surgical services.
A seamless transition of care of these patients from Birmingham Children’s Hospital to UHB is being developed with the establishment of Adolescent/Young Adult clinics at Birmingham Children’s Hospital. The consultant(s) delivering the adult service have an honorary contract with Birmingham Children’s Hospital NHS Trust and they hold joint clinics at Birmingham Children’s Hospital. All cardiologists at the Children’s Hospital collaborate with the consultants in adult congenital heart disease in the management of adults with congenital heart disease at UHB.
Recently a dedicated cardiac liaison nurse (Ms. N Pope) has been appointed at UHB to promote and develop transition services.
Trans-telephonic transmission of ultrasound images has recently been established with one of the major paediatric centres in the West Midlands region. It is envisaged that links will be developed with the major paediatric units over the next few years. Dr. Oliver Stümper is leading the development of this service.
We are also actively pursuing the development of transmission of data through PACS, and would envisage that this may well develop as the main source of data transmission.
General Paediatric cardiology
The department sees and admits patients from the West Midlands Region as well as the other parts of the U.K. Due to its clinical excellence the department also get referrals from Europe and Asia.
The Unit has a special interest in the management of children with Hypoplastic Left Heart Syndrome for which it has the largest cohort of patients in Europe. It is acknowledged as a leading international centre for treatment of this condition. It is also recognised as a leading international centre for the management of complex pulmonary atresia and congenitally corrected transposition of the great arteries.
The unit possesses specialised cardiac skills in fetal diagnosis and therapeutics, Trans-oesophageal and intra-operative echocardiography, electrophysiology and pacing. It continues to be involved in the assessment and development of interventional devices and the training of colleagues at other cardiac centres in their use.
Out-patient clinic attendance: 10,500
Cardiac CT & MRI: 400-500
Fetal studies: 1100+
Cardiac catheters: 500 of which 2/3 are interventional. Although the number
of procedures has not changed significantly, the overall complexity has
• Bypass operations: 500, with a growing tendency to undertake more complex
procedures on younger patients, with an additional 50 at the University Hospital where we provide the Adult Congenital Heart Service.
Dr. Bhole currently leads the organisation of educational supervision within the department, according to guidelines and standards set out by the Postgraduate Dean and the Royal Colleges of Physicians, and of Paediatrics and Child Health. The department has a newly created dedicated seminar room with full teaching and projection equipment. Good facilities exist for producing teaching materials such as illustrated guidelines and distance-learning packages in hard copy on electronic forms. The hospital library has Level 1 accreditation with distinction (1999).
The individual will be expected to contribute to undergraduate medical student teaching and to play a role in the training of other relevant staff groups.
All medical students who are attached to the Children’s Hospital for paediatric teaching receive tuition in Paediatric Cardiology. The successful candidate will be involved in formal/informal teaching to the undergraduate students attached to the unit.
The Cardiology Department participates with the other departments in the hospital in weekly case presentations. In addition, there are also weekly pathological conferences, some of which include cardiac cases. Each week there is a teaching session for the Heart Unit – alternating Journal Club, Research and Audit. The trainee would be encouraged to support teaching SHOs for the MRCPCH.
The successful candidate will be encouraged to develop & maintain appropriate level of skills to support the individual’s role within the department, and his/her professional development. The candidate will have a supervising consultant with whom he/she would be expected to develop a training programme.
As with other members of the department, the candidate will be required to have annual appraisals in keeping with the guidelines of the General Medical Council.
The successful candidate will be expected to undertake on-call commitments, currently arranged at a 1:8 partial shift system; providing a non-resident, 24-hour on- call commitment (this is currently under review). This will involve on-calls over the weekends also. The individual will be expected to undertake an out-of-hours commitment, which will vary depending on the duties of the post, but will not exceed the limits defined in the Terms and Conditions of Service, paragraph twenty. Working patterns are in accordance with the New Deal on Junior Doctors’ Hours.
It is expected for the candidate to be present for the PICU rounds on the days that he/she is on-call, and the following day to ensure that there is an appropriate hand- over of clinical activities.
It is expected that the appointee will actively participate in departmental audit. The department has a full time Database and Audit Manager (John Stickley), who is also actively developing Service Line Reporting, as the Cardiac Services are spearheading this new pilot project. An updated computer system and data management system (Heartsuite®) has been installed throughout the offices, wards, outpatients and heart investigation unit. The Trust’s I.T. department supports this dedicated system, which also links to the hospital’s Patient Administration System.
Clinical Audit within the department is lead by Dr Rami Dhillon. In additional to monthly audit meetings of Cardiology and Cardiac Surgical activity, quarterly multidisciplinary Audit meetings involving one session are supported by the Trust with curtailment of clinical activity for these sessions.
The post holder will be encouraged to pursue his/her research interests and is expected to remain aware of current Research and Development initiatives in relation to clinical service developments.
Interested applicants are invited to visit on an informal basis by arrangement with Dr. V Bhole, Consultant Paediatric Cardiologist & Programme Director (Tel. No.: 0121 333 9457) or Dr. Tarak Desai, Consultant Paediatric Cardiologist(Tel. No.: 0121 333 9459)