Chester MP Stephen Mosley has swapped his suit for his scrubs

Here is his blog and video diary of his day.


By Stephen Mosley MP for Chester
4,000 - that’s how many meals are produced in the Countess of Chester Hospital’s kitchen every day.
And it was to the kitchens that I headed for the first morning of my week’s work experience at the Countess of Chester NHS Foundation Trust. I joined the 75 strong catering team, to make the lunchtime meal for the 650 inpatients, the staff restaurant and sandwiches for the Coffee Shop, as well as providing meals for Ellesmere Port Hospital and the Bowmere Hospital.
And unusually for a hospital, each meal is produced in-house by chefs from the raw ingredients, with every patient’s meals individually catered for and portioned up on the kitchen’s conveyor belt by the hardworking kitchen staff.
Every patient fills in an order sheet every evening – for Monday lunch time the choice was beef and vegetable casserole, fisherman’s bake, veggie sausage, ham salad or soup and sandwiches. Followed by apple pie or mixed fruit with custard, rice pudding, ice cream, jelly, yoghurt or cheese and biscuits.
After the meals had been served and sent to the wards, there was no let up. The equipment needed cleaning, and before we know it the empty trays start returning and into the industrial dishwashers. Then the clean trays, dishes and cutlery needed sorting ready for the evening meal.
There was just time for me to have a bowl of the delicious beef casserole before heading over to pathology, to see the work of the blood services, cellular pathology and blood transfusion teams.
Again, the scale of the operation comes as a surprise. The blood services team test over 2,000 samples a day, with each sample receiving, on average, nine separate tests. The blood services lab was more like a high-tech automated production line rather than a hospital, with hundreds of blood samples arriving from GPs and hospital doctors every hour.
The blood services team are proud of their record, with over 90 per cent of blood tests being completed within an hour and almost all tests completed within two hours.
Next I was off to the Cellular Pathology Lab, which was more how I imagined a hospital lab to be.
Samples of tissue, fluids and cells are fastened in wax overnight, before being sliced, mounted on microscope slides and dyed before examination under a microscope. The process is extremely time consuming and manpower intensive, with cytology (testing of cells) and histology (testing of tissue) taking several days to complete.
Then it was a visit to the consultant, to examine the slides under a microscope and analyse the results.
With time running out, we finally visited the Blood Transfusion department and saw their testing and blood storage facilities. Yet again there was no escape from high technology, with a brand new biometric identification system for verifying fingerprints being used to allow nursing staff to check out blood supplies for use in transfusions, removing any fear of human error mistakes.
Thank you to Mike Phelan, Craig Hough, Steve Marshall, Alan Shaw and all their teams for making my first day so interesting and informative.
Tomorrow (Tuesday) I will be in the Day Surgery in the morning and then join the Cleaning Staff in the afternoon.

Day 3 at the Countess of Chester Video Blog

I started my third day’s work experience with some of the Countess of Chester’s 320 domestic staff, seeing at firsthand the frontline of the battle to prevent hospital superbugs.

It is easy for CDIF, MRSA or even the winter vomiting bug to spread in the confined space of a busy general hospital, and the only way to combat them is through a fixation on cleanliness. What was immediately noticeable was the pride that the domestic staff have in the hospital. They’re proud of the shining floors, they’re proud of their successful record in preventing infections, and they’re even proud that the hospital doesn’t smell like a hospital (down to the non-smelly disinfectants they use apparently).

First I joined the linen team handling the thousands of clean sheets, pillowcases and gowns that the hospital uses everyday, followed by a visit to the Decontamination Unit. It is in the Decontamination Unit that all standard hospital equipment, ranging from mattresses to Baxter pumps, gets thoroughly cleaned.

After every patient, the hospital’s air mattresses are taken downstairs to the decontamination unit, disassembled and thoroughly cleaned inside and out.

I then joined one of the stars of the domestic team, Pat, in the front window of the hospital – the A&E Department.

In A&E you see everything – just before I arrived Pat had had to clean up urine from one of the waiting rooms. Things were more pleasant when I was there, the Plaster Room was covered in plaster of paris after a cast had been fitted to a patient. Thankfully I saw no sign of one of the worst dangers that a cleaner faces in the hospital – a needle sticking out of a rubbish bag.

But there can be lighter hearted moments as well. Just last week a bat got into the microbiology lab, and after much screaming and a phonecall to the Bat Conservation Society, a volunteer “bat lady” arrived to help capture the bat and release it safely back into the wild.

My afternoon was with the hospital’s Transformation Team, tasked with delivering “the Countess Way” and, using LEAN techniques, improve standards and value for money. After I met the team I was dispatched to the Cardio Department Medical Secretaries office to construct a spaghetti diagram of their activity.

I took an opportunity to learn about medical records (and learn that after spending some £20 billion on the NHS National Computer System, it doesn’t work).

I also learnt about the Cardio department’s successful trial of “e-clinics”, allowing GPs to email questions to the Cardio Consultants and hopefully reduce the number of referrals GPs need to make to the hospital.

Next it was off to the Operating Theatres, to discuss changes to the measurement sheets the Operating Theatre staff use to measure performance and highlight improvements. Great I thought when I saw that one of the Theatres had a utilisation rate of over 100%. Not good I was told, apparently this would mean a lack of emergency capacity and that staff would need time off in lieu, resulting in cancelled appointments and operations in future days. A theatre usage rate of 77% is thought optimal, meaning that there is capacity for extra emergency operations if they are required.

Then it was off to Ward 51, for a spot check of their Communications Cell. The Ward gained a 100% score, with a visible improvement in one of their key measurements – the number of falls that occur on the Ward. When falls occur they are publicly recorded along with the location, cause and whether they could have been avoided. Action can then be taken to try and prevent similar incidents in the future, and the approach seems to be working.

Lastly it was back to the office and a discussion on DNAs (Do Not Attends). Around 29,000 patients fail to attend their appointments at the Countess every year, costing the hospital millions and blocking appointments that could be used by others.

At around 8.5%, this is lower than the national average, but still way below the best performing hospital, Sheffield, where it is around 2%. By reducing DNAs the Countess can reduce costs, protect jobs and allow more patients to be treated. I implore everyone in Chester to make sure that if you can’t make an appointment, let the hospital know so they can make sure that someone else is seen instead.

Joining the nursing staff on the fourth day of my visit to the Countess of Chester

Waiting to begin my fourth day at the Countess I bumped into Sir James Sharples, the Chairman of the Countess of Chester NHS Foundation Trust and former Chief Constable of Merseyside Police. For the first time during my visit I spoke to one of the Senior Management and (as well as getting his views of the recent disturbances) discussed how the hospital is progressing at the halfway point of the hospital’s 3 year cost saving program to reduce costs by £7million a year. But I was NOT at the Countess to chat with senior management, so I quickly joined Sian Williams, Head of Nursing, and started my day with the Countess’ nursing team.

We headed down to Accident & Emergency, where we met Jane Evans who proudly showed me round the department. The majors area, the minors area, the 22 bed Emergency Assessment Unit and the reception area.

Chester’s A&E department deals with an average of just under 200 patients a day, some 70,000 a year in a unit originally built for 35,000. The department is currently coming to the end of major building work to extend their space and the tour included the soon to be opened extension to the majors area.

Next stop was the A&E Consultants meeting, where the discussion was on the Hospital’s bid to gain Trauma Unit Status. According to the Trauma Audit & Research Network, the Countess has one of the best records in the country on treating trauma patients and gaining Trauma Unit Status will improve things further.

Next I joined the hospital’s nursing staff in their Weekly Access Meeting, which reviewed the previous weeks’ activities and looked at forthcoming activities.

Although it’s the middle of summer, winter planning was top of the agenda. Last year there were huge strains on the NHS, with icy weather, influenza and bird flu, followed by the Winter Vomiting bug stretching capacity to the maximum.

The nurses and hospital are determined that things will be different this year – normally there are 5 extra care beds available, this will increase to 6 in November and 27 in December, with the extra beds being available for at least 3 months.

Then it was the midday beds meeting. The beds meeting occurs 3 times a day and monitors the availability of hospital beds and staffing levels. There are a number of patients requiring extra care in the hospital, so approval is granted to take on some agency staff over the weekend.

Next I joined the team in ”Majors” (major injuries), which left me admiring the professionalism and teamwork that exists in our NHS and appreciating the difficult job that hospital medical staff face on a daily basis.

I joined the hospital’s two Matrons for lunch and afterwards Matron Clare Williams took me to the Acute Coronary Ward to see life on a ward from the nurses’ perspective. It was a busy day on the ward as several patients had been transferred to Broad Green in Liverpool, each one required constant specialist care in the ambulance leaving more work for the nurses left behind in the ward.

To finish off it was back to A&E to join the Nurse Practitioner in the “Minors” (minor injuries) Assessment room. Some patients were referred to X-ray and physiotherapy, whilst others had wounds cleaned and dealt with on the spot.

Meanwhile a couple of policemen were dealing with a Section 136 patient, waiting for a specialist psychiatric assessment. Hundreds of hours of police time are taken up every month dealing with patients requiring mental health care. With both the police officers and NHS staff telling me that the current system isn’t working, it highlights a concern that I will take up with the Minister.

Word of my visit has gone round the hospital, and as well as the “official day”, I have received requests from other people to visit – today it was a meeting with Medical Director, Dr Clough, discussing Tier 2 Immigration Visas for mid-level doctors, medical training and the proposed Primary Care Centre at Delamere Street. I also joined Dr Ewins in the Diabetes Department, met his team and learnt about how they are working with Chester GPs to deliver Shared Care for diabetes patients. This allows the hospital team to look after complicated cases and GPs to look after people closer to home.

With the recall of Parliament on Thursday, I was only able to do four days of my week’s work experience, and I have promised to do my final day in September. I’ve also promised to add a meeting with the Trade Unions to my diary.

Thank you to everyone who has been involved in arranging and supporting my week at the Countess. It has given me an insight into the amazing work that goes on in a hospital and on many occasions been a real eye-opener. Thank you.