Newham Hospital

Updated in Dec 2020

Newham Hospital opened in 1983, providing centralised services for the population of Newham, replacing Queen Mary’s Hospital for the East End in Stratford and East Ham Memorial Hospital, both of which are closed. In 2012, Newham University Hospital NHS Trust merged with Barts, Royal London and Whipps Cross University Hospital NHS Trusts to form Barts Health NHS Trust. Newham hospital has just under 400 beds. The latest CQC rating was “requires improvement” overall, an improvement from the previous “inadequate“. It is said to be “good” in the domain of caring and “requires improvement” in effective, responsive and well led. The urgent and emergency services are rated “good” and the medical care services are rated “requires improvement”.

1 Respiratory trainee will be posted here (usually 1 year rotation) at each time. There are normally an Acute medical trainee doing a 6-month respiratory rotation here and 2 trust grade respiratory registrars working with the respiratory trainee.

Consultant speciality interests

• Dr T O’Shaughnessy (cancer, asthma, COPD)
• Dr N Jayasekera (TB)
• Dr V Macavei (Sleep and ventilation)
• Dr R McDermott (TB)
• Dr S Lloyd-Owen (Sleep and ventilation, cancer)

Dr Jayasekera and Dr McDermott rotate to cover the ward monthly.

Dr Macavei and Dr Lloyd-Owen rotate to cover the ward monthly.

Typical week for SpRs

	Mon	Tue	Wed	Thu	Fri
AM	Cons/SpR WR	Sleep clinic	SpR WR	Cons/SpR WR Gen resp clinic	Cons/SpR WR Gen resp clinic
Lunch	Weekly grand round				Dep. teaching
PM	Admin/Referrals TB clinic	Bronch list	Admin/ Referrals EBUS list	Local diag. MDT	Admin/Referrals

• The above timetable is for the respiratory trainee. The rota is organised by Dr Jayasekera. Due to the number of respiratory SpRs, it is quite easy to take leave and Dr Jayasekera is quite flexible and understanding to allow leaves. She would also offer to hold the SpR referral bleep if the trainee needed to take annual leave.
• Due to COVID-19, there is no dedicated SpR clinics at present. The SpR will do the above clinics when required to cover the consultant absences or as per trainee requirements.
• There are normally only a handful of referrals a day and this could normally be shared between the SpR colleagues.
• The respiratory trainee is allowed to attend all training days even with no SpR on the ward.
• There is a monthly M&M meeting.
• Respiratory clinics are all held at Shrewsbury Road Health Centre in East Ham (except for Dr Jayasekera’s Thursday am clinic which is held at Greenway Centre in the main hospital site). X-ray is available on-site in-hours at the Shrewsbury Road Health Centre.

Other optional clinic opportunities that you could join:

• Lung cancer
• Advanced COPD

Bronchoscopy

• Adequate experience in diagnostic bronchoscopy and endobronchial biopsy.
  • Tuesday afternoon list with Dr Jayasekera – up to 4 patients on the list.
  • Additionally, you could join Dr Macavei’s Thursday morning list depending on clinical commitments.
• The bronch list is normally attended by the respiratory trainee only unless the trust grade doctors would like to be involved as well.
• Dr Jayasekera is quite easy-going and will allow you to do bronchoscopy independently fairly quickly with her still being around in the endoscopy unit if required for help. Therefore, you can expect to achieve full independence at the end of the 1-year rotation
• EBUS with Dr McDermott every other Wednesday as an opportunity
• Suitable place to train in ST3

Estimated number of bronchoscopic procedures in 6 months per trainee: 30 – 40 (with 1 – 10 endobronchial/transbronchial biopsies)

Estimated number of EBUS/TBNA in 6 months per trainee: 0 – 10

Thoracic US and pleural procedures

• Dedicated Resp department portable US machine available 24/7.
• Dr Jayasekera is the level 2 competent Consultant in the Respiratory department to sign trainees off for level 1.
• There are occasional opportunities for medical talc pleurodesis.
• Pleural biopsies are done by radiology.
• Indwelling pleural catheter insertions are referred to Barts.

Estimated number of thoracic US in 6 months per trainee: 21 – 30

Estimated number of pleural aspirations in 6 months per trainee: 11 – 20

Estimated number of chest drain insertions in 6 months per trainee: 1 – 10

NIV/Sleep

• Adequate acute NIV and Optiflow/HFNC experience with adequate NIV/Optiflow machines and easy to initiate on the respiratory ward, ED and CCU. (No respiratory HDU here)
• Many cases with chronic respiratory failure requiring domiciliary NIV. These cases are then referred to Barts Sleep service.
• Overnight pulse oximetry available as part of sleep studies investigation.

Estimated number of adequate involvement in management/initiation of NIV in 6 months per trainee: 11 – 40

GIM

• On call frequency over a 12-week rota is as below:
  • 3 weekend nights and 4 weekday nights
  • 3 weekend long days and 4 weekday long days
• The on-call consists of:
  • Weekday Day: 2 long day SpRs (take and ward), 2 long day take SHOs, 1 twilight SHO (take/ward), 1 twilight F1 (take) and 2 long day F1s covering the wards.
  • Weekend Day: 2 long day SpRs (take and ward), 2 long day take SHOs, 2 long day ward SHOs, 2 long day ward F1s and 1 long day ward discharge F1 (discharge WR in the am, flexible in the pm)
  • Night: 2 night SpRs (take and ward) and 3 night SHOs (2 ward and 1 take)
• The Respiratory team tends to cover the Respiratory Consultants’ take (with mid-take by elderly care consultant team) on Wednesdays. Post take by the Respiratory team happens on Thursdays and 1 in 3 weekends. Patients from the respiratory take that are moved to medical wards are looked after by the the respective ward teams. Outliers from the respiratory take that are moved to non-medical wards (including those that are still in ED) are looked after by the respiratory team.
• There is now a new Acute Assessment Unit at St Andrew’s wing in the main hospital site. There is now an acute medical care team looking after all the patients in the unit (the post take team used to look after these patients).
• Rota gaps are thankfully rare and are well covered by locum.
• The acute take is well supported generally with a very good ED team.
• There are about 15 – 30 patients during the day and 10 – 15 patients at night on average. Pathology is variable and interesting due to the patient cohort in the area.
• You will probably have to manage cardiac arrests approximately 20% of your shifts.

GIM experience has been rated “good” by trainees here.

Teaching

• Simulation facilities
• Observed undergraduate teaching
• Contribution to PACES teaching

Management/leadership

• Rota organiser role available
• Encouraged to take on management projects and attend courses
• Management/governance meetings, lots of incident reporting with feedback, strongly encouraged and supported in service improvement projects

Quality improvement

• Consultants encourage trainees to get involved in QIP, audits and writing case reports.

Other services/specialist training opportunities

• Lung function – full lung function tests available
• TB – plenty of cases, including drug resistant TB, extrapulmonary and complex cases (in and outpatients)
• Lung cancer – some lung cancer experience with the presence of a very kind lung cancer specialist nurse
• Palliative care – helpful palliative care team that SpRs will get to know well

Trainees have reported inadequate experience in allergy, integrated care, pulmonary rehabilitation, ILD, CF, occupational/genetic/developmental lung disease and pulmonary hypertension.

Research

• No specific opportunities highlighted, but the department actively contribute to a number of Trust-wide research projects
• Encouraged to obtain Good Clinical Practice certificate

Stage of training best suited to this rotation

• ST3 – 4
  • good exposure to TB and airway diseases junior trainees
  • good place to learn bronchoscopy skills with the opportunity to gain independence
  • adequate pleural experience but no dedicated pleural clinic with limited consultant supervision
  • medical take load is mediocre so less burden on junior trainees who are trying to settle into the registrar role
• ST6 – 7
  • Dr Jayasekera will push senior trainees to get involve in management/service development
  • Opportunity to run your own bronchoscopy list with consultant nearby to help if required
  • Opportunities to step up on the ward and also post-take GIM patients with consultant supervision

 Recent trainee comments:

“A pleasant hospital with excellent clinical support from supervisors.”

“Lots of vital TB experience.”

“Ideal post for early respiratory trainee.”

“I really enjoyed working at Newham and gained a lot of general SpR experience whilst being well supported by the consultants.” 

“Would you recommend this post to other Respiratory SpRs? Yes, strongly agree.“

“Would you consider applying to work here as a Consultant? Yes, agree.“