The Harley Street Clinic

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1 The Harley Street Clinic Focusing on our comprehensive Paediatric Oncology Service Dr Stergios Zacharoulis Consultant Paediatric Oncologist Non-malignant haematology Dr Josu De La Fuente The London Neurosurgery partnership Mr Sanj Bassi & Mr Chris Chandler Spinal surgery for scoliosis Professor Hilali Noordeen ISSUE NO. 2

2 Welcome to the 2nd Edition of The Harley Street Clinic Specialist the healthcare magazine aimed at both medical professionals and the knowledgeable general public. In this edition we place the spotlight on our outstanding paediatric consultants, staff, services and treatments. I have often been told that our children s services are Harley Street s hidden gem. In 2013 we started to take the hidden word out by launching The Harley Street Clinic Children s Hospital. This brought together all of our paediatric consultants and services under one distinct brand. The Children s Hospital s services culminated in the opening of the Outpatient Centre at 84 Harley Street. So we now offer everything from consultations, diagnostics, day care, inpatients, intensive care and even bone marrow transplantation on the same campus. You can find out more at The content of this edition aims to reveal the diversity, the originality and the complexity of how we operate. No longer should the gem be hidden. I hope you find the magazine both interesting and enjoyable. Aida Yousefi CEO Contents Aida Yousefi Chief Exectutive Officer 04 Welcome to The Harley Street Clinic Children s Hospital 06 Chain of Hope The Harley Street Clinic provides vital link 08 The London Neurosurgery Partnership Chris Chandler and Sanj Bassi 10 An interview with Consultant Paediatric Oncologist Stergios Zacharoulis 12 Life changing options in NON-MALIGNANT HAEMATology Josu de la Fuente 14 Infographic The Children's Hospital in numbers 16 MEET MR SIMON clarke Clinical Lead of London s first Children s Hernia Centre 18 Successfully managing Chest wall deformities Amulya Saxena 20 creating a truly special place A welcoming team and a well-designed environment 22 Spinal surgery for scoliosis Hilali Noordeen 24 PLAY, ART AND MUSIC THERAPY Supporting children to be children 26 The Children s Hospital CAMPUS MAP 02

3 Paediatric Intensive Care Welcome to The Harley Street Clinic Children s Hospital Bringing together a multi-disciplinary team of world class paediatric consultants and nursing/medical staff in cancer, cardiac care, neurosurgery, specialist surgery and general medicine. The facilities that combine to make the Children s Hospital one of the most vibrant and innovative specialist centres in Europe include: 1 3 bed Paediatric Intensive Care Unit (PICU) with its 40 year history of clinical excellence, the PICU is, we understand to be the biggest such private facility in Europe 5 bed step down High Dependency Unit ensuring suitable levels of care prior to discharge to the ward 1 8 bed inpatient ward dedicated to children, including inside and outside play areas 5 bed surgical day care ward C omfortable and child-friendly Chemotherapy Day Unit staffed by dedicated nursing staff P urpose-built paediatric haemato-oncology unit offering bone marrow and stem cell transplantation 04 O utpatient department offering a comprehensive range of treatments and diagnostic services including MRI, CT, Digital X-Ray, Ultrasound, Bone Densitometry and Dental scans. Paediatric Ward 84 Harley Street Outpatients Centre Working together, we operate under a model of family centred care, which includes parents and siblings as well as the care of the patient at every step. The patient is not simply handed over to us but we work with parents and guardians, making joint decisions as part of a wider team of supportive professionals.

4 From War-TOrn SyrIA to TurKEY and THEN to LONDON The Harley Street Clinic provides vital link for The Chain of Hope Janshir s story Mr Victor Tsang Paediatric Cardiac Surgeon treating a patient in Jamaica The Harley Street Clinic has developed positive links with a number of charities over the years both aimed at adults and children. One charity which the Hospital has had very close links with is Chain of Hope a children s charity which carries out vital heart surgery on children from developing and war-torn countries. It is a little known fact that 1 child in every 100 is born with a heart defect. Most of these can be corrected as a matter of routine in the developed world. In contrast, if uncorrected these defects can cause considerable suffering and premature death. This afflicts a massive number of children around the world. Chain of Hope has put together teams and frameworks to enable treatment of as many of these children as possible. This is often undertaken in-country using both local doctors and nurses together with UK and other European Consultant specialists who give their time freely. For some cases, the patient needs to be flown to a specialist children s hospital and The Harley Street Clinic has been proud to help when needed. Emma Scanlan, Chief Executive Officer at Chain of Hope, is extremely appreciative of the support the charity receives both from The Harley Street Clinic and the surgeons who operate here. She says, Over 30 operations have been performed during the last 5 years at the Hospital through world renowned paediatric cardiac surgeons Professor Marc De Leval, Mr Victor Tsang, Mr Martin Kostolny, and Mr Oliver Ghez and cardiologists Professor John Deanfield and Dr Robert Yates. The backing that the Hospital and the specialists have given has offered new hope to young children who can now look forward to the rest of their lives. We are delighted to be able to offer children the highest level of quality of care The Harley Street Clinic delivers. Dr Martin Kostolony Paediatric Cardiac Surgeon with Janshir at The Harley Street Clinic Chain of Hope brought the case of 8 year old Janshir to the attention of The Harley Street Clinic and Paediatric Cardiac Surgeon Mr Martin Kostolny. Little Janshir had a condition known as Tetralogy of Fallot which if not treated would have severely restricted both his life span and quality of life in the meantime. Not only that, Janshir s recent life had been traumatic as his family had to flee war-torn Syria where their home had been destroyed and then fled via tented camps to Turkey. Janshir s father was even imprisoned for 25 days and tortured. A relative put them in touch with Chain of Hope who flew him to London and The Harley Street Clinic for life-saving treatment. The operation involved patching up a huge hole in his heart, widening a crucial vessel taking blood out of the heart and correcting a narrow valve. Neither the Consultant nor the Clinic charged fees for this. Janshir has now been discharged the operation having been a success, and it is hoped that he continues to enjoy his music and seeing his football team Barcelona play. 06

5 THE best from both HEALTHCAre sectors The London Neurosurgery Partnership The London Neurosurgery Partnership, originally eight neurosurgeons who had worked together as NHS consultants at King s College Hospital, London, was founded three years ago to provide a complete multi-disciplinary 24/7 neurosurgical service covering all the disciplines and sub-specialities at The Harley Street Clinic Children s Hospital. The idea, explains one of the founders, Mr Chris Chandler, Consultant Neurosurgeon, was to translate best practice from the NHS into the private sector; to provide what he describes as a blue ribbon service whereby patients, no matter what kind of neurosurgical problem they had, could make one phone call and know they would be seen by the right neurosurgeon. For five years before the formation of the partnership, the practice was run singlehandedly by Consultant Neurosurgeon Mr Sanj Bassi. It was incredibly busy, and impossible for one consultant to specialise in every area, so I brought in support from a number of colleagues with complementary skills, he explains. The formation of The London Neurosurgery Partnership was a natural progression. We already worked well as a group in the NHS at King s College Hospital and I wanted our team to replicate this expertise in the private sector, says Sanj. Historically, surgeons in private practice might take on a number of cases in areas they were less familiar with. Sanj explains, By joining together in the private sector, there is no professional or financial competition, meaning consultants are not tempted to take on cases to bring in more business for themselves. The end result is that within the partnership each patient ends up with the right specialists and being able to ask your colleagues for a second opinion is also invaluable. Although patients are initially referred to the most appropriate consultant for their condition, they often receive a consensus opinion from the group who meet regularly to discuss each patient s progress. Chris explains, Our idea was to work as one unit, so that we could make sure each child saw the consultants who specialised in their condition. We aimed to take the best that the NHS and the private sector could offer and marry them together. It s that co-dependency and the close working relationship that we already had in the NHS which we have brought to the Children s Hospital. The group chose The Harley Street Clinic Children s Hospital to provide paediatric neurosurgery care as the Hospital already had the expertise in treating complex cardiac conditions which has ensured that the Paediatric Intensive Care Unit and high dependency care is second to none. Sanj explains, Drawing in more paediatricians with special skills allows the hospital to cement what they already have and now includes complex care not only for cardiac but for cancer and neurosurgery. He adds We deal with the most complex brain and spinal tumours from all over the world and this is possibly because of the multi-disciplinary support we have from colleagues in other departments including paediatrics and intensive care. The group not only has access to outstanding facilities at the Children s Hospital but are supported by an exceptional team. Our specialist staff include dedicated teams of children s nurses, resident medical officers, a top class theatre team, and every other service we need across the board. For me there is really no other private hospital that can offer that kind of service. He adds, You wouldn t even be able to find this level of service in an NHS children s hospital, so from my perspective it can t be bettered as a place to manage brain tumours in children. The London Neurosurgery Partnership sees patients from tiny babies to young adults, and between the 11 consultants covers the full range of paediatric problems with subspecialities including complex spinal work; vascular surgery; the management of hydrocephalus; treatment of complex skull based tumours; pituitary surgery; functional and epilepsy surgery; trauma of the head and spine; and brain haemorrhages. As well as offering one of the busiest private brain and spine tumour services in London for both primary and secondary tumours, consultants in the partnership see a diverse group of adult patients that include those with degenerative spinal conditions; disc prolapses; fractures of the spine; and spinal tumours. Chris explains, We are expanding our portfolio of advanced brain tumour surgery techniques; we are already at the cutting edge of neurooncology service delivery, with a whole range of new techniques that improve survival for patients with all types of brain tumours. Patients may be referred by their GP but also by physiotherapists, osteopaths, chiropractors, and pain specialists and other consultants. It s really important to communicate with others in the wider team to involve all the different elements needed to offer the best treatment, which might not always be surgical, explains Chris. It s about being a coordinator, making sure all the different people involved in their management are informed and involved in the decision making process so they are truly getting the best service. That is what our partnership is about, and it s great to work with such a dedicated cohort of diverse individuals, all at the top of their game. Chris further adds, An added bonus is that the people I work with at the hospital are the same as those I work with every day in the NHS so there is a seamless transition between the two sectors, which plays to all our strengths. Mr Sanj Bassi Consultant Neurosurgeon Mr Chris Chandler Consultant Neurosurgeon 08

6 An interview with Consultant Paediatric Oncologist Stergios Zacharoulis Dr Stergios Zacharoulis graduated from the Aristotelis School of Medicine, Thessaloniki, Greece. Later he moved to the USA where he undertook further training and became a certified Paediatrician and Paediatric Oncologist. He joined the staff at The Harley Street Clinic Children s Hospital five years ago. The Specialist interviewed him earlier this month between appointments. Why did you choose to practise at The Harley Street Clinic Children s Hospital? It s the only paediatric oncology service in the private sector that is comprehensive, so there was already the infrastructure to provide the type of service we needed. What makes the service unique? There is nothing like it in the private sector anywhere else in London. Paediatric oncology is a speciality that epitomises the need for a multi-disciplinary team in almost every paediatric service so that we can provide essential complex care for these children. At The Harley Street Clinic Children s Hospital we not only have leading oncology experts and the latest equipment, we also have experts in every other speciality under one roof so we can offer a comprehensive service. Where do patients come from? Mostly from overseas. We have patients from all over the world including the UK, but they primarily come from the Middle East, Russia, and Greece. What are the latest developments in treating solid tumours? We have an excellent new service that provides autologous bone marrow transplantation the only private centre of its kind in London and we are also the only centre that provides immunotherapy for children with solid tumours. Our department is also at the forefront of personalising treatment for children with brain and solid tumours because we are able, with our infrastructure, to characterise more accurately all the tumours we see, allowing us to identify targetable mutations in the tumour with medications that are effective. We don t treat every patient with the same tumour in the same way; we individualise treatment based on the molecular profile using new drugs that show promise. What changes have occurred in your team over the last few years? As well as the personalisation of treatment, we now have subspecialists with expertise in specific tumours. We also have regular multidisciplinary team meetings with neurosurgeons from The London Neurosurgery Partnership. What do you enjoy most about your work? Working in paediatric oncology means that there is never an easy day and there are always families who are going to receive bad news. But equally, we are fighting together with the families and there is nothing like the feeling you get when a child s cancer is in remission. That s what gives us the strength to continue the war against cancer. Dr Stergios Zacharoulis Consultant Paediatric Oncologist What conditions do you treat? Children with all kinds of solid tumours often have very complex paediatric cancers. These include patients with metastatic tumours, relapses, and complex brain tumours that require an ongoing multi-disciplinary approach from specialists including neurosurgeons, neurooncologists, neurologists, and all the support services. What other new services do you offer? As well as autologous bone marrow transplantation and immunotherapy, for the last two years we have established a pathway to new drug therapies that are not yet widely available. What are your plans for the service? We are expanding rapidly, with more consultants coming on board. We will be staying at the frontline of innovation with an expansion of the bone marrow transplantation service, introducing more new drugs that are showing benefits for example, biological modifiers and we are also planning to expand immunotherapy and include allogeneic bone marrow transplantation as part of our service. 10

7 Life changing options in Non-malignant haematology Many people, when they think of haematology, associate it with the diagnosis and treatment of leukaemia, a condition already well supported by leading experts at The Harley Street Clinic Children s Hospital. However, what they may not realise is that there are also many non-malignant haematological problems that affect children, many of which have previously been difficult to recognise, diagnose and treat. Consultant Josu de la Fuente, who is at the forefront of research and treatment for non-malignant paediatric haematology, explains, We are trying to bring the same level of care as leukaemia for all those conditions of the blood which are not related to cancer, but are far more common and can reduce the quality of life and the functioning of a child to exactly the same level. Patients come from all over the world, and they choose to see Josu largely because of his international reputation in the field of nonmalignant haematology. We always associate blood clots with women who are taking the pill, but there are rare situations in childhood where children form clots and need help with anticoagulation. He has also built the largest cohort of patients worldwide who suffer from rare Diamond- Blackfan Anaemia (DBA), and he has achieved the most successful number of bone marrow transplants for those who cannot produce blood and do not have a close match within their families. Blood conditions can have a serious impact on a child s quality of life, draining energy, affecting concentration at school, and causing repeated infections. Not only does this affect a child s wellbeing and family life, it can also impact on their education. However, Josu explains, because there is so little understanding of these conditions, people often accept the symptoms as the norm or think that they will be too complex to treat, whereas the reverse is true: it is usually possible to pinpoint the condition and provide effective treatment that will control (or remove) symptoms. And, while Josu often sees patients referred by consultants from other countries, many children in the UK have serious problems but are never referred because of a lack of understanding of their condition. This is despite the fact that advances in the understanding of genetics and how blood is produced mean that it is usually possible to diagnose and treat even the most complex problems, so there is no reason why a child who has a rare type of blood disorder cannot live a normal life in the same way as those who have more easily recognisable disorders. Conditions that Josu treats include those in which children do not produce the right amount of blood, or where the blood doesn t work well; this can be because they have been born with problems or because they have acquired a condition during childhood. Other conditions include excessive bleeding or bruising, immune thrombocytopenia (where the platelets have been destroyed by antibodies) and the more common Von Willebrand Disease (VWD). More rarely, Josu treats children who have blood clots: We always associate blood clots with women who are taking the pill, but there are rare situations in childhood where children form clots and need help with anticoagulation, he explains. Many of Josu s patients have some form of anaemia, which can be caused by a number of factors: a child may not have the necessary nutrients to produce healthy blood, may produce the wrong forms of haemoglobin, or have a fundamental problem with the bone marrow, where it is unable to produce healthy blood; in other cases, the immune system may not be functioning correctly, causing it to interfere with blood production. If you need to refer a patient to Josu please contact his PA: Tel: or pa.delafuente@hca healthcare.co.uk Dr Josu De La Fuente Consultant Paediatric Haematologist 12

8 The Harley Street Clinic Children s Hospital 13 bed 18 bed 5 bed 84 H a r L E Y StrEET our CHILDrEN s HOSPITAL OUTPATIENT CENTre includes: Twelve Consulting rooms Two treatment rooms the largest private PICU in EurOPE Main Ward High DEPENDENCY UNIT Specialities Consultants Dedicated Paediatric Staff 45 21,115 3,195 4 Bespoke ChemotherAPY Chairs 5 Be d Su rgic A L DAY Care Ward Beds Hospital Paediatric Outpatient visitors in the last 4 years Paediatric operations performed in the last 5 years Hours a day days a year more day every Leap Year! 4 be D H A E M ATO - ONC OL O g y UNIT Sir Magdi Yacoub and Jaroslav Stark start Paediatric Cardiac Surgery at The Harley Street Clinic Prof Marc De Leval joins the team in 1977 and the speciality goes from strength to strength Started offering Paediatric Cancer services People from 137 countries throughout the world have visited the Children s Hospital website over the last year. Started offering Paediatric Neurosurgery services Paediatric Intensive Care Unit completely refurbished 137 The Outpatient Centre opens at 84 Harley Street

9 T he Specialist interviewed Mr Simon Clarke, a Consultant Paediatric and Neonatal Surgeon, about his recent trip to Ecuador, where he worked as a volunteer with Hernia International (herniainternational.org.uk), and his role as the new Clinical Lead at the Children s Hernia Centre. According to the charity Hernia International, inguinal hernia is the most common treatable surgical condition worldwide. However, as it s estimated that one billion people have little or no access to healthcare services, the usually straightforward operation needed to repair this type of hernia is performed much less frequently than needed. The result is that neglected hernias cause mortality (from strangulation) and physical incapacity. Simon was a member of a combined UK-US-Czech volunteer medical team that went to Ecuador during September last year, a country where there is little funding to accommodate elective surgery. As Simon explains, We fly out as a group of surgeons from different continents and provide elective surgery for a week or two at a time. This is because these countries are so busy dealing with emergencies that they don t have time for the more simple stuff that we take for granted in Europe. In Ecuador children and adults can wait several years for surgery and, as a result, are in a lot of pain. The Harley Street Clinic has been very generous helping the charity for the past couple of years last year in Cambodia. Closer to home, Simon has worked at The Harley Street Children s Hospital for some four years, having been encouraged by other colleagues at the hospital to join. And he has not looked back. Today Simon s patients are drawn from London and the rest of the UK, the Middle East, and the USA. In view of his experience, as well as his international work, Simon organised an interested group of paediatric surgeons to launch the Children s Hernia Centre at The Harley Street Children s Hospital and to develop this as London s first specialist centre for children s hernia. He explains, Hernias in children are different to those in adults and operations on very small children/babies can be complex, requiring extensive specialist paediatric training. A team of five consultants now practise at the Centre: four paediatric surgeons, Mr Simon Clarke, Mr Bruce Okoye, Mr Eric Nicholls, and Dr Steffano Giuliani. Dr Aubrey Bristow is the team s specialist paediatric anaesthetist. Each consultant has performed more than 500 hernia operations on children (the minimum required to join the team) and has demonstrated excellent patient outcomes through an annual appraisal process. The team are also now able to offer the latest in advanced minimal access surgical procedures that can be performed on premature babies as well as adolescents. Simon and the team commonly treat four types of hernia at the Centre: inguinal, umbilical, epigastric and incisional. Like many of the specialists who work at the hospital, Simon says he loves his work, It s incredibly satisfying to see a family that is initially very troubled and fearful about their child s problems leave our hospital reassured, having received the highest standard of care. The job we do is an extremely privileged one. Children are a great joy to work with and are some of the most honest people you will ever meet in life! If you need to refer a patient with a suspected hernia please contact the GP Liaison Team at The Harley Street Clinic on: or childrensherniacentre@ hcahealthcare.co.uk Mr Simon Clarke Consultant Paediatric Haematologist Meet Mr Simon Clarke Clinical Lead of London s first Children s Hernia Centre 16

10 Successfully managing Chest wall deformities in the paediatric population Consultant Paediatric Surgeon Professor Amulya Saxena is part of the team at The Harley Street Clinic Children s Hospital that specialises in the management of chest wall deformities. Typically more common in the Caucasian population, chest deformities vary in severity from mild (where they may require monitoring over several years, but without treatment) to severe (where they may need open surgical correction). Referrals are often based on Amulya s global reputation in the field of chest wall conditions. He trained at the Medical University of Munster, in Germany, which has published the world s largest series about pectus repairs in the Journal of Thoracic and Cardiovascular Surgery. Having published extensively in peer reviewed journals himself, Amulya has also pioneered techniques and instruments specifically for paediatric applications in minimally access surgery. Professor Amulya Saxena Consultant Paediatric Surgeon The most common chest wall deformity we see is funnel chest or pectus excavatum, which is present in around one in every 400 white male births, explains Amulya. This type of congenital abnormality, with a 3:1 male to female ratio, can occur spontaneously, be linked with a familial history, or is sometimes associated with syndromes such as Marfan s or Ehlers-Danlos syndrome, with most cases recognised within the first two years of life or later in school aged children. The other common type of deformity (five times less common than funnel chest) and affecting around 10-15% of Amulya s patients, is pigeon chest or pectus carinatum, where the sternum is raised and the chest protrudes. Although pigeon chest can be diagnosed in early childhood, it is more usually recognised a little later, between the ages of 9 and 12, explains Amulya. Patients with this type of deformity can suffer from asthma, and it can also be associated with Marfan s syndrome and/or other syndromes. Along with funnel chest and pigeon chest, Amulya also sees a number of patients where there is a mix of deformities; these include combinations of funnel and pigeon chest, as well as patients with Poland s syndrome. Where a deformity is minor, and the body grows close to normal contours, there is often no need for any treatment. However, Amulya explains, With these children, it s important to observe and monitor them throughout their growing years, so that if there is a significant increase in deformity with a growth spurt, we can recognise this early and offer appropriate treatment. For children with funnel or pigeon chest with moderate deformities, Amulya and his team offer conservative treatment using mechanical devices such as suction devices and orthotic braces to correct the problem. The devices are typically worn for between six months and a year to restore the normal chest contours. However, success in such treatments depends on early referral and a pliable chest wall that can be remodelled, explains Amulya. Where there are more severe deformities, patients are usually offered a minimal access surgery procedure or thoracoscopic repair in which the deformity is corrected using a metal bar to correct the chest wall. However, in the most complex or severe cases, where there is a combination of deformities, open surgical procedures such as the PLIER technique (Pectus Less Invasive Extrapleural Repair), which was developed by Amulya and has significantly better outcomes than traditional open surgical procedures, may be necessary to correct the deformity. Amulya chose to practise at The Harley Street Children s Hospital because of the backup that is readily available in terms of paediatric intensive care and the staff s experience of complex cardiac/thoracic surgery. Specialist training means that my colleagues are already experts in the care of patients following thoracic surgery, and there is a multi-disciplinary team of experts in all the areas of support that they may need, he explains. As well as pleasant surroundings, the hospital also offers a very up-to-date infrastructure for my patients, who come from the UK, Europe and the Middle East. Options that have only been available during the past few years have revolutionised the treatment of chest wall deformities. During my training, I learned to perform radical open surgery to correct these deformities but nowadays the management of mild and moderate deformities has changed to enable them to be treated much more conservatively using suction devices, orthotic braces and minimal access treatments, says Amulya. Amulya s ambitious plans for the future include using his experience (of over 20 years) in treating chest wall deformities to develop the hospital s service so that it becomes one of the best state-of-the-art centres in the UK. Chest wall deformity surgery is also offered by Mr Nagarajan Muthialu. 18

11 A welcoming team and a well-designed environment create a truly special place A complete refurbishment of The Harley Street Clinic Children s Hospital s inpatient first floor Paediatric Ward and Georgian building Outpatient Centre at 84 Harley Street brings together our paediatric services at the Children s Hospital. Bright colours, bold artwork and homely furnishings have given our designers the perfect opportunity to provide a friendly space for children and their families. Simple sympathetic adaptations, taking into account the size of our young patients, including lower walls around the cubicles in our dedicated paediatric Oncology Day Care Centre and scaled down beds in both our Paediatric Bone Marrow Transplant Unit and wards all help to provide a welcoming environment. The bespoke environment supports our diverse, multi-disciplinary team (MDT) of dedicated paediatric support staff who ensure that each family s experience in both inpatients and outpatients is as relaxed and stress free as possible. Helder de Quintal, Associate Specialist in Paediatric Services and Clinical Lead for the paediatric resident medical officers, explains: I see patients daily, admitting them onto the ward and coordinating their medical care. I am effectively the eyes and ears of the consultants in their absence. Helder liaises with the consultants and communicates care plans to the rest of the MDT that he leads; this includes physiotherapists, dietitians, clinical psychologists, play therapists and pharmacists. Many patients are from overseas. It can be difficult for them to adjust to being in London and understanding how the paediatric service works, explains Helder. We are the first people they meet so it s important to listen and communicate so we can coordinate their care. There are differences in culture as well as language barriers, but we have interpreters who work alongside us. We want parents to feel involved with their child s treatment and be able to ask questions. Paediatric Matron, Libby Basson manages the nursing team caring for paediatric inpatients in intensive care and the high dependency unit, as well as the paediatric ward and paediatric surgical day unit. The care is complex because we work in many different areas including cardiac, oncology, spinal surgery and general cases. Nurses can become skilled in many specialities, so it s a great opportunity for career progression, she explains. Libby has also been involved in the recruitment and management of nurses, liaising with consultants, and bringing different services together, as well as building new services in paediatrics. The team has also developed a comprehensive discharge programme, informing and supporting parents so they are confident in caring for their children s needs when they take them home. Left to right Branislav Topalovic Modern Matron of Outpatient Services David Swarc Senior Charge Nurse Branislav Topalovic, Modern Matron of Outpatient Services, has worked at the hospital for over 10 years, managing a team of over 45 staff across both paediatric and adult services. As well as offering dedicated clinics, including cardiology, neurology and orthopaedics, the new Children s Hospital Outpatient Centre gives children and their families access to allied health services including dietitians, nurse-led assessment clinics and a pharmacy dispensary. Procedures including noninvasive cardiac and allergy testing can also be carried out on site. Looking to the future, Branislav and his team are keen to continue in expanding the services offered, but he stresses, The Hospital exemplifies everything I was taught during my nursing training, to provide both the best facilities and staff. Whether our patients go on to be admitted as an inpatient or are given a clean bill of health following their consultation and assessment, the Outpatient Centre is a special place for our patients and their families to begin their journey towards getting better. Working alongside Branislav is David Swarc, Senior Charge Nurse, at the Outpatient Centre who is using his eight years experience gained working with inpatients to develop services to support Helder, Libby and their team: We are aiming to work more closely with the inpatients team to ease the patient journey and complement inpatient services, he explains. This includes expanding our services to develop pre-admission clinics and, post-discharge, following up patients to support their continued care. It s a joy to work with each child to create a bond and support them and their families, to help them feel calm and welcome. Libby Basson Paediatric Matron Helder de Quintal Associate Specialist in Paediatric Services 20

12 Spinal surgery for scoliosis: new cutting edge technology that s less invasive Professor Hilali Noordeen is a consultant orthopaedic and spinal surgeon who specialises in carrying out scoliosis surgery to correct children s spinal deformities. Although not exclusively a childhood condition (seven in every 10 older adults are affected) scoliosis affects as many as three to four children in every 1,000 in the UK ( NHS Choices). A consultant for over 20 years, 15 of them at The Harley Street Clinic, Hilali is at the forefront of a revolutionary new treatment for children with early onset scoliosis (EOS), a side-to-side spinal curve usually diagnosed before the age of 10 (or later, depending on skeletal maturity). The procedure involves implanting adjustable magnetic growth rods that can be lengthened remotely without the need for further surgery as the child grows. Why did you choose to practise at The Harley Street Clinic Children s Hospital? The hospital has, without question, the best paediatric intensive care facilities in the country, as well as a fantastic multi-disciplinary team of clinicians on hand, both on the ward and in the paediatric intensive care unit. What makes the hospital particularly appropriate for children with spinal deformity? Many children who have spinal deformity also have other conditions so having a multi-disciplinary team of paediatric specialists including cardiologists, cardiac surgeons, gastroenterologists and neurologists together in one place is a massive advantage. Importantly, all the imaging facilities are available on-site 24 hours a day, meaning that we can treat even the most complex cases at the hospital. What is a typical patient pathway? We see around 20 patients a week who have been referred by their GP or other specialists. The patient will see me for a consultation and if they need treatment, they are then booked in at the Hospital. After treatment, they are regularly followed up over the next few years. What types of treatment do you offer? It depends on many factors the specific condition, the age of the patient, and any other disabilities they may have. We usually start by trying to correct the problem conservatively, for example using bracing or a plaster jacket. If that isn t successful, we may operate to fit a magnetic rod or carry out more complex surgery. How do magnetic growth rods work? Magnetic growth rods, which are attached to one or both sides of the spine, are the most important recent development in treating early-onset scoliosis. The rods provide an internal brace system that, following the initial surgery, can be lengthened non-invasively around every six months in the Hospital using a remote control device. The treatment is particularly suitable for children who are skeletally immature and where definitive surgery would not be advisable. We use the MAGEC (MAGnetic Expansion Control) System, developed by Ellipse Technologies, Inc. The hospital has, without question, the best paediatric intensive care facilities in the country Where do patients come from? All over the world: all parts of the UK as well as Australia, the USA and the Middle East. In many cases they choose to see me because I have a particular interest in spinal deformity and its treatment using magnetic growth rods. What do you enjoy most about your job? I enjoy all aspects of the job: coming to work each day and seeing the patients; being able to operate on them; and, particularly, the follow-up appointments that can continue over many years. I begin by seeing very young patients (I am often asked to view their prenatal scans before treating them as babies) and watch them develop, managing the correction of their deformity over the next 20 years or so. This means I get to know them throughout their childhood, as they grow through each new stage of their lives school, university, and beyond. What about the psychological aspects of treatment? That s an important factor and we do have the ability to refer patients to psychologists if necessary. However, we usually find that any concerns can be managed within the clinical setting which, at The Harley Street Clinic Children s Hospital, is a very nurturing environment. Referrers can contact Hilali on: +44 (0) NHS Choices. introduction.aspx. Last updated Professor Hilali Noordeen Consultant Orthopaedic and Spinal Surgeon 22

13 To all the Doctors, Nurses, Therapists - I want to say a BIG THANK YOU to you all for your help, and mostly for making me better Love, K xxx (Sorry for the times I shouted in the room) The Psychosocial team at The Harley Street Clinic Children s Hospital work with children and their families, offering holistic support throughout what is often difficult, long term, treatment emphasizing that they think of their patients as children first, regardless of their medical conditions. Therapies include counselling, play, art, and music. The team works with inpatients and outpatients across all specialities. However, it is the long term cases, particularly oncology patients and their families, where their support is crucial. Senior Play Specialist, Shazzie Charane, explains: When these children come to us they are often scared, confused, and in many cases feeding off their parents anxiety. Parents also need support; with a serious diagnosis their whole world can feel as if it s collapsed. Shazzie s team, includes play specialists and support workers. In some cases, the focus on a child s illness has taken over their lives to such an extent that it s easy to forget they have the same needs as any other child and that includes having fun, she says, explaining that a major role of the psychosocial team is to bring normalising play and socialisation into the hospital environment. If a child has been in hospital a long time, they can become hospitalised meaning, for example, that they don t want to do messy play because they are worried about germs, she says. Sometimes play specialists can help a child understand more about their condition and medication; at other times they provide distractions from unpleasant treatments, including singing and blowing bubbles. Making happy memories for these children is a really important part of our role because, in many cases, they have spent a long time in hospital, explains Shazzie. We always celebrate special events such as birthdays, wherever they are in the hospital as an inpatient. play, SUPPOrting CHILDrEN with art, & music Therapy Although the work can be emotionally draining, the rewards of working with children who are so ill include seeing them recover and even small steps are encouraging: If I see just one smile a day it makes it all worthwhile, says Shazzie. Language barriers can be overcome by the use of interpreters. However, as Counselling Psychologist Dr Elaine Mayon-White explains, much of what we communicate is through body language and tone of voice: If you are working with a family in distress, it involves listening to their story as well as reassuring the family that they are not alone, she says. The type of therapy offered to children and their families varies, depending on each child s needs and developmental stage. We usually begin with some behavioural work, but as part of that I might then contact another member of the team, explains Elaine. For example, a child connecting with drawing, painting or other art processes might benefit from specialised time with a specific therapist. In fact, each week, the team meets to discuss individual cases so that specific needs can be addressed. Art Therapist, Nana Zhvitiashvili, explains In Art Therapy there is a growing body of research that suggests it helps improve a child s ability to cope with the difficulties of cancer or other long term treatment, and adapt to stressful and traumatic experiences. Art therapy offers patients creative ways of expressing thoughts and feelings through visual means, and as a form of non-verbal communication to complement verbal discussion as part of their rehabilitation process. Nana says, This can be achieved by reducing symptoms of depression to processing anxiety, isolation, and changes in body image. The team has recently facilitated a new service at the Children s Hospital, masterminded by children with cancer, known as the Chemo Fun Club, enabling children to explore many activities which have included a six-week animation workshop, Food Days in co-operation with the dietitians, and a Winter Olympics supported by the physiotherapy team. Nana explains, It provides our adolescent patients with a platform to socialise, enable peer learning, and feel empowered by contributing ideas. It s an example of the integrated approach our multi-disciplinary team offers, where we are trying to go far beyond their treatment plan. Shazzie Charane Senior Play Specialist 24

14 P N ae eu d roi at Co ns su ri ul r c tin g R ge ry oo m s Appointments Mon Fri: 8am to 8pm Sat: 9am to 5pm 78 Medical hscgp@hcahealthcare.co.uk General info.thsc@hcahealthcare.co.uk t r ee 84 St C H hi O o l C ut sp dr en p it e t at a l n r i Con e en s Tre sul t Ca atm tin Asse rdia ent g Ro Blo ssm c Te Ro om M o s om s e Ro ino d Te nt B ting s om r O sts ay pe ra tio ns H ar le y P R ae a d & Ro C d i i a o t o o n th r m s e ic Rad s ul r Im io t ap ag the in y in ra g g py W ey M m ai ou n The H th Pa at o r e s C e a di s p i St r ta e et Chi re U atric l Sur ldr nit In ten Pa gic en siv On edia al D s Wa e Im col tr rd a i y CT agi og y c H C ae are an ng i m d ncl at D ud o igi in ta g lx M -R RI ay, P O ae D nc d ay o i a C lo t r C ar g ic h Co em e y ns oth ul er tin ap gr y oo m s t 26 Medical Enquiries r ee Switchboard (24 hr) St Contact Details th ou 81 Children s Hospital m ey W The Harley Street Clinic Our campus encompasses five different buildings, all within close proximity to each other.

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