Hospital ready to head into future

ANDREW Grace is like a child with a new toy - in the best possible sense.

York Hospital's clinical director for head and neck services is filled with infectious enthusiasm about his state-of-the-art new £4.3 million head and neck unit.

Standing in the spacious central waiting area, he gestures at the ceiling. Its middle has been raised to allow glass windows to be fitted, letting natural daylight in for the benefit of patients waiting below.

"That cost an extra £80,000, but it was something we wanted because otherwise there would have been no natural light," says the head and neck consultant.

That same attention to detail is everywhere in the new unit: from the clean, bright reception area and the suites of consulting and treatment rooms to the speech therapy classroom, the sound-proofed audiology rooms and the hearing aid fitting rooms.

No fewer than five hospital specialities have been brought together in this one unit. They are:

Ear, nose and throat (ENT)

Maxillofacial surgery, dealing with problems of the face, mouth, jaw and neck

Orthodontics, dealing with crooked teeth and jaws and problems such as cleft lips

Audiology, for people with profound hearing and balance problems

Speech and language therapy.

Between them the staff here see as many as 40,000 patients every year - patients suffering from everything from profound hearing and speech problems to cancer of the neck and throat and deformities of the face, teeth and jaw.

Previously, the various specialities were scattered about the hospital. ENT and audiology shared a cramped corridor which doubled as a patient waiting area. The other specialisms were spread around - with the balance centre, for example, at the other end of the hospital.

Bringing everybody together in one place makes sense, Mr Grace says - because the various teams often have to work together.

Patient Roy Baker, who had his larynx removed because of cancer, can't believe the change.

When he first came to the hospital, in August 2002, he spent two hours waiting in a narrow corridor to see a consultant. "It was a thoroughfare," he says. "People were in and out, running about, rushing off to get fibre-optic cables which had been sterilised in another area. The change is enormous. It is just unrecognisable."

It is the cleanness and spaciousness of everything that is most remarkable. York Hospital, on its inner-city site, has always been short of space to develop.

For the new head and neck unit, the decision was taken to build upwards. It is built on top of the hospital's kitchens.

"We didn't think it was possible at first," Mr Grace admits. Then engineers decided a lightweight construction, with a special lightweight concrete floor, would work.

The unit was built over 12 months, with the help of £1 million from the NHS Modernisation Agency, and accepted its first patients late last year.

Astonishingly, there are about 95 rooms up here, sharing 1,700 square metres of floor space arranged in corridors around the central waiting area.

ENT and maxillofacial surgery have six new, fully-equipped consulting rooms and three nurse treatment rooms each. The orthodontics area has a state-of-the-art, four-chair surgery, where a single consultant can supervise staff treating four patients at once, and a separate two-chair surgery - and there is even an on-site laboratory where technicians make moulds for straightening patients' teeth and jaws.

The audiology unit has five modern, sound-proofed rooms for carrying out hearing tests, as well as four sound-deadened fitting rooms. "And we can even get patients in wheelchairs in," says chief audiologist Richard Addis, gesturing at the generously wide doors to one of the rooms. "We really struggled to do that before."

Further along are two sound-deadened speech therapy rooms - the sound-proofing is important, says speech therapist Ruth Wallace, because people learning to speak again after surgery or throat cancer need to project their voices loudly - and a speech-therapy classroom equipped with state-of-the-art audio-visual equipment.

The balance centre - one of the top three such centres in the country - is equipped with a suite of rooms to diagnose balance problems caused by damage to the inner ear. Almost one in ten people suffer from such problems, Mr Grace says.

What patients will notice most, however, is the comfortable waiting area, with its attached children's play area and internet facilities, and the modern private consulting and treatment rooms.

Before, in the old and cramped corridors, finding a quiet space where patients could talk with medical staff in proper privacy, was well-nigh impossible, Mr Grace says. And that had an impact on the quality of care patients could be given.

"Patients cannot open up if they think somebody may be overhearing," he says.

The new unit will do more than make patients feel better. Having so much space and such modern facilities will improve the speed and quality of treatment, Mr Grace says.

Before, there were bottlenecks caused by the fact staff didn't have enough rooms to work in. "Now we can use the manpower we have. There is so much space for us to manage more patients."

Waiting times should come down, in other words.

But will they? Selby and York Primary Care Trust, which pays for patients to be treated, is so broke it has been asking the hospital not to treat patients so quickly.

Nobody likes that situation, Mr Grace admits. "There is no doubt that the cash limitations are a problem. We worked hard to bring waiting times down and now to be told to let waiting times rise a bit - it isn't ideal."

He is convinced, however, that it is simply a hiccup. He has been with the hospital for more than eight years - and there were periods when waiting times were as long as two years. They are now six months: and he believes the hospital will be able to hit its target of achieving 18-week waiting times by 2008.

The bottom line, he says, is that the hospital now has one of the best head and neck units in Yorkshire, if not the country - a unit that will stand the test of time.

"And had the PCT not been supportive, we would not have what we've got today."

:: Case study - Roy Baker

For a man who has had his vocal cords removed, 59-year-old Roy Baker speaks remarkably well. Over the telephone, he says proudly, many people wouldn't know.

Roy, a retired company director from Beal near Selby, had his larynx removed after being diagnosed with cancer in 2002.

He had been suffering from an increasingly hoarse voice, he says - and tests at York hospital revealed his vocal cords had shrivelled up from the cancer.

The surgery left him breathing through a hole in his neck. But remarkably, despite having no vocal cords, he has learned to speak again. He has to press a button in his neck before he can speak, to divert air up through his mouth.

But his 'voice' - generated by vibrating the back of his throat - sounds remarkably like anyone else's. He even has an accent.

Much of his ability to speak is thanks to the help of speech therapist Ruth Wallace. Over a period of three years, he says, he had something like 30 or 40 intensive sessions with her, gradually learning how to produce and project his new voice.

His overwhelming feeling now is simply gratitude to be alive. If his GP hadn't sent him to York Hospital when he did, he says, he would probably be dead by now.

So what does he think of the new unit, compared with his early experiences?

"There is so much space and light. It is amazing!"

:: Case study - Michelle Kirkman

Michelle probably owes her life to the fact she began to lose her voice.

The 30-year-old from Strensall was pregnant with her first daughter, Megan, when she began to have problems in June 2004. "Sometimes I would lose my voice," she says. "And I couldn't shout - which was nice for my husband!" She went to her GP, who noticed a lump in her neck, and referred her to the ear, nose and throat unit.

By then, she had just had baby Megan - born in July - and vividly recalls her first impression of the unit.

"It was heaving!" she says. "Very small and cramped. I remember being stuck in a corridor on a chair, with people walking past all the time."

The speech therapist was mainly interested in trying to find out why Michelle was having problems with her voice. Michelle mentioned the lump on her neck and a consultant was called.

He told her he wanted to take a needle biopsy. She had to wait half an hour for him to find a room - but within another half hour, he had given her the result.

There was a 95 per cent chance she had Hodgkins lymphoma, a form of cancer that attacks the lymphatic system.

Further tests revealed she had a 15cm tumour in her chest, and a 4cm lump in her neck.

Surgery removed the neck lump, but the chest tumour was too deep. Instead, she had to undergo six months of chemotherapy.

It made her sick, and she lost all her hair - hardly the start to life as a new mum she had been looking forward to. "I called us the 'balding Kirkmans', because I'd lost my hair, Jon her husband has no hair, and of course Megan had no hair!" she says.

But now, more than a year after finishing treatment, her hair has grown back.

So what does she think of the new head and neck unit?

"It's very spacious, very clean, very light," she says. "So warm and welcoming and sunny."

Updated: 10:25 Friday, January 27, 2006