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Botulinum toxin (Botox) injection for a squint - patient information

Description: This factsheet contains information about having a botulinum toxin (Botox) injection to treat your squint.
Url: /Media/UHS-website-2019/Patientinformation/Eyes/Botulinum-toxin-Botox-injection-for-a-squint-2245-PIL.pdf

Nourishing fluids - patient information

Description: If your appetite is poor, nourishing fluids are a good way to add extra calories and protein into your diet. This factsheet contains some recipe ideas that you can try at home.
Url: /Media/UHS-website-2019/Patientinformation/Medicinestherapiesandanaesthetics/Nourishing-fluids-2392-PIL.pdf

PLANETS texture modified recipe book

Description: A texture modified recipe book for patients with cancer of the oesophagus or stomach A texture modified recipe book for patients with cancer of the oesophagus or stomach Contents Introduction 3 Patient stories 4 From the dietitian 8 From the Chef 9 Purée food 10 Purée breakfast recipes 12 Purée soups 16 Purée main meals 20 Purée side dishes 30 Purée desserts & snacks 34 Drinks & supplement recipes 38 Soft & bite sized diet 40 Soft & bite size breakfast recipes 42 Soft & bite size main meals 46 Soft & bite size side dishes 54 Soft & bite size desserts & snacks 56 Introduction This recipe book aims to provide you with a selection of easy to prepare, high calorie and protein recipes of a suitable purée or soft texture that may be helpful during chemo or radiotherapy or following surgery for oesophageal or stomach cancer. The recipes in this book will make larger portions than you may be able to manage, so you will be able to divide them into several smaller portions. Each recipe will indicate if it can be stored in the fridge or frozen. Ensure you defrost food thoroughly and cook through. What is texture modification? A texture modified diet will contain carefully selected foods of an appropriate consistency which can be more easily managed if you are struggling with swallowing or pain on eating, or healing following surgery. Food fortification In order to help minimise weight loss, especially when you may only be able to manage small portion sizes it can be helpful to ‘fortify’ your food to maximise its nutritional content. • Avoid foods labelled as ‘diet’ or ‘light’ and choose full fat dairy products. • Add extra butter, cream, evaporated or condensed milk to increase calories. • Add fortified milk to drinks and foods. (see recipe below) Fortified milk recipe • 1 pint (approximately 600ml) full cream milk • 4 heaped tablespoons (60g) skimmed milk powder 1. Add milk powder to a small amount of milk and mix to a paste. 2. Gradually add the remaining milk. 3. Store in the fridge and use instead of normal milk. 2 3 Patient stories The following are advice and tips are from patients with oesophageal or stomach cancer who have followed a purée and soft & bite sized diet... Gordon Oesophagectomy August 2018 Early in 2018 I was diagnosed with cancer of the oesophagus. I had three cycles of chemotherapy after which in August 2018 I underwent an oesophagectomy at Southampton General Hospital. Initial foods by mouth consisted of purée foods including scrambled egg and soups. I was initially also receiving the bulk of my nutrition through a Jejunostomy feeding tube, which was weaned down and stopped in February 2019. I was provided both in hospital and at home with high calorie/protein supplements in the form of Fortisip. We (my carer was an active participant in finding an acceptable diet, a situation I would consider as being almost essential) then tried various commercial varieties such as ‘Complan’. For the first few weeks after leaving hospital I didn’t feel thirsty at all and again my carer became concerned that I would become dehydrated. Given the restricted room available for food intake in my re-arranged insides there was always a tussle for space between solids and liquids and we could not settle on a highly nutritious solution to meet both requirements. As soon as I was able to eat almost anything – I still have difficulty digesting pastry ten months after the op – I started to eat quantities of cheese, puddings and cream. We have now resorted to supermarket sourced ‘protein bars’ such as ‘Nature Valley’ and ‘Graze’ that I munch between the three traditional meals. I also ‘graze’ on nuts, biscuits and fruit. To start with I lost weight, going from 68.5kg down to 63.3kg at the end of April. Since then it has stabilised and we hope to perhaps gain another kilo or two. Not too much because, according to the NHS chart, for someone of my height it is an ‘ideal weight’. I think now, ten months down the track, we are getting things right. A typical daily intake for me is as follows: Breakfast: Coffee, cereal (not too much sugar), toast with a spread of some sort, fruit juice. Lunch: Possibly left-overs from last evening’s meal, eggs in a variety of ways, cheese on toast, soup, a sandwich followed by a piece of fruit. (continued over) 4 Evening meal: A whole variety of dishes; roasts, casseroles, stir fry, salads, curries usually followed after an hour or so by a dessert. All those meals are of very small portions – though getting bigger all the time, some days better than others – so in between meals I have snacks comprising a range of protein bars, biscuits, fruit and cashew nuts by the handful. It seems to be working.I’m feeling stronger all “ ” the time, exercising and enjoying life! Janice Oesophagectomy May 2019 I had an oesophagectomy in May 2019 so I am currently almost 5 months post-op. I won’t lie, up to a month ago I found the whole eating and dietary issues frustrating. A lot of that was down to my impatience in accepting that recovery was going to take a good year or more. However, in the last few weeks, I feel I’ve finally ‘cracked it’ and found a regime that works for me. The day before being discharged from hospital my daughter visited and, between us, we ‘brainstormed’ a list of foods that could be, or were already, puréed. Armed with an extensive list, my daughter shopped for all the items including some baby food containers. She filled the containers with some prepared meals and left them stacked in my fridge and freezer ready for my return. I can’t tell you just how much that helped in the early days at home. Not having to worry about what to prepare and eat to start with was a blessing. Luckily, my husband was happy to see to himself so I could concentrate on my own needs. Some of the foods I stocked up with were: • Tinned custard, semolina and variety of soups. • Potatoes, butternut squash, and carrots. • Whole milk, cream, strong cheese, eggs, creamy yoghurts, butter and ice cream. • Salmon, white fish, skinless sausages. • Jelly cubes (for milk jellies). • Cheese sauce granules, gravy granules and dried milk (for making the fortified milk). • Weetabix and instant porridge. (continued overleaf) 5 5 • Some baby foods that I used as a base e.g macaroni cheese that I just added more grated cheese to. • Smoothies I thought the easiest food to eat would be mashed potato enriched with an egg, milk, butter and cheese but I actually found it quite difficult to swallow so stuck to the butternut squash instead (still with everything added). Keeping hydrated was difficult as I’m not a great drinker anyway. You definitely need to drink a good 30 mins before or after food and not at the same time. I kept a jug of fortified milk on the go and used it for cereal, jelly and frozen milk lollies (using Nesquick). I did find that my taste buds changed and I struggled with dairy products in particular. Moving on to soft foods after 4 weeks was bliss. I was so bored with puréed food by that point. I was losing weight but was expecting that and hoped that the loss would slow down with a more varied diet. I still wasn’t keen on the sweet dairy products although I kept trying various yoghurts and desserts. I must say I did spend a lot of money on food but also wasted a large amount of food as well! I eat anything that could be mashed with a fork and found stronger flavours worked for me. • Cottage pie • Spaghetti Bolognese • Tagliatelle • Vegetable curry • Skinless sausage casserole • Cheese omelette with thin cut ham added My ‘go-to’ snacks included: cheese and crackers, buttery cheese straws, mini Babybels, tiramisu, spicy crisp puffs e.g Cheetos. Trying to keep a small portion of food warm enough for the 30 mins needed to eat it was a problem. I overcame it by buying a child’s wide-necked food thermos flask. It certainly kept the food at a reasonable temperature. After a couple of months, I was able to move on to a normal, varied diet. I now eat whatever I fancy and it’s just been trial and error finding the foods that work for me. My portions have increased considerably and I enjoy stir-fries, curries, roast dinners, fry-ups – you name it and I’ll try it. The only thing that I don’t cope with very well is red meat but everything else is fine. I make sure I chew everything thoroughly but it did take some time to realise when I’d eaten enough. Sometimes, that last spoonful was one too many and it would stick in my throat. It would go down eventually but it’s uncomfortable at the time. 6 My taste buds are getting back to normal and I now enjoy chocolate, cream cakes and some desserts again. I always keep a couple of ready meals in the fridge (Marks and Spencer do a range designed for a smaller appetite). I snack on things like crisps, peanuts, cashew nuts, fruit loaf, crumpets, waffles and fruit and nut chocolate bars. At my last weigh-in I had gained over 2kilos so I know the only way is up now and I’m feeling very positive about the future. I now eat whatever I fancy and it’s just been trial and error finding the foods that work for me. 7 7 From the dietitian… We have worked closely with our patients in producing this recipe book to help support you after surgery or during chemo/radiotherapy when you may find your appetite is very low. The recipes are designed to maximise the calorie and protein content, which will help you to better maintain your weight. Eating small portions regularly every few hours over the day can help, as well as serving small portions of food on a side plate or in ramekins so that it doesn’t look too overwhelming. Dietitian, Sarah Davies Don’t feel you have to make everything from scratch, you can often buy foods of an already appropriate texture from supermarkets, for example pots of custard or smooth soup to save you time. Several online ready-made meal companies can deliver good quality meals that have a range of suitable textures, including ‘mini’ or ‘petite’ ranges for smaller portions, which you may find helpful if you are feeling too tired to cook. Choose ‘purée’ or ‘soft and bite sized’ ranges according to which stage of diet you are on. If you require further advice or are worried about your weight or diet please ask to be referred to a dietitian. We hope you find this book helpful! 88 From the Chef… It’s really inspiring for me to read the positivity within the patient stories and learn about the different food plans that have worked for each individual. I can fully appreciate a lack of desire to get creative in the kitchen, especially post surgery, though along with some great existing recipes already in this book, I have put together some of my own that will hopefully encourage you to think positively about food and flavours. There will obviously be days where you may wish to simply blitz up a can of pre prepared soup though if feeling adventurous it would be a pleasure to learn that any of my recipes have been given a run through! Please do enjoy! Blender advice To get a really smooth consistency to your food it is really important that you use a powerful blender. I personally find the Ninja range superb & at an affordable price range. They have some great models from around £49.99 and are available from most supermarkets or it’s worth looking online for a good deal. If your blender fails to create the desired smooth texture, you can pass it through a fine sieve afterwards and discard any ‘lumps’. If the consistency of the food is a little dry, simply add a little extra water whilst blending. Chef, Gary 9 Purée foods 10 What is a purée diet? • A purée diet should be smooth throughout without any bits, lumps, skins or shells. • Food can be puréed using a blender or food processor. • Food can also be sieved to ensure there are no lumps. • Food should be puréed separately so there are individual portions of each food on the plate. This helps to retain the taste and colour of each item and makes it more appealing. • Add additional liquids to blend such as gravy, milk or stock. • Enhance flavours by adding sauces such as smooth mustard, curry powder, soy sauce or lemon juice. Suggested purée meal plan Breakfast 8.00am Drink Mid-morning snack 10.00 -10.30am Drink Lunch 12.00 -1.00pm Drink Mid-afternoon snack 2.30 - 3.00pm Drink Dinner 5.00 - 6.00pm Drink Dessert/ Evening Snack 7.00 - 8.00pm Purée cinnamon porridge Nourishing coffee Purée scrambled eggs Supplement drink Salmon Mousse Glass of milk Cream of chicken soup Supplement drink Purée shepherd’s pie Nourishing malt drink Purée rice pudding 1111 Purée breakfast recipes 12 Cinnamon Porridge • 25g porridge oats • 175g full fat milk • ¼ teaspoon of cinnamon • 1-2 tablespoons of full fat Greek yogurt to serve 1. Put the porridge oats in a saucepan, pour over the milk and sprinkle in a pinch of salt. Bring to the boil and simmer for 4-5 minutes, stirring from time to time and watching carefully that it doesn’t stick to the bottom of the pan. 2. Or you can try this in a microwave. Mix the porridge oats, milk and a pinch of salt in a large microwave-proof bowl, then microwave on High for 5 minutes, stirring halfway through. Leave to stand for 2 minutes before eating. 3. Stir through the cinnamon and drizzle with Greek yogurt to serve (you can thin this down with some more milk if needed). Storage: Refrigerate Weetabix, Peanut Butter & Banana Smoothie • ½ a banana • 2 tablespoons of smooth peanut butter • Approximately 250ml full fat milk • 1 Weetabix biscuit (or shredded wheat) 1. Slice the banana into the blender. 2. Add the peanut butter and 3 tablespoons of the milk. 3. Blend together until well combined. 4. Crush the Weetabix into the mixture. 5. Add the remaining milk and blend until smooth. Storage: Refrigerate 13 Purée Scrambled Eggs • 2 eggs • 6 tablespoons of single cream or approximately 60ml of full fat milk • Butter 1. Lightly whisk the eggs, 6 tbsp of single cream or full fat milk and a pinch of salt together until the mixture has just one consistency. 2. Heat a small non-stick frying pan for a minute or so, then add a knob of butter and let it melt. 3. Pour in the egg mixture and let it sit, without stirring, for 20 seconds. Then stir with a wooden spoon, lifting and folding it over from the bottom of the pan. 4. Once cooked through, place eggs in your blender and blend until smooth (you may need to add a little more milk to give the correct consistency). Storage: Refrigerate Fruity Greek Yogurt Smoothie • 250ml Full fat Greek yogurt (or pineapple flavoured Greek yogurt) • 50ml full fat milk • ½ a banana • 30g fresh or frozen mango • 30g fresh, tinned or frozen peach slices 1. Place the yogurt and fruit into the blender and mix until smooth (if using frozen fruit you may need to let this defrost for a few moments to make it easier to blend). 2. Add additional milk to thin down as required. Storage: Refrigerate 14 15 Purée soups All soups can be kept in the fridge for 1-2 days or frozen 16 Cream of Chicken Soup • 2 tablespoons of olive oil • 600ml chicken stock • 1 medium onion, chopped • 175ml double cream • 1 medium leek, thoroughly washed and chopped • A pinch of pepper • 2 large chicken breast fillets (chopped) 1. Heat the oil in a pan, add the onion and cook until softened. 2. Add the leek and cook for a further 5 minutes. 3. Add the chicken, stock and seasoning and bring to the boil for 2 minutes then reduce to a simmer. 4. Allow to simmer for 25 minutes until the chicken is cooked through. 5. Add the cream then blend until smooth. Lamb and Vegetable Soup • 2 tablespoons of olive oil • 800ml vegetable stock • 400g lamb mince • 150ml full fat milk • 1 medium onion, choppe d • 120g skimmed milk powder • 3 large carrots, peeled & cho ppe d • 100ml double cream • 1 medium potato, peeled & chopped 1. Heat the oil in a pan and add the lamb and onion and cook for 5 minutes, breaking up the lamb into small pieces. 2. Add the carrot and cook for 10 minutes until soft. 3. Add the potato and stock and bring to the boil, then reduce to a simmer for a further 30 minutes. 4. Combine the milk with the skimmed milk powder then add to the pan with the cream and season. 5. Blend the soup until smooth. 17 Pea and ham soup • 2 tablespoons of oil • 1 medium onion, chopped • 1 medium potato, peeled and finely chopped • 400ml vegetable stock • 600g frozen garden peas • 100g cooked ham, finely chopped • 300ml full fat milk • 100g skimmed milk powder • 30g parmesan 1. Heat the oil in a pan and add the onion. Cook for 5 minutes until soft 2. Add the potato and stock and season. Boil for 15 minutes until the potato is soft. 3. Stir in the peas and ham and cook for another 10 minutes 4. Mix the milk with the skimmed milk powder and then add to the soup along with the parmesan. 5. Blend the soup until smooth and then sieve to ensure all pea shells are removed. Seafood chowder • 1 tablespoon of olive oil • 1 medium onion, finely chopped • 1 tablespoon of plain flour • 2 small potatoes, peeled and finely chopped • 600ml fish or vegetable stock • 300ml full fat milk • ½ teaspoon of grated nutmeg • 170g salmon, chopped into small chunks • 150g cod, chopped into small chunks • 60ml single cream • 200g frozen prawns (thoroughly defrosted) 1. Heat the oil in a saucepan and add the onion. Cook for 5 minutes until soft, then add the flour and cook for a further 2 minutes. 2. Add the potatoes and stock and bring to the boil for a minute then turn down to a simmer and cook for around 15 minutes until the potatoes are soft. (continued over) 18 3. Add the milk and nutmeg with the salmon and cod and cook for 5 minutes. 4. Add the cream and prawns and simmer for 5 minutes until cooked through. 5. Blend the soup until smooth. Sweet potato and lentil soup • 3 tablespoon of olive oil • 1 large onion, finely chopped • 10g minced ginger (or ginger paste) • 10g minced garlic (or garlic paste) • 600g sweet potatoes, peeled and finely chopped • 200g dried red lentils • 400g tin of coconut milk • 800ml vegetable stock • 100ml double cream • 120g skimmed milk powder 1. Heat the oil in a saucepan then fry the onions, garlic and ginger for 5 minutes. 2. Rinse and drain the lentils. 3. Add the sweet potatoes, lentils, coconut milk and stock and simmer for 30 minutes until the potatoes are soft. 4. Mix together the cream and skimmed milk powder then add to the soup. 5. Blend until completely smooth (you may need to sieve the soup to ensure the lentils are completely blended). 19 Purée main meals 20 Salmon Mousse • 125g smoked salmon • 50g cream cheese • 25g crème fraiche • The juice of ½ a lemon 1. Place all of the ingredients in your blender and combine until smooth. 2. Season with salt and pepper to taste and serve. Storage: Refrigerate Fish Pie • 2 skinless and boneless white fish fillets (approximately 200g) • 2 skinless and boneless smoked haddock fillets (approximately 200g) • 400ml full fat milk • 50g butter • 3 heaped tablespoons of plain flour (50g) • A pinch of nutmeg 1. Put the fish in the frying pan and pour over the milk. 2. Bring the milk to the boil then reduce and simmer for 8 minutes. 3. Lift the fish onto a plate and strain the milk into a jug to cool. Flake the fish into large pieces in a baking dish. 4. Melt the butter in a pan, stir in the flour and cook for a minute over a moderate heat. Take off the heat then pour in a little of the milk from the jug and stir until blended. 5. Continue to add the milk gradually, mixing well until you have a smooth sauce. Season with nutmeg and pepper to taste. 6. Add to a blender with the fish and blend until smooth. 7. Layer in a small dish with creamy mashed potato on top (see recipe in side dishes section). 8. Heat the oven to 200°c and bake for 30 minutes. Storage: Refrigerate or freeze 21 Mediterranean inspired chicken & chorizo casserole chickpea - spinach - fresh basil This recipe is inspired by big Mediterranean flavours. The strong flavours from the chorizo flavour the whole dish and make it a pleasure to eat. The recipe will give a generous 4 - 6 portions though likely more for smaller appetites. • 100g diced chorizo • 200g diced chicken thigh • 1 onion, diced • 1 stick celery, diced • 1 carrot, diced • 1 tin of chick peas, drained • 2 tins chopped tomatoes • 200g baby spinach leaves, washed • Handful fresh basil • Juice of one lemon • Salt and pepper Gary’s 1. Start with a hot pan and colour the chorizo on all sides (no need for any oil) 2. Add the chicken and stir in - cook for a few minutes 3. Add the onion, carrot and celery - cook for about 5 more minutes over a gentle heat (lid on) 4. Add the tinned chickpeas and tomatoes - bring to the boil and simmer for 30 minutes, stirring occasionally 5. Add the baby spinach and fresh basil 6. Add salt and pepper and lemon 7. Blend until smooth 8. Enjoy 22 Mild red lentil & butternut squash curry coconut - lime - lemongrass This simple recipe is for a mild curry with Asian flavours. You can replace the squash with chicken if desired but I personally love a vegetarian curry and you get plenty of calories from the coconut milk and the red lentils. You can omit the chilli if wanting a milder version or add one or two extra in. Again, allows for 4 - 6 generous portions. • 1 butternut squash, diced • 1 onion, diced Gary’s • 4 cloves garlic, crushed • 1 inch fresh ginger, grated • 1 stick lemongrass, diced • 1 green chilli, de-seeded • Juice of two limes • Bunch fresh coriander • Teaspoon mild curry powder • Dash of fish sauce • Teaspoon turmeric • 200g red lentils • Two tablespoons soy sauce • Coconut oil for cooking 1. In a hot pan, heat the coconut oil and add the garlic, ginger, lemon grass and onions - sweat for a few minutes 2. Add the squash, chilli and curry powder - cooking for 5-10 minutes until starting to soften (keep lid on) 3. Add the coconut milk and bring to the boil - simmer for twenty mins 4. Meanwhile, boil the red lentils in 400ml water for five minutes with the turmeric (the water should evaporate whilst they cook) 6. Add the cooked lentils (drained) into the sauce 7. Add the lime juice, fish sauce and soy sauce 8. Blend until smooth 9. Enjoy 23 Vegetarian ‘Shepherd’s pie’ puy lentils - butter beans - root vegetables minted gravy Very fond of vegetarian food?..... I’ve included this recipe which works really well with the lentils replacing the meat. Plenty of flavour from the vegetables and served with buttery mash and additional gravy, it’s a real treat. • 200g puy lentils (cooked) • 1 onion, chopped • 1 stick celery, chopped • 1 carrot, chopped • 1/2 small swede, chopped • 4 cloves garlic, chopped • 1 tin butter beans, drained • Tablespoon tomato purée • Teaspoon dried mint • Teaspoon dried mixed herbs • Salt and pepper Gary’s 1. In a hot pan, sweat the onions with the dried herbs for a few minutes 2. Add the other vegetables and cook for a further ten minutes (lid on) 3. Add the tomato purée and red wine 4. Add the lentils and butter beans 5. Add the Worcester sauce and salt and pepper 6. Add the gravy 7. Simmer for 30 minutes 8. Blend until smooth adding a little extra water or gravy if necessary 9. Serve with the mash and extra gravy 24 Mash Ingredients • 40g potato, diced • 100g butter • Salt and pepper • Dash grated nutmeg (optional) • Teaspoon Dijon mustard 1. Bring the potatoes to the boil and simmer for 20 minutes until soft 2. Drain and beat with a whisk until smooth - avoid using the blender which will break down all the starch, causing loss of the natural texture we all love in a good mash. As long as it’s given a good beat with a sturdy whisk it will become smooth or you can use a ricer, putting through twice. 3. Add salt and pepper, butter and mustard Chef Gary’s Top Tips Invest in some reusable tubs. They are great for portioning and storing food when batch cooking. You can then prepare food ahead of time and freeze for when you need something that’s quick, healthy and nutritious. Purée down tinned rice pudding for a quick dessert that is packed full of calories. When the texture is one dimensional it’s so important to add flavour to keep you interested and looking forwards to mealtime. A little extra salt, sugar or lemon juice can go a long way. As long as you can purée them to a fine texture, add fresh herbs to any recipe to give dishes extra flavour. Basil is great with tomato based dishes and coriander pairs brilliantly with coconut or curried recipes. As you move forwards, by using the pulse on the blender, you can leave some texture in the dishes. All my recipes can of course be left ‘unblended’ if catering for other family members or friends. 25 Minced beef • ½ tbsp sunflower oil • 30g onion (finely chopped) • 30g carrots (finely chopped) • 100g minced beef (or substitute for Quorn mince) • 1 tablespoon of tomato purée • 200ml beef stock • 2 tablespoons of Worcestershire sauce 1. Heat the oil in a medium saucepan and soften the onions and carrots. 2. When soft, add the minced beef and cook until browned. Then add the tomato purée and Worcestershire sauce and fry for a few minutes. 3. Pour over the stock and then simmer for 30-40 minutes. 4. Place the mixture into a blender and blend until smooth. Serve into small portions. Ideal with mashed potato or purée vegetables (see sides section). Storage: Refrigerate or freeze Shepherds’ pie • 350g minced beef (or substitute for Quorn mince) • 2 tablespoons of olive oil • 1 small onion, chopped • 100g mushrooms (optional) • 2 medium carrots, peeled and chopped • 2 tablespoons of tomato purée • 350ml beef stock • 50g butter • 50g flour 1. Heat the olive oil in a pan and add the onions and soften. 2. Add the mince and brown through. (continued over) 26 3. Add the mushrooms and carrots. Cover with a lid and leave to cook on a medium heat, stirring regularly. 4. Make a roux sauce by melting the butter in a separate pan. Using a whisk add the flour and whisk well until combined. 5. Add the beef stock a little at a time to the roux, still mixing well to make a thick sauce. 6. Add this sauce with the tomato purée to the beef mixture and stir well. 7. Transfer to the blender and mix until smooth. 8. Place in a small dish and top with creamy mashed potato (see side dishes section). 9. Bake in the oven for 15-20 minutes until cooked through. Storage: Refrigerate or freeze Purée chicken • 100g of diced chicken breast • 1 small onion chopped • 100ml chicken stock • ½ a chopped leek • 1 tablespoon of chicken gravy granules • 1 teaspoon of oil 1. Heat the oil in a pan then add the onion, leek and chicken and cook through. 2. Add the chicken stock and simmer for 15 minutes. 3. When cooked, add the gravy granules then transfer to the blender and blend until smooth. Ideal to serve with creamy mashed potato. Storage: Refrigerate or freeze 27 Macaroni cheese • 3 tablespoons of butter • 350g of pasta (penne or spiral pasta) • 1 teaspoon garlic paste • 1 teaspoon mustard • 3 tablespoons plain flour • 500ml full fat milk • 250g cheddar cheese • 50g grated parmesan 1. Boil the pasta until cooked then drain and set aside. 2. Meanwhile melt 2 tablespoon of butter in a saucepan. 3. Add the garlic paste and English mustard and cook for 1 minute. 4. Stir in 3 tablespoons of plain flour and cook for 1 more minute. Gradually whisk in 500ml of the milk until you have a lump-free sauce. 5. Simmer for 5 minutes, whisking all the time until thickened. 6. Take off the heat and stir in the cheddar and parmesan. 7. Add the pasta then blend with the sauce until smooth. Add extra milk if you need to thin the mixture down. Storage: Refrigerate 28 Red lentil Dahl • 250g red lentils • 1 teaspoon turmeric • A pinch of salt • 2 tablespoons sunflower oil • 1 teaspoon cumin • 1 medium onion, finely chopped • 50ml cream 1. Put the lentils in a pan of 800ml of water and bring to the boil. 2. Add the turmeric and salt and simmer uncovered for 15 minutes. Stir occasionally until the lentils have broken down completely to a purée (the consistency of a smooth thick soup). 3. Heat the oil in a separate pan and add the onion. Cook for 5 -10 minutes until soft. 4. Add the onion, cumin and cream to the lentils then blend until smooth. Storage: Refrigerate or freeze 29 Purée side dishes 30 Creamy mashed potato • 6 medium potatoes, peeled and chopped into chunks • 60g butter • 100ml double cream 1. Place the potatoes in a pan and cover with cold water 2. Bring to the boil then cover with a lid and reduce to a simmer for 20 minutes until the potatoes are soft. 3. Drain the remaining water, add the cream and butter and gently heat. 4. Mash the potatoes or beat. Storage: Refrigerate or freeze Hint: Try adding cream cheese or mustard to give extra flavour Cauliflower cheese • 150g cauliflower florets • 1 level tablespoon of cornflour • 2 tablespoons of full fat butter or olive oil spread • 150ml full fat milk • 30g cheddar cheese, finely grated 1. Wash the cauliflower then steam for 8-10 minutes until soft. 2. To make the sauce combine the flour, butter and milk in your blender. 3. Transfer into a microwaveable container and microwave for 45 seconds then stir through. 4. Microwave for another 15-30 seconds until the sauce starts to thicken then stir in the grated cheese. 5. Combine the cauliflower and sauce in the blender until smooth. Add additional milk if required. Storage: Refrigerate or freeze 31 Sweet potato and carrot purée • 250g carrots, chopped • 250g sweet potato, chopped • 1 tablespoon of garlic purée • 25g butter 1. Put the sweet potato and carrots into a pan of boiling salted water and cook for around 15 minutes until soft. 2. Drain the vegetables then stir through the garlic purée and butter. 3. Blend until smooth. Storage: Refrigerate or freeze Hint: You could also try adding 100g parsnip Butternut squash purée with ginger • 1 butternut squash, halved lengthways and deseeded • Olive oil • 4cm piece of fresh root ginger, peeled and finely grated • 3 tablespoons of butter • 2 tablespoons of double cream or crème fraiche • Nutmeg (optional) 1. Preheat the oven to 200°c 2. Rub a little olive oil into the cut side of the butternut squash then roast in the oven on a baking sheet for around 45 minutes or until soft. 3. Scoop out the flesh with a spoon and set aside (discard the skin) 4. In a pan melt 2 tablespoons of butter and add the ginger and cook for 5 minutes. 5. Place the cooked squash and ginger in the blender and blend thoroughly until smooth. 6. Return to the pan and add the remaining butter and nutmeg if you are using this. Stir through the cream or crème fraiche. Storage: Refrigerate or freeze 32 Purée ratatouille • 50g aubergine • 50g courgette • 40g red or yellow pepper • 2 tablespoons of olive oil • 200g passata • 1 small onion, finely chopped • 30g mushrooms • ½ garlic clove peeled and crushed • 1 tablespoon of red wine vinegar • 50ml single cream (optional) 1. Heat the oil in a casserole dish or saucepan and cook the onions and garlic on a low heat for 10 minutes until soft with the lid on. 2. Add the peppers, aubergine and courgettes. Season with salt and pepper and cook for a further 20 minutes with the lid on. 3. Pour in the passata and red wine vinegar and cook for another 5 minutes without the lid 4. Transfer to your blender and blend until smooth. Stir through the single cream to add additional calories before serving Storage: Refrigerate or freeze 3333 Purée desserts & snacks 34 Banana dessert • 1 medium banana, peeled and sliced • 10g ground almonds • 1 teaspoon maple syrup • 2 tablespoons double cream • 20g skimmed milk powder • 1 teaspoon vanilla extract 1. Freeze the banana slice for at least 2 hours 2. Blend the frozen banana, almonds, maple syrup, cream, skimmed milk powder and vanilla extract into a creamy smooth texture. Add some extra milk if it is difficult to blend Storage: Refrigerate or freeze Rice pudding • 120g pudding rice • 700ml full fat milk • 50g sugar (or swap for sweetener) • 200ml cream • 1 teaspoon of vanilla extract • ½ teaspoon of ground cinnamon • 75g ground almonds • A pinch of salt • 100g skimmed milk powder 1. Blanch the rice in a pan of boiling water for 3 minutes 2. In another pot mix 600ml of milk with the sugar, cream, vanilla extract, cinnamon and salt and bring to the boil 3. Add the blanched rice and ground almonds and simmer for 30 minutes, stirring occasionally 4. Combine with the remaining 100ml of milk and skimmed milk powder 5. Blend until completely smooth and then serve into small portions Storage: Refrigerate 35 Vanilla custard • 1 pint of full fat milk • 55ml single cream • 1 vanilla pod or ¼ teaspoon of vanilla extract • 4 egg yolks • 30g caster sugar • 2 level teaspoons of cornflour 1. Bring the milk, cream and vanilla to simmering point gradually over a low heat. 2. Remove the vanilla pod if used. 3. Whish the egg yolks, sugar and cornflour together in a bowl until well blended. 4. Pour the hot milk and cream mixture into the egg mixture, whisking all the time with a balloon whisk. 5. Return to the pan and stir over a low heat until thickened. Storage: Refrigerate Spiced pear (ideal with the vanilla custard) • 2 pears, peeled, cored and cut into small chunks • A small pinch of cinnamon • A splash of full fat milk 1. Steam the pear for 8-10 minutes until tender. 2. Transfer to the blender and add a splash of milk and cinnamon and blend until smooth. 3. Can be frozen into ice cube trays. Storage: Refrigerate 36 Lemon mousse • 150g lemon curd • Zest of ½ a lemon • 150ml of double whipping cream 1. Put two-thirds of the lemon curd in a large bowl with the zest and cream. 2. Beat with an electric whisk until it holds its shape. 3. Dribble over the rest of the lemon curd, marbling the curd as you add it. 4. Transfer into small pots or glasses. Cover with clingfilm and freeze for 30-40 minutes until set. Storage: Refrigerate 37 Drinks and supplement recipes 38 Nourishing malt drink • 150ml full fat milk • 1 heaped tablespoon milk powder • 3 teaspoons of malted drink powder such as Ovaltine or Horlicks • 2 tablespoons cream Nourishing coffee • 150ml full fat milk • 1 heaped tablespoon milk powder • 1 teaspoon coffee powder • 2 tablespoons of cream Chocolate mocha pots • 1 teaspoon of coffee granules dissolved in a splash of boiling water • 25g butter • 100ml of chocolate Fortisip • 200g plain chocolate broken into chunks • 50g Muscovado sugar (or swap for sweetner) 1. Place all of the ingredients in a small pan and stir gently over a low heat until it has fully melted 2. Pour into small espresso size cups and allow to cool 3. Transfer to the fridge to set Cappuccino • 1 sachet of instant cappuccino mix • 110ml of hot water • 1 bottle of neutral of mocha flavoured Fortisip 1. Put the water, cappuccino mix and Fortisip in a saucepan. Mix well and heat gently until at serving temperature Fortisip milk jelly • 1 packet of blackcurrant or raspberry jelly • 400ml of Strawberry Fortisip • 100ml boiling water 1. Cut the jelly into cubes and place in a bowl 2. Add the boiling water and stir until the jelly is dissolved 3. When cooled slightly, add the Fortisip 4. Mix thoroughly and transfer to small containers and leave in the fridge to set What is Fortisip? You will initially be prescribed high calorie supplement drinks such as Fortisip Compact Protein. This will help you to maximise your nutritional intake. They are available in 8 flavours through your GP: vanilla, strawberry, banana, mocha, peach/mango, berries, neutral, and hot tropical ginger. They can also be frozen into ice cube trays or ice lolly moulds. 3399 soft & bite sized diet 40 What is a soft and bite sized diet? • A soft diet should be of fork-mashable consistency and require some chewing. • Avoid crunchy, sharp foods with skins and doughy foods such as bread. • Continue to aim for small regular meals and snacks over the day. Suggested soft and bite size meal plan Breakfast 8.00am Drink Mid-morning snack 10.00 -10.30am Drink Lunch 12.00 -1.00pm Drink Mid-afternoon snack 2.30 - 3.00pm Drink Dinner 5.00 - 6.00pm Drink Dessert/ Evening Snack 7.00 - 8.00pm Overnight oats Fortified cappuccino Pancakes and crème fraiche Supplement drink Salmon fish cakes Glass of fortified milk Flapjack Supplement drink Beef casserole with pepper mash Nourishing malt drink Tiramisu 41 Soft & bite sized breakfast recipes 42 No-bread eggs benedict • 1 ripe avocado, destoned • 2 slices of ham or smoked salmon • 2 eggs • 2 tablespoons mayonnaise • 1 teaspoon mustard • 2 teaspoons white wine vinegar 1. Bring a saucepan of water to the boil 2. Scoop the avocado flesh into a bowl and season with salt and pepper. Mash with the back of a fork and leave to one side 3. Once the water is boiling carefully crack in the eggs and poach at a gentle simmer for about 4 minutes until the yolk is still runny 4. While the eggs are poaching make the hollandaise sauce. Whisk together the mayonnaise, mustard and vinegar with 3 tablespoons of warm water 5. Once cooked layer the ham or salmon with the mashed avocado then top with poached eggs and spoon over the sauce Storage: Refrigerate Overnight Oats • 120g rolled oats • 120ml full fat Greek yogurt • 220ml full fat milk • ½ tablespoon honey or maple syrup (or sweetener) • 1 teaspoon vanilla extract To make ‘coconut latte’ overnight oats substitute full fat milk for 170ml coconut milk, do not use vanilla extract and instead add: • ½ teaspoon ground cinnamon • 60ml brewed coffee 1. Place all of the ingredients into a large glass container and mix well 2. Put the top on the container & refrigerate for at least 2 hrs or overnight Storage: Refrigerate 43 Potato waffles You will require a waffle iron • 300g peeled potatoes, chopped • 2 tablespoons butter • 1 onion, finely chopped or grated • 1 garlic clove finely chopped • 30g plain flour • 2 eggs 1. Boil the potatoes in a pan of water for around 15 minutes or until soft 2. Meanwhile melt the butter in a pan over a medium heat. Add the onion and garlic and cook until soft 3. Preheat the waffle iron according to the manufacturer’s instructions 4. Drain the potatoes when cook then combine with the onion mixture, flour, eggs and season with salt and pepper. Mix in a large bowl until well blended 5. Scoop the batter into the waffle iron and cook until golden brown Storage: Refrigerate Hint- Ideal to serve with scrambled egg, ham, mushrooms or a combination of toppings 44 Pancakes with banana and crème fraiche • 55g plain flour • 1 egg • 100ml full fat milk • 25g butter • 1 banana • Crème fraiche • Handful of raspberries or blackberries (optional) 1. Sift the flour with a pinch of salt into a large mixing bowl 2. Make a well in the centre of the flour and break in the egg 3. Whisk together and gradually add the milk until a smooth consistency 4. Melt 25g butter in a pan and add half of this to the batter mix and whisk in 5. Get the pan very hot with the remaining butter, then turn down to a medium heat 6. Add about 2 tablespoons of batter to the ban and tilt the pan to completely cover in the batter and thin 7. Cook the pancake on each side until golden but not too crispy 8. To make the fruit purée spoon the berries into a sieve and push through to remove any pips. Serve with crème fraiche Storage: Refrigerate 45 Soft & bite sized main meals 46 Salmon fish cakes • 4 medium potatoes, peeled and chopped into small pieces • 350g skinless and boneless salmon, flaked • Zest of 1 lemon • 1 tablespoon plain flour • 15g fresh chives, finely chopped • 1 medium egg • 30g grated parmesan • 2 tablespoon olive oil 1. Preheat the oven to 180°c 2. Put the potato pieces in a pot of boiling water and cook for 10-15 minutes until soft 3. Drain and mash the potato and allow to cool 4. Add the flaked salmon, lemon zest, flour, chives, egg and parmesan to a large bowl 5. Mix with the mashed potato until well combined 6. Divide the mixture into 8 cakes and shape 7. Place on a baking tray and brush with olive oil 8. Cover with tin foil and bake for 10-15 minutes until cooked through Storage: Refrigerate or freeze Smoked fish chowder • 450g smoked haddock fillet • 170g carrots, peeled and • 60g butter finely chopped • 1 onion, finely chopped • 150ml single cream • 2 tablespoons plain flour • 230g potatoes, peeled and finely chopped 1. Boil 1 litre of water in a saucepan then reduce to a simmer and cook the haddock for about 10 minutes until tender. (continued overleaf) 47 2. Drain the haddock and keep the water to use as stock later 3. Flake the haddock removing any skin and bones 4. Heat the butter in a pan and add the onion and cook until soft 5. Stir in the flour and cook for a minute then gradually add the water back as stock. Bring to the boil stirring constantly 6. Add the potatoes and carrots and simmer for 10 -15 minutes until tender 7. Stir in the flaked fish and cream. Season and serve Storage: Refrigerate Salmon curry • 1 tablespoon olive oil • 1 small onion, sliced • 2 garlic cloves, crushed • ¼ chilli, deseeded and sliced finely • 1 teaspoon milk curry powder (or medium if preferred) • 1 tin salmon or approximtely 200g fresh salmon fillet • 1 spring onion, chopped • 2 tablespoons tomato purée • Boiled brown rice 1. Heat the oil in a pan over a medium heat. Add the onion and garlic and cook until soft 2. Add the chilli and cook for another minute 3. Add 5 tablespoons of water and stir then turn down the heat to a simmer for 5 minutes until the water evaporates 4. Add the tin of salmon, spring onion, tomato purée and salt and pepper 5. Simmer until cooked and soft then serve with a small amount of cooked rice Storage: Refrigerate or freeze 48 Pesto chicken • 1 tablespoon olive oil • 2 small chicken breast fillets, sliced • 1 garlic clove, crushed • 1 tablespoon green or red pesto • 200ml crème fraiche • 10 cherry tomatoes • Boiled rice or pasta 1. Heat the olive oil over a medium heat. Add the chicken and cook for 405 minutes until brown on all sides 2. Immerse the cherry tomatoes in boiling water for a few seconds then carefully remove and peel off the skin 3. Add the onion, garlic, pesto and peeled tomatoes. Cook for 5 -10 minutes stirring continuously 4. Ensure the chicken is tender and fully cooked then stir in the crème fraiche 5. Serve with cooked rice or pasta Storage: Refrigerate 49 Beef and Swede Casserole • 2 tablespoons olive oil • 2 onions, finely chopped • ½ celery stick, sliced finely • 500g diced braising beef • 700ml beef stock • 500g swede, peeled and diced • 300g potatoes, diced • 3 thyme sprigs • 1 bay leaf • Mashed potato to serve 1. Heat the oil in a saucepan or casserole dish 2. Fry the onions and celery for a few minutes until turning brown 3. Add the beef and brown all over for 3-4 minutes 4. Add the stock, swede, potatoes, thyme and bay leaf. Bring to the boil then reduce the heat 5. Simmer for an hour or transfer to a slow cooker if preferred 6. Cook until the beef is tender then remove the thyme and bay leaf before serving Storage: Refrigerate or freeze Moussaka • 500g potatoes, peeled • 3 tablespoons olive oil • 1 red onion, sliced finely • 500g lamb mince • 2 garlic cloves, crushed • 1 teaspoon mixed spice • 500g carton of passata • 2 aubergines, sliced finely • 300ml crème fraiche • 150g grated cheddar 1. Boil the potatoes whole for 20 minutes until soft then drain and allow to cool 2. In another pan add 2 tablespoons of olive oil and fry the onion until softened 3. Add the lamb and fry for 5 minutes until cooked 4. Add the garlic, mixed spice and passata & bring to a simmer 5. Heat the oven to 200°c 6. Warm a new pan over a high heat and add a little oil. Cook the aubergines on each side 7. Once cool slice the potatoes into thick slices 8. In an ovenproof dish layer the potatoes, then aubergines, then a layer of lamb mince mixture and repeat until all of the ingredients are used, ensuring an aubergine layer is on top 9. Spread the crème fraiche over the top and sprinkle with cheddar 10. Bake in the oven for 10 minutes or until the top is golden Storage: Refrigerate or freeze 50 51 Vegetarian lasagne • 1 red pepper, deseeded and cut into chunks • 2 courgettes, sliced • 1 small aubergine • 2 garlic cloves • 1 red onion, finely chopped • Olive oil • 250g Quorn mince • 1 tablespoon Worcestershire sauce • 1 tin tomatoes • 1 teaspoon oregano • 450ml full fat milk • 25g butter • 40g plain flour • 70g cheddar • 30g parmesan • 120g lasagne sheets 1. Heat the oven to 220°c 2. Put the peppers, courgettes, aubergines, half the garlic and half the onion into a roasting tin. Season and drizzle with olive oil then roast for around 30 minutes until tender 3. Heat 2 tablespoons of olive oil in a pan and add the remaining onion and garlic and fry for a few minutes until soft. Add the Quorn mince, Worcestershire sauce, tomatoes and oregano and simmer for 5 minutes 4. In a separate pan put the milk, butter, flour and seasoning. Heat and whisk until thickened and smooth. Stir in the cheddar and parmesan 5. Layer the Quorn mince mix, roasted vegetables, lasagne sheets and cheese sauce alternately in an ovenproof dish 6. Cook for around 40 minutes at 200°c until golden Storage: Refrigerate or freeze 52 Swedish meatballs • 250g mince beef • 1 garlic clove, chopped • ½ onion, finely chopped • ½ egg • 2 tablespoons chopped fresh parsley • Olive oil • 1 tablespoon butter • 20g plain flour • 250ml beef stock • 120ml cream • 1 teaspoon Worcestershire sauce • Pasta (tagliatelle or penne) 1. To make the meatballs mix together the beef, garlic, onion, egg and parsley in a bowl. If the mixture is very thick add a little more egg 2. Using a tablespoon roll out meatballs from the mixture 3. Heat oil in a pan over a medium heat and add the meatballs and cook for about 10 minutes until browned, turning occasionally. 4. Remove the meatballs and leave to cool on a paper towel 5. To make the sauce melt the butter in a pan and whisk in the flour until golden brown. Slowly whisk in the beef stock and cook until thickened 6. Add the cream, Worcestershire sauce and season with salt and pepper. 7. Add the meatballs and coat in the sauce then sprinkle with parsley. 8. Boil the pasta in water until soft then serve with the meatballs Storage: Refrigerate or freeze 53 Soft & bite sized side dishes 54 Spinach mash • 500g potatoes, peeled and chopped • 100g spinach • 60ml single cream • 20g butter 1. Boil the potatoes in a pan of water until soft 2. In a separate pan steam the spinach leaves until wilted. When cool squeeze out excess liquid 3. Blend the spinach with the butter until almost smooth 4. Mash the potato in a large bowl then stir in the spinach purée and cream Storage: Refrigerate or freeze Pepper mash • 1 red pepper, quartered with seeds removed • 500g potatoes, peeled and chopped • 60ml single cream • 20g butter 1. Roast the pepper under a hot grill, skin side up until it blackens. 2. Leave to cool then peel the skin from the pepper then blend until smooth 3. Meanwhile boil the potatoes in a pan of water until soft 4. Mash the potato in a bowl then stir in the butter, cream and pepper purée Storage: Refrigerate or freeze Hint: You could use the purée side dish recipes within this book and mash with a fork rather than blend completely 55 Soft & bite sized desserts & snacks 56 Hummus and butter biscuits For the biscuits: For the hummus: • 160g plain flour (whole wheat or white) • 1 tablespoon sugar • Pinch of salt • 80ml water • 4 tablespoons unsalted butter • 1 400g tin of chickpeas • 1 small clove of garlic • 1 tablespoon tahini • 1 lemon • Olive oil 1. Preheat the oven to 200°c 2. Line a baking sheet with parchment paper 3. Put the flour, sugar and salt in a food processor 4. Add the butter and blend until the butter is fully incorporated 5. With the mixer still running, add the water and blend until it forms a smooth dough 6. Once smooth remove the dough from the blender and divide into 4 equal pieces 7. Lightly flour the work surface then roll each dough piece into a large triangle, turning frequently to stop it sticking to the surface 8. Use a pizza cutter or knife to cut into approximately 3cm squares. 9. Place onto the baking sheet and cook until lightly browned for about 10 minutes 10. To make the hummus; drain the chickpeas and add to the blender. Peel and add the garlic and tahini with a good squeeze of lemon juice and 1 tablespoon of olive oil 11. Season with a pinch of salt and blend until smooth. Add extra lemon juice or a splash of water if needed Storage: Refrigerate hummus, store biscuits in an airtight container 57 Tiramisu • 600ml double cream • 175g pack sponge fingers • 250g mascarpone (full-fat) • 25g dark chocolate • 5 tablespoons golden caster sugar • 2 teaspoons cocoa powder • 300ml strong coffee (2 tablespoons coffee granules in 300ml boiling water) 1. Put the double cream, mascarpone and caster sugar in a large bowl and whisk until completely combined 2. Pour the coffee into a shallow bowl and dip in the sponge fingers a few at a time for a few seconds until nicely soaked but not too soggy 3. Grate the dark chocolate coarsely 4. In a large dish form alternating layers of sponge fingers, then a layer of cream mixture and topped with chocolate and cocoa powder. Repeat until all the ingredients have been used up Storage: Refrigerate for up to 2 days Flapjacks • 115g rolled oats • 55g butter • 200g no added sugar, seedless Jam (try fig, apple or pomegranate) • Dark chocolate for drizzling 1. Heat the oven to 180°c 2. Melt the butter and jam in a large pan over a gentle heat 3. Add the oats and stir until well combined 4. Press into a greased square tin or cake tin 5. Bake in the oven for 25-30 minutes until brown 6. Melt some dark chocolate and drizzle over the flapjack to serve 7. Once cool cut into small pieces 58 Apple sponge pudding • 2 large cooking apples, peeled and cored • 85g caster sugar (or swap for sweetener) • 3 tablespoons cold water • ½ egg • Finely grated zest and juice • 1 teaspoon baking powder of 1 lemon • 65g plain flour 1. Quarter the apples and place in a saucepan with
Url: /Media/UHS-website-2019/Docs/Services/planets-texture-modified-recipe-book.pdf

Squint surgery for adults - patient information

Description: We have given you this factsheet because you are on the waiting list for an operation to correct your squint.
Url: /Media/UHS-website-2019/Patientinformation/Eyes/Squint-surgery-for-adults-1780-PIL.pdf

Eating and drinking with a high output stoma - patient information

Description: This factsheet provides information on how to manage your high output stoma.
Url: /Media/UHS-website-2019/Patientinformation/Digestionandurinaryhealth/Eating-and-drinking-with-a-high-output-stoma-2412-PIL.pdf

Procedure for making triclyceride emulsion

Description: NIHR Southampton Biomedical Research Centre The NIHR Southampton Biomedical Research Centre (BRC) has a tight quality assurance system for the writing, reviewing and updating of Standard Operating Procedures. As such, version-controlled and QA authorised Standard Operating Procedures are internal to the BRC. The Standard Operating Procedure from which information in this document has been extracted, is a version controlled document, managed within a Quality Management System. However, extracts that document the technical aspects can be made more widely available. Standard Operating Procedures are more than a set of detailed instructions; they also provide a necessary record of their origination, amendment and usage within the setting in which they are used. They are an important component of any Quality Assurance Framework, but in themselves are insufficient and need to be used and interpreted with care. Alongside the extracts from our Standard Operating Procedures, we have also made available here an example Standard Operating Procedure and a word version of a Standard Operating Procedure template. Using the example and the Standard Operating Procedure template, institutions can generate their own Standard Operating Procedures and customise them, in line with their own institutions. Simply offering a list of instructions to follow does not assure that the user is able to generate a value that is either accurate or precise so here in the BRC we require that Standard Operating Procedures are accompanied by face-to-face training. This is provided by someone with a qualification in the area or by someone with extensive experience in making the measurements. Training is followed by a short competency assessment and performance is monitored and maintained using annual refresher sessions. If you require any extra information, clarification or are interested in attending a training session, please contact Dr Kesta Durkin (k.l.durkin@soton.ac.uk). This document has been prepared from Version 2 of the BRC Standard Operating Procedure for making up triglyceride emulsion for assessing pancreatic function. It was last reviewed in September 2015 and the next review date is set for September 2017. The version number only changes if any amendments are made when the document is reviewed. Page 1 of 5 NIHR Southampton Biomedical Research Centre NIHR Southampton Biomedical Research Centre Procedure for making C MIXED TRYGLYCERIDE EMULSION 13 BACKGROUND There are a number of ways of assessing pancreatic function using non-invasive methods. One of these is to orally administer a substrate that is labelled with a tracer, which when ingested will be absorbed and subsequently oxidised so that the tracer may then be detected on the breath. The amount of tracer in breath then reflects pancreatic function. The substrate used is a type of triglyceride where one of the carbon atoms of the fatty acids is modified to contain a stable isotopic tracer (13C) ? in this case, 2-[13C]octanoyl-1,3-distearin or 13C mixed triglyceride (13C-MTG). Triglycerides are a form of fat which occur naturally in the diet. In order to reflect the normal digestion of fat in food, the 13C-MTG must be incorporated into a food matrix similar to how triglyceride is found in the diet normally. The substrate is then incorporated into a lipid emulsion with other ingredients and the final product resembles a milkshake. This also makes it more palatable for the subject to consume. PURPOSE The purpose of this document is to ensure the safe and accurate preparation of the emulsion containing 13C-MTG. Several steps which must be carried out in the correct sequence are involved in making-up the emulsion. It is important to ensure that this is done consistently so the resulting emulsion is the same each time. Changes in the proportion of ingredients, their sequence of mixing and the temperature of the emulsion each can affect the way the substrate is handled in the gut. SCOPE This procedure applies to all personnel involved in making up the emulsion containing 13C-MTG for non-invasive assessment of pancreatic function. Page 2 of 5 NIHR Southampton Biomedical Research Centre RESPONSIBILITIES It is the responsibility of the person preparing this 13C mixed triglyceride emulsion drink, to ensure that it is made up and administered to the participant, according to this procedure. PROCEDURE 3.5g Olive oil 3g Sunflower oil 33.2g Milk powder (Marvel) 9g Glucose 4.5g Caster sugar 10g Strawberry Nesquik flavouring 22g Double cream 200 ml Bottled water 10mg 13C-MTG/kg bodyweight of subject 2 slices of white bread and 10g butter to serve as toast Weighing boats (?7). Saucepan for use on the hob Thermometer Food blender Large ceramic mug Small ceramic mug to drink the emulsion from Weighing scales Large (400ml) Pyrex beaker Small (200ml) Pyrex beaker 2 pipettes Spatula 1. In the Nutrition kitchen on level C in the WTCRF, weigh out the required mass of sugar (4.5g), glucose (9g), Nesquik (10g), double cream (22g) and milk powder (33.2g) to the nearest 100mg or 0.1g in separate weighing boats. 2. Transfer the oils using a plastic pipette (pastette). Weigh olive oil (3.5g) into a weighing boat and then press the TARE button and add sunflower oil (3g) into the same boat. 3. Place the weighing boat on the scales DO NOT PRESS TARE. Calculate the mass of 13C-MTG required according to the subject's body weight and add this mass to the weighing boat. It should be 10mg 13C-MTG/kg body weight. Record the final weight to the nearest mg. Do not touch/switch the scales off. 4. Fill up the saucepan from the cupboard in the kitchen with water from the hot water system by the sink and put onto the hob to heat until the water reaches a gentle boil. Try to keep at this state throughout the process. Page 3 of 5 NIHR Southampton Biomedical Research Centre 5. Fill the larger of the two ceramic mugs with hot water from the hot water system and place the blender attachment in there to warm up. 6. Measure out 70ml of bottled water and put into the smaller (200ml) of the two Pyrex beakers then put this beaker with water in, into the saucepan to heat up. Make sure that the amount of water in the saucepan is appropriate so that the beaker can sit stably. 7. Measure out 100ml of bottled water and put into the larger (400ml) Pyrex beaker and put into the water bath. 8. Add the smaller of the two ceramic mugs into the pan (with the 400ml beaker in) and transfer the 13C-MTG into the smaller ceramic mug in the water bath. It will melt. Reweigh the weighing boat by putting back on the scales and record the weight of the empty boat. The amount of 13C-MTG dispensed will be the difference between the weight of the boat with 13CMTG boat before weighing out the 13C-MTG and the empty weighing boat after tipping the 13C-MTG into the mug in the pan. 9. Add the sugar and glucose to the smaller (200ml) Pyrex beaker 10. When the 13C-MTG has melted, add the oils into this smaller ceramic mug, using a pastette. 11. Add the double cream and wait for the temperature of the mixture to increase. 12. Add the milk powder to the smaller (200ml) beaker and mix with the blender whilst keeping the beaker in the pan. 13. Replace the blender to the insulated mug with the hot/warm water in. Do not worry about loss of mixture on the blender. 14. Add the mixture in the smaller (200ml) Pyrex beaker into the ceramic mug still in the pan, and blend for 2 minutes with the blender, keeping the mug immersed in the hot water. 15. Lift the blender out and hold over the mug whilst you put in the Nesquik. 16. Blend in the beaker for 30 seconds, whilst the mug is kept the pan. 17. Rinse the remainder from the blender into the emulsion with approximately 50ml of bottled water from the larger (400ml) Pyrex beaker (which should be in the pan and should contain 100ml of bottled water). This should be achieved by pouring the 50ml of water onto the blender attachment whilst held over the mug. Allow time for the contents to cool slightly (see point 19). 18. During this period, make two slices of white toast spread with 10g butter. 19. Allow time for the contents of the small ceramic mug to cool slightly ? do not allow the temperature of the drink to fall too much. It should be taken to the participant at a temperature for them to sip the drink (as if you would a tea, coffee or hot chocolate ? no lower than 70?C. A yellow thermometer can be found in the cupboard should you wish to check this). 20. Take the emulsion, toast and remaining 50ml hot water in the larger (400ml) Pyrex beaker to the subject. (The larger Pyrex beaker should now contain the remaining, approximately 50ml of bottled water). 21. Ask the participant to eat one of the slices of toast. Page 4 of 5 NIHR Southampton Biomedical Research Centre 22. Ask them then to drink the Nesquik-flavoured drink 23. Using a stopwatch, keep a note of the time it takes the subject to drink the emulsion. 24. Pour the remaining 50ml hot water from larger (400ml) Pyrex beaker into the mug and swirl around. 25. Give the washings to the subject to drink. 26. When all the emulsion has been ingested, give the subject the second piece of toast to eat. Page 5 of 5
Url: /Media/Southampton-Clinical-Research/Procedures/BRCProcedures/Procedure-for-making-triclyceride-emulsion.pdf

Annual report 20-21

Description: 2020/21 Incorporating the quality report University Hospital Southampton NHS Foundation Trust Annual Report and Accounts 2020/21 Presented to Parliament pursuant to Schedule 7, paragraph 25(4)(a) of the National Health Service Act 2006 © 2021 University Hospital Southampton NHS Foundation Trust Table of contents Welcome from our chair and chief executive 6 Overview and performance 8 Performance report 9 Overview 10 Accountability report 29 Directors’ report 30 Remuneration report 53 Staff report 65 NHS Foundation Trust Code of Governance 81 NHS Oversight Framework 81 Annual governance statement 84 Quality report 95 Statement on quality from the chief executive 96 Priorities for improvement and statements of assurance from the board 99 Other information 153 Annual accounts 180 Statement from the chief financial officer 181 Auditor’s report 182 Foreword to the accounts 188 Statement of Comprehensive Income 189 Statement of Financial Position 190 Statement of Changes in Taxpayers’ Equity 191 Statement of Cash Flows 192 Notes to the accounts 193 5 Welcome from our chair and chief executive 2020/21 was undoubtedly the most challenging year in the history of the NHS, and we have felt the impact of the COVID-19 pandemic here at University Hospital Southampton NHS Foundation Trust (UHS) in full. Responding to this has meant there isn’t a single part of our organisation that hasn’t changed in some way over the last year and we have all had to adapt to a rapidly changing environment. Our staff have been unwavering in their dedication, hard work and commitment to keeping our hospitals running, our patients cared for, and their colleagues supported. Every single member of the UHS family has played their part. The loss of life from COVID-19 has been devastating, and at UHS we stand shoulder-to-shoulder with everyone affected by this tragedy, including the families of staff members whom we lost. We must recognise the incredible work of Southampton Hospital Charity, which has funded boost boxes, wellness rooms, a helpline and so much more to support staff at a time when their wellbeing is more important than ever. As the nationwide vaccination programme continues to offer hope of life more like pre-pandemic times, we are proud to have been at the forefront of these efforts - from being part of early research for the Oxford-AstraZeneca vaccine, to the opening of one of the largest vaccination hubs in the region on our site in December 2020. We will continue to play a key role in vaccination development by leading the world’s first clinical trial into the effectiveness of COVID-19 booster vaccines, as well as taking part in a study involving pregnant people. Our response to COVID-19 has prompted innovation and new ways of working across the Trust, to the benefit of patient experience. At the start of the pandemic we faced real challenges of capacity and increases in waiting times, which led to us working with Spire Southampton so cancer treatment and surgery could continue for patients at highest risk. We also increased the number of outpatient attendances which took place by telephone or video call, and our patient support hub was set up to provide a single point of support for patients who had been advised to shield. We are immensely proud of the record of the Trust during the pandemic, exemplified by the number of patients we were able to take into our care from well outside the local area. The Trust is in a strong financial position as a result of careful spending and efficiencies, which has allowed us to invest significantly in upgrading our estate. These improvements have seen the opening of the general intensive care unit, and the new cancer ward, which was built in just six months. These formed part of overall capital expenditure of £80 million during the year. The last year has seen us say goodbye to two members of our executive leadership team. Paula Head left the chief executive officer role in November to join the national response to COVID-19, before becoming a senior fellow at The King’s Fund. Derek Sandeman moved on from being our chief medical officer to take the same position at the Hampshire and Isle of Wight Integrated Care System. We are grateful to both for their efforts on the Trust leadership team during the most challenging of years. One of our non-executive directors, Jenni Douglas-Todd, also left the Trust to take on the important role of director of equality and inclusion with NHS England and NHS Improvement. 6 Looking ahead to the future, UHS will play a key role in the Hampshire and Isle of Wight Integrated Care System. Our commitment is to deliver services with partners through clinical networks, collaboration and integration across geographical and organisational boundaries for seamless patient care. We as a Trust board are looking forward to implementing our own five year strategy, which sets out ambitions for what we want the hospital to be in 2025, for both patients and staff. Our focus will always be on enabling world class people to deliver world class care. Peter Hollins David French Chair Chief Executive Officer 7 OVERVIEW AND PERFORMANCE Performance report Introduction from our chief executive Over the last year, the way in which the Trust has worked and performance it has achieved, has been transformed by the COVID-19 pandemic. • UHS saw a number of large surges in demand for inpatient care, and for intensive respiratory support in particular, due to COVID-19 infection rates. Our capacity to deliver intensive care had to be increased, and many of our staff moved from other services such as our elective theatres in order to meet this need for care. • We have introduced and continue to maintain a number of changes to reduce the risk of COVID-19 being transmitted, or adversely affecting patient outcomes, within the Trust. Changes have included the wearing of additional personal protective equipment by our staff (especially when caring for patients who might have COVID-19 or undertaking higher risk procedures), reducing the number of patients coming to our outpatient departments and increasing the number of telephone and video consultations, separating elective and emergency patients within our departments and regular testing of our staff and all patients on or prior to their admission to hospital for treatment. • Public concerns about safety, government restrictions and the efforts of community services actually contributed to reductions in the total number of patients who sought hospital care this year. • Treatment plans have been modified by a number of services, in partnership with patients, to reduce the risk posed by COVID-19 to those patients. This was often appropriate in those circumstances in which the normal treatment would significantly reduce the patient’s own resistance to infections. Our performance has, in many cases, been strongly influenced by these profound changes. We have responded well to the need to provide the most urgent care, and the adverse impacts on elective care have been slightly less than the average across the NHS. However, we remain very concerned by the significant increase in the numbers of patients waiting longer than they should for elective care. It will take concerted and sustained action within both the Trust and the wider NHS in order to return elective performance to levels achieved before the pandemic whilst also continuing to meet urgent care needs as the restrictions that have been implemented within our society are progressively relaxed. 9 Overview About the Trust Our services University Hospital Southampton NHS Foundation Trust is one of the largest acute teaching trusts in England with a turnover of more than £1 billion in 2020/21. It is based on the coast in south east England and provides services to over 1.9 million people living in Southampton and south Hampshire and specialist services, including neurosciences, respiratory medicine, cancer care, cardiovascular, obstetrics and specialist children’s services, to more than 3.7 million people in central southern England and the Channel Islands. The Trust is also a designated major trauma centre, one of only two places in the south of England to offer adults and children full major trauma care provision. As a leading centre for teaching and research, the Trust has close working relationships with the University of Southampton, the Medical Research Council, National Institute for Health Research (NIHR), Wellcome Trust and Cancer Research UK. UHS is consistently one of the UK’s highest recruiting trusts of patients to clinical trials and in the top ten nationally for research study volume as ranked by the NIHR Clinical Research Network. 12,000 Every year over staff at UHS: treat around 160,000 inpatients and day patients, including about 75,000 emergency admissions see over 650,000 people at outpatient appointments deal with around 150,000 cases in our emergency department deliver more than 100 outpatient clinics across the south of England, keeping services local for patients The Trust provides most of its services from the following locations: • Southampton General Hospital – the Trust’s largest location, where a great number of specialist services are based alongside emergency and critical care and which includes Southampton Children’s Hospital. • Princess Anne Hospital – located across the road from Southampton General Hospital and providing maternity care and specialist care for women with medical problems during pregnancy and babies who need extra care around birth across the region. • Royal South Hants Hospital – although the Trust does not operate this site near the centre of Southampton it provides a smaller number of services from this location. • New Forest Birth Centre – located at Ashurst on the edge of the New Forest and run by experienced midwives and support staff it offers a safe, ‘home away from home’ environment for women having a healthy pregnancy and expecting a straightforward birth. The services provided by the Trust are commissioned and paid for by local clinical commissioning groups (CCGs) and, in the case of more specialised services (such as treatments for rare conditions), by NHS England. Over 50% of UHS services are paid for by CCGs and approximately 48% by NHS England. We provide these under a standard NHS contract, which incorporates ongoing monitoring of the Trust and the quality of the services provided. 10 Our structure UHS gained foundation trust status on 1 October 2011. A foundation trust is a public benefit corporation providing NHS services in line with the core NHS principles: that care should be universal, comprehensive and free at the point of need. The Trust is licensed as a foundation trust to provide these services by Monitor (the independent regulator, now part of NHS England and NHS Improvement) and the healthcare services we provide are regulated by the Care Quality Commission. Being a foundation trust has enabled greater local accountability and greater financial freedom and has supported the delivery of the Trust’s mission and strategy over a number of years. The diagram below provides an overview of the overall organisational structure of the Trust. Public and foundation trust members Council of Governors Board of Directors Executive Directors Division A Surgery Critical Care Opthalmology Theatres and Anaesthetics Division B Division C Cancer Care Emergency Medicine Helicopter Emergency Medical Services Medicine and Medicine for Older People Pathology Specialist Medicine Women and Newborn Maternity Child Health Clinical Support Division D Trust Headquarters Division Cardiovascular and Thoracic Neurosciences Trauma and Orthopaedics Radiology Corporate Affairs Communications Estates, Facilities and Capital Development Finance Human Resources Informatics Patient Support Services Procurement and Supply Transformation and Improvement (‘Always Improving’) Research and Development Strategy and Business Development 11 The Trust is also part of an integrated care system in Hampshire and the Isle of Wight, which is a partnership of NHS and local government organisations working together to improve the health and wellbeing of the population across Hampshire and the Isle of Wight. Our values Our values describe how we do things at UHS and act as a guide to all staff working with colleagues to deliver high quality patient care and a great patient experience every day. Our values are: Patients, their families and carers are at the heart of what we do. Their experience of our services will be our measure of success. Partnership between clinicians, patients and carers is critical to achieving our vision, both within hospital teams and extending across organisational boundaries in the NHS, social care and the third sector. We will ensure we are always improving services for patients through research, education, clinical effectiveness and quality improvement. We will continue to incorporate new ideas, technologies and create greater efficiencies in the services we provide. 12 Our strategy 2021-25 The Trust’s strategy was updated during 2020/2021 to take account of everything our staff had experienced during the COVID-19 pandemic and what we had learnt from this. The vision for UHS is to continue on its journey to become an organisation of world class people delivering world class care. Our strategy is organised around five themes and for each of these describes a number ambitions we aim to achieve by 2025. Theme Ambitions Outstanding patient outcomes, • We will monitor clinical outcomes, safety and experience of our experience and safety patients regularly to ensure they are amongst the best in the UK By 2025 we will strengthen our and the world. national reputation for outstanding • We will reduce harm, learning from all incidents through our patient outcomes, experience and proactive patient safety culture. safety, providing high quality care • We will ensure all patients and relatives have a positive experience and treatment across an extensive of our care, as a result of the environment created by our people range of services from foetal and our facilities. medicine, through all life stages and conditions, to end-of-life care. Pioneering research • We will recruit and enable people to deliver pioneering research and innovation in Southampton. We will continue to be a leading teaching hospital with a growing, reputable and innovative research and development portfolio • We will optimise access to clinical research studies for our patients. • We will enable innovation in everything we do, and ensure that ‘cutting edge’ investigations and treatments are delivered in Southampton. that attracts the best staff and efficiently delivers the best possible treatments and care for our patients. World class people • We will recruit and develop enough people with the right Supporting and nurturing our knowledge and skills to meet the needs of our patients. people through a culture that values • We will provide satisfying and fulfilling roles, growing our talent diversity and builds knowledge and through development and opportunity for progression. skills to ensure everyone reaches • We will empower our people, embracing diversity and embedding their full potential. We must provide compassion, inclusion and equity of opportunity. rewarding career paths within empowered, compassionate, and motivated teams. Integrated networks and collaboration We will deliver our services with partners through clinical networks, collaboration and integration across geographical and organisational boundaries. • We will work in partnership with key stakeholders across the Hampshire and Isle of Wight integrated care system. • We will strengthen our acute clinical networks across the region, centralising when necessary and supporting local care when appropriate. • We will foster local integration with primary and community care as well as mental health and social care services for seamless delivery across boundaries. • We will build on our successful partnership with University of Southampton (UoS), growing our reputation as a national leading university teaching hospital. 13 Theme Foundations for the future Making our enabling infrastructure (finance, digital, estate) fit for the future to support a leading university teaching hospital in the 21st century and recognising our responsibility as a major employer in the community of Southampton and our role in broader environmental sustainability. Ambitions • We will deliver best value to the tax payer as a financially efficient and sustainable organisation. • We will support patient self-management and seamless care across organisational boundaries through our ambitious digital programme, including real time data reporting, to inform our care. • We will expand and improve our estate, increasing capacity where needed and providing modern facilities for our patients and our people. • We will strengthen our role in the community as an employer of choice, a partner in delivery of services to our population and by leading the Greener NHS agenda locally. During each year of the strategy the Trust will set out a more detailed series of objectives to achieve and progress towards the delivery of its ambitions. In 2020/21 these objectives included: • Recovery, restoration and improvement of clinical services • Implementing the ‘Always Improving’ strategy • Restoring a full research portfolio • Continuing our focus on staff wellbeing including the long-term effects of coronavirus (long COVID) • Working in partnership with the newly established integrated care system • Creating a sustainable financial infrastructure • Making our corporate infrastructure (digital, estate) fit for the future to support a leading university teaching hospital in the 21st century, including an estates masterplan. Performance against these objectives will be monitored and reported to the Trust’s board of directors on a quarterly basis. Principal risks to our strategy and objectives The board of directors has identified and manages the principal risks to the delivery of its strategy and objectives through its board assurance framework. The principal risks to the delivery of its strategy and objectives identified by the Trust during 2020/21 were that: • it would be unable to form effective partnerships that achieve networked care for patients; • it could not develop the estate in line with the ambitions set out in the strategy; • it would fail to restore and increase capacity following the COVID-19 pandemic to meet waiting times for elective care and cancer care needs; • it would fail to introduce and implement new technology for the transformation of care; • it would be unable to retain, recruit, develop and train a diverse and inclusive workforce necessary to meet the strategic goals; • it could not develop a sustainable model within the new financial regime that preserves quality care; • it would fail to provide vulnerable service users with timely and high quality and appropriate care; • it would not reach the ambition of outstanding compliance and quality standards; • it could not sufficiently engage with key stakeholders and system partners to support effective interventions and maintain the health of the local population; • it would be unable to respond to the needs of the NHS in order to deliver our strategy; • it would fail to capitalise on its relationship with the universities in Southampton and other health education providers in line with our strategy; • it would not develop innovative education and training approaches. 14 While the COVID-19 pandemic presented the Trust with new risks as it introduced more stringent infection control processes, stopped certain types of activity and responded quickly to care for large numbers of seriously ill patients who had tested positive for COVID-19, it also prompted innovation across a wide range of areas. However the ongoing impact of the pandemic on both our staff, patients who have had COVID-19 and patients who have waited longer than expected for treatment as a result, added to the risks facing the Trust. National targets for performance have not been amended as a result of the pandemic, although the national plan has focussed on the recovery of activity levels as the first stage in a restoration of elective services. Capacity – The initial and subsequent waves of the COVID-19 pandemic have led to increases in the waiting times for patients and the number of patients waiting more than 52 and 78 weeks has increased significantly. While the Trust was able to recover capacity quickly between waves of the pandemic, its ability to reduce the overall waiting list and the length of time patients are waiting for treatment remains one of the key risks for the Trust. This may be compounded by the reduction in the number of referrals from GPs during the pandemic, leading to a potential future increase in the number of patients being referred as people visit their GPs for the first time with more advanced disease. During the pandemic the Trust utilised the support available from the independent sector to continue cancer treatment and surgery for those patients at highest risk. It also increased the number of outpatient attendances which took place by telephone or video call. The Trust developed a clinical assurance framework during the year to better assess the risk of harm to patients as a result of delays in treatment and this has been utilised in decision-making around the allocation of resources to those areas where there is the greatest risk of potential harm to patients. In addition to opening additional capacity during 2020/21 (described in the Estates section below), the Trust also committed expenditure and commenced construction works in 2020/21 in order to be in a position to open an additional endoscopy room and four further operating theatres during 2021/22 and prepared plans for a significant expansion in ophthalmology outpatient capacity. These initiatives will contribute to improvements in elective waiting times that needed following the pandemic. Quality and compliance – The Trust continued to monitor the quality of care delivered throughout 2020/21. During the COVID-19 pandemic the primary focus became infection prevention and control, with the launch of a successful COVID ZERO campaign that saw the Trust reduce the transmission of the virus in hospital (nosocomial transmission). The Trust also achieved its annual target for reduction in Clostridium Difficile infections, however, there was one MRSA Bacteraemia during March 2021, the only such event in 2020/21. The Trust continued to develop its proactive patient safety culture during 2020/21 with changes to the way in which patient safety incidents are investigated and the approval of its Always Improving strategy, which will be launched in 2021. Reporting and investigation of incidents continued during 2020/21. Partnerships – During 2020/21, the Trust and its partners worked together very effectively to discharge patients safely and provide ongoing support to patients who had tested positive for COVID-19, to ensure patients requiring urgent cancer treatment and surgery were able to continue their treatment in the independent sector and to develop a COVID-19 saliva testing pilot with the University of Southampton and local authorities. Work to respond to the COVID-19 pandemic, however, meant that as a system we were unable to progress the Hampshire and Isle of Wight strategic plan delivery at the pace we would have wanted or had set out to achieve, particularly the development of networks. Nonetheless the application for Hampshire and Isle of Wight to become an integrated care system was approved with effect from 1 April 2021. 15 Existing networks continued to develop and improve. The Trust also became the Wessex Cancer Surgical Hub during 2020 as a result of a national initiative with the aim of maximising the number of patients receiving curative surgery. Both the Wessex Cancer Alliance and the Trust ended the year as the second highest performing among their respective peers for cancer treatment. Workforce – While additional staff were recruited to specifically assist the Trust during the pandemic, the Trust continued to recruit nurses from overseas during 2020/21 meaning that the number of vacancies has reduced compared to the position prior to the pandemic. Changes to recruitment processes were approved in 2020/21 to improve the fairness, transparency and quality of these. The Trust also continued to work with its staff networks and specific focus groups to increase diversity in leadership roles. While workforce capacity continues to be one of the biggest challenges faced by the Trust, during 2020/21 our main focus has been on supporting our staff to respond to the COVID-19 pandemic and providing both the tools and time to help staff recovery. We are incredibly proud of the way that staff responded to the pandemic and continue to recognise this in whatever ways we can, however, we also want to ensure that staff continue to be able to contribute to patient care at their best and want to stay and develop with the Trust. Technology was also used at levels not previously achieved to continue to deliver training to staff and enable staff to work from home where possible, ensuring a safer environment for patients and staff in the hospitals. Estate – The Trust continued to invest in and develop its estate during 2020/21 including the opening a new general intensive care unit (GICU), a new operating theatre and a new cancer care ward, built in just six months. These were part of £80 million of capital expenditure in 2020/21. The Trust has also established a programme to reduce backlog maintenance in addition to continuing to add to and improve the environment in which services are provided to patients and the working environment for staff. Innovation and technology – There have been exceptional levels of achievement in relation to COVID-19 related research activity, including in partnership with the universities. You can read more about these from page 167 of the quality report. The board of directors also supported the funding of an expansion of research and innovation activity to allow the continued delivery of the Trust’s ambitions to innovate and improve and transform its services. Sustainable financial model – The Trust achieved its forecast breakeven position in 2020/21. Income was more predictable in 2020/21 as block contract arrangements were put in place in response to the COVID-19 pandemic and ensured that costs were covered. The Trust continues to maintain a strong cash position and to implement improvements and efficiency savings, allowing it to continue to invest in its services. 16 Summary of performance COVID-19 bed occupancy UHS has experienced two distinct peaks in inpatient care for patients with COVID-19 infection, with smaller numbers of patients continuing to receive care outside these peak times. Bed occupancy reached a maximum of 173 in the first peak in April 2020, and 322 in the second peak in January 2021. All bed types Intensive care/higher care beds 17 Emergency access through our emergency and eye casualty departments Public concerns about safety, government restrictions on the activities people were able to do, and the efforts of community services contributed to significant reductions in the total number of patients who presented to our departments. All patients presenting to the emergency department Many changes were introduced within our departments in the course of the year to ensure that emergency assessment and treatment could be provided safely, including wearing of protective equipment by staff and patients, providing care in separate areas for patients suspected or known to have COVID-19, and using rapid laboratory tests to identify infection and confirm/exclude COVID-19 as a cause. Emergency access performance (measured as the percentage of patients discharged from emergency department care or admitted to a hospital bed within four hours of arrival to the department) improved significantly in 2020/21 compared to previous years. The national target of 95% was not achieved, however, the performance of our departments compared favourably with the average for acute trusts in England. 18 Emergency access four hour performance 19 Elective Waiting times Demand We saw a significant reduction in the number of elective referrals to hospital in the early part 2020/21, though they had returned close to pre-pandemic levels by the end of the year. It is likely that this pattern relates to a range of factors including reluctance from members of the public to attend healthcare facilities at that time, changes to the ways in which primary care was accessed, and efforts made within primary and community to avoid hospital referrals needing to be made. Accepted referrals The number of patients referred to hospital with suspected cancer also reduced during 2020/21; 7% fewer patients were seen across the year as a whole, though referrals returned to pre-pandemic levels or higher from July 2020 onwards. Patients seen following ‘Two week wait’ urgent referral for suspected cancer 20 Activity UHS hospital appointments, diagnostic tests and elective admissions were all significantly reduced during 2020/21 due to the impact of COVID-19. • During periods of higher bed occupancy with COVID-19 it was necessary to significantly reduce the number of elective admissions undertaken in order that additional staff could work in intensive care. Less clinically urgent and therefore longer waiting patients were primarily those affected. • Throughout the year, additional infection prevention measures have reduced the number of patients that can be seen in each session, particularly when higher risk ‘aerosol generating’ procedures are planned, but also as a result of additional PPE being worn or to enable greater distancing of patients attending outpatient departments. UHS was offered additional capacity at local independent sector hospitals and used this effectively to minimise these adverse impacts. Approximately 30% of outpatient appointments are now undertaken by telephone or video, helping to maintain the capacity for patient care whilst reducing the infection risk for those patients and helping to maintain distancing measures for those patients still attending our outpatient departments. The graphs below show 2020/21 activity levels as a percentage of those achieved in the previous year. Elective admissions (including daycase) 21 Outpatient attendances Performance The average waiting time for first outpatient appointments has remained close to nine weeks for the majority of the year. UHS has however experienced very significant deteriorations in the waiting times our patients experience for diagnostic tests to be undertaken and elective treatment to be provided. The reduced number of new patients referred to hospital early in 2020/21 has moderated the extent of the growth in the total numbers of patients waiting, and the greatest rate of growth has unfortunately been amongst those groups of patients already waiting longest. 22 Diagnostics Our performance measures for diagnostics report on a total of 15 different frequently used tests. The waiting list is approximately 50% bigger than it was before the pandemic and stable through the second half of the year. At the end of the year 28% of patients were waiting more than six weeks to receive their investigation compared to the national target of 1%. The tests with the largest numbers of longer waiting patients include non-obstetric ultrasound, MRI and endoscopies, and further recovery will be driven through a combination of recruitment, independent sector capacity and an additional endoscopy room which opened at the start of April 2021. Patients waiting for a diagnostic test to be performed (sum of 15 different frequently used tests) Percentage of patients waiting over 6 weeks for a diagnostic test to be performed 23 Referral to Treatment Our waiting list from referral to treatment increased in size by 6% (2,220 patients) during 2020/21, rising when the recovery in referral numbers exceeded the recovery in clinical activity, the total increase in waiting list size would have been significantly higher had it not been for the significant reduction in the referrals received by the hospital especially during the early months of the pandemic. Looking forward, we anticipate referrals numbers returning to pre-pandemic levels, and being able to maintain the total size of our waiting list by delivering an equivalent number of treatments each month. Number of patients waiting between referral and commencement of a treatment for their condition The national target is that at least 92% of patients should be waiting for treatment no more than 18 weeks from their referral to hospital. Our performance against this measure is now 12% worse than one year ago, at 66%. Our performance continues to be typical of the major teaching hospital trusts that we benchmark with and the trend has been similar to that experienced across trusts in England. Percentage of patients waiting up to 18 weeks between referral and treatment 24 Unfortunately, the number of patients waiting significantly longer than the 18 week target has increased at a faster rate than the size of the waiting list as a whole. The graph below shows how the percentage of patients who have waited more 52 weeks increased. The number of patients who have waited more 52 weeks increased from 40 in March 2020 to 3,419 by March 2021 (of these 445 patients had waited more than 78 weeks). Such patients often require surgical treatment, particularly in the orthopaedic, ear nose and throat and oral surgery specialities. The impact on surgical care has been greater than that in outpatients during the pandemic, and it is also more challenging to increase capacity due to the need for additional operating theatres and a combination of different healthcare professionals to work within them. UHS opened an additional operating theatre in 2020/21, and has a further four theatres scheduled to open during 2021/22, which will make a significant contribution to our capacity to treat more patients. Unfortunately, the number of patients waiting significantly longer than the 18 week target is likely to continue to grow further in the short term, due to diagnostic investigations having been progressed less quickly than usual during the pandemic, the need to prioritise our increased treatment capacity according to the clinical urgency of conditions and because our scheduled capacity increases will not be completed before the autumn of 2021. Percentage of patients waiting more than 52 weeks, between referral and commencement of a treatment for their condition 25 Cancer Waiting Times UHS has been mostly successful in maintaining the timeliness of urgent services for patients with suspected cancer through the pandemic, and our performance has been amongst the best in both the south-east and nationally. UHS prioritised the theatre and intensive care capacity we were able to provide during the pandemic in order to meet the needs of those patients with the greatest clinical urgency, used capacity offered by independent sector hospitals to supplement that available within NHS, and operated a hub through which hospitals in Wessex were able to collaborate to continue critical cancer surgery during periods of peak COVID-19 demand. The national target is to provide the first definitive treatment to at least 85% of patients with cancer with 62 days of referral to hospital. Whilst UHS performance remained below this level in the majority of months, our performance has been significantly better than the national average, and has improved relative to other trusts. Treatment for Cancer within 62 days of an urgent GP referral to hospital 26 The national target is to provide the first definitive treatment to at least 96% of patients within 31 days of a decision to treat being made and agreed with the patients; both for the first and any subsequent treatments for cancer. UHS achieved this level on average across the year, and in the majority of months. The treatments provided are typically by means of surgery, chemotherapy/immunotherapy or radiotherapy. The most significant performance challenge this year has been in radiotherapy, where more sophisticated treatment plans improve patient outcomes but take longer to prepare, and there was also reduced treatment capacity whilst we replaced one of our ‘Linear Accelerator’ treatment machines with a new model. First definitive treatment for cancer within 31 days of a decision to treat Equality in service delivery Identifying and addressing health inequalities have been the central part of the Trust’s approach to improving the experience of care for our patients, families and carers. Over the past year, new initiatives have augmented progress on existing work to ensure there is appropriate support, due regard and recognition of those patients and their families and carers who are most at risk of poor experiences, outcomes and access to services. In 2020 we added two questions to our patient surveys, asking first if patients felt themselves to have a disability or require a reasonable adjustment, and, if yes, whether the Trust met this need. In 2020/21, the results were: TOTAL Had a disability / required a reasonable adjustment 27% Had this need met by the Trust (positive response) 95% This question was added to our major Friends and Family Test surveys as well as our local service-specific patient surveys. In June 2020 the Trust launched the sunflower lanyard scheme for hidden disabilities, participating in the national initiative to ensure that people whose disabilities are not visible are able to access further support and reasonable adjustments by means of a nationally recognised indicator (the sunflower). In 2020/21, 618 lanyards were issued with those needs recorded to ensure future reasonable adjustments are made for those individuals. 27 Carers have always been essential partners in the care that we provide, and having introduced a new post at the end of 2019 to focus solely on carer experience, this work has culminated in a Trust strategy for improving the involvement, support and experience carers have of our services. We have, over the past year, introduced carers cards, virtual peer support and carer-specific information about services while actively participating in local and regional work on carers. In January 2021 we realised our ambition of becoming an accredited ‘Veterans Aware’ hospital, with our submission of evidence being recognised as ‘strong’ and indicative of an organisation that has made great progress in helping to provide enhanced support for the armed forces community. Towards the end of 2019 we worked with the disability organisation AccessAble to produce accessibility guides for all of our services and estate. These online guides allow patients and visitors with disabilities to plan their journey and identify potential challenges to the environment. In 2020/21 our guides had 5,000 unique visits per month. One of our COVID-19 initiatives, a patient support hub, was set up in May 2020 to provide a single point of support for our patients who had been advised to shield. The service has grown and now offers support to patients and carers who are vulnerable, disabled or with additional needs. This includes coordinating community transport, arranging companions to assist with attending appointments, hosting a technology library to support those who are digitally excluded in accessing virtual appointments and information, and most recently receiving funding to pilot volunteer-led support for diabetes patients. Across the Trust, we continue to actively promote the importance of asking patients and carers about disabilities and reasonable adjustments, flagging needs on our patient administrative system to prompt our services to take proactive steps to ensure that any needs or adjustments are met on each and every visit. This has been of vital importance for meeting accessible information and communication needs. We are currently one of first trusts to pilot a new translation app that provides immediate interpretation into different languages, and we have worked closely with our communication support partners to ensure that where virtual appointments are needed, people with communication needs (BSL, foreign language) are supported to access care virtually. Our specialist nursing liaison teams continued to support access to services throughout the pandemic, ensuring that patients with dementia, with learning disabilities and autism, were supported to attend hospital where necessary. Further information about the Trust’s work in relation to equality, diversity and inclusion can be found on page 69 and pages 106 and 160 in the quality report. Going concern After making enquiries, the directors have a reasonable expectation that the services provided by the Trust will continue to be provided by the public sector for the foreseeable future. For this reason, the directors have adopted the going concern basis in preparing the accounts, following the definition of going concern in the public sector adopted by HM Treasury’s Financial Reporting Manual. David French Chief Executive Officer 28 June 2021 28 Accountability report Directors’ report Board of directors The board of directors is usually made up of six executive directors and seven non-executive directors, including the chair. Since 1 January 2021 the number of non-executive directors has been reduced by one as Jane Bailey’s reappointment as a non-executive director was deferred to allow her to lead the Hampshire and Isle of Wight saliva mass testing programme. Jane is expected to return to the board of directors in her non-executive director role by 1 July 2021. Paragraph B.1.2 of the NHS foundation trust code of governance provides that at least half the board of directors, excluding the chair, should comprise non-executive directors determined by the board to be independent. Pending the reappointment of Jane Bailey as a non-executive director, the Trust has been operating with one fewer non-executive directors than is required by the Trust’s constitution and the Trust has been non-compliant with this paragraph of the code. During this period the provisions of the Trust’s constitution that a quorum for meetings of the board of directors requires at least one non-executive director and one executive director to be present and for the chair to have a second and casting vote in the case of an equal vote continued to apply. The board of directors has given careful consideration to the range of skills and experience it requires to run the Trust. Together the members of the board of directors bring a wide range of skills and experience to the Trust, such that the Board achieves balance and completeness at the highest level. The chair was determined to be independent on his appointment and the other non-executive directors have been determined to be independent in both character and judgement. This included specific consideration of Jane Bailey’s continued independence following her role leading the Hampshire and Isle of Wight saliva mass testing programme. The chair, executive directors and non-executive directors have declared any business interests that they have. Each director has declared their interests at public meetings of the board of directors. The register of interests is available on the Trust’s website. 30 The current members of the board of directors are: Non-executive directors Peter Hollins Chair Peter graduated in chemistry from Hertford College, Oxford. Joining Imperial Chemical Industries in 1973, he undertook a series of increasingly senior roles in marketing and then general management. Following three years in the Netherlands as general manager of ICI Resins BV, in 1992 he was appointed as chief operating officer of EVC in Brussels – a joint venture between ICI and Enichem of Italy. He played a key role in the flotation of the company in 1994, before returning in 1998 to the UK as chief executive officer of British Energy where he remained until 2001. From 2001, he held various chairmanships and non-executive directorships. In 2003, he decided to return to an executive role as chief executive of the British Heart Foundation in which post he remained until retirement in March 2013. He joined Southampton University Hospital Trust as a non-executive director in 2010, became senior independent director and deputy chairman of UHS in 2014 and was appointed chair in April 2016. Trust roles: • Chair of remuneration and appointment committee • Chair of governors’ nomination committee Jane Bailey Non-executive director In 1985, Jane joined the pharmaceutical company Glaxo as a management trainee, having graduated from London University with a degree in environmental science and pharmacology. Here she rose to senior commercial vice-president, gaining experience of a broad range of disease areas across different regions of the world. She specialised in leading global research and development teams in the formation of strategies to bring new medicines to patients. She also worked to ensure that the medicines developed were supported by robust evidence demonstrating their clinical and cost-effectiveness. In delivering this she gained extensive experience of leading large diverse teams across a complex global organisation. For five years, Jane ran her own strategy development consultancy, working across a breadth of healthcare organisations. In 2017 Jane gained an MSc in public health, with distinction, at King’s College, London University. Her studies focused on how to ensure the public are engaged in development of healthcare services and how social theories can help inform effective disease prevention and management. Jane is a director of Wessex NHS Procurement Limited, a joint venture between the Trust and Hampshire Hospitals NHS Foundation Trust and a director of Healthwatch Portsmouth. Trust roles: • Deputy chair and senior independent director • Chair of finance and investment committee • Audit and risk committee member • Charitable funds committee member • People and organisational development committee member • Remuneration and appointment committee member • Wellbeing Guardian 31 Non-executive directors Dave Bennett Non-executive director Dave graduated in chemistry from the University of Southampton before entering management consulting, becoming a partner in Accenture’s strategy practice. In 2003 he joined Exel Logistics (later acquired by DHL), managing the company’s healthcare business across Europe and the Middle East. During this time, he established NHS Supply Chain, a UK organisation responsible for procuring and delivering medical consumables for the NHS in England, as well as sourcing capital equipment. Dave joined the board of Cable & Wireless as sales director in 2008. He later set up his own strategy consulting practice serving the healthcare sector, completing numerous projects in the UK and the US. Dave has also served as a non-executive director at The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust between 2009 and 2016, where he chaired the Trust’s quality committee. Dave is a non-executive director at the Faculty of Leadership and Medical Management and a director of Royal College of General Practitioners (RCGP) Enterprises Ltd and RCGP Conferences Ltd. Trust roles: • Chair of charitable funds committee • Chair of finance and investment committee (from 1 January 2021) • Audit and risk committee member (from 9 February 2021) • Quality committee member • Remuneration and appointment committee member • Chair of Trust’s organ donation committee 32 Non-executive directors Cyrus Cooper Non-executive director Cyrus Cooper is professor of rheumatology and director of the MRC Lifecourse Epidemiology Unit. He is also vice-dean of the faculty of medicine at the University of Southampton and professor of epidemiology at the Nuffield Department of Orthopaedics (rheumatology and musculoskeletal sciences, University of Oxford). He leads an internationally competitive programme of research into the epidemiology of musculoskeletal disorders, most notably osteoporosis. His key research contributions have been: • discovery of the developmental influences which contribute to the risk of osteoporosis and hip fracture in late adulthood • demonstration that maternal vitamin D insufficiency is associated with sub-optimal bone mineral accrual in childhood • characterisation of the definition and incidence rates of vertebral fractures • leadership of large pragmatic randomised controlled trials of calcium and vitamin D supplementation in the elderly as immediate preventative strategies against hip fracture. He is president of the International Osteoporosis Foundation, chair of the BHF Project Grants Committee, an emeritus NIHR senior investigator, a director of The Rank Prize Funds and associate editor of Osteoporosis International. He has previously served as chairman of the Scientific Advisors Committee (International Osteoporosis Foundation), the MRC Population Health Sciences Research Network and the National Osteoporosis Society of Great Britain. He has also been president of the Bone Research Society of Great Britain and has worked on numerous Department of Health, European Community and World Health Organisation committees and working groups. Cyrus has published extensively on osteoporosis and rheumatic disorders and pioneered clinical studies on the developmental origins of peak bone mass. In 2015, he was awarded an OBE for services to medical research. Trust roles: • Quality committee member • Remunerati
Url: /Media/UHS-website-2019/Docs/About-the-Trust/Annual-reports-and-quality-accounts/annual-report-20-21.pdf

Squint in adults - patient information

Description: This factsheet contains information about squint in adults.
Url: /Media/UHS-website-2019/Patientinformation/Eyes/Squint-in-adults-1779-PIL.pdf

Nourishing puddings - patient information

Description: Puddings can be an enjoyable way to add extra calories and protein into your diet. This factsheet contains some quick and easy recipe ideas for nourishing puddings or snacks that you can try at home.
Url: /Media/UHS-website-2019/Patientinformation/Medicinestherapiesandanaesthetics/Nourishing-puddings-2393-PIL.pdf

Dot card exercise - patient information

Description: This factsheet explains what a dot card is and how to perform the exercise safely at home.
Url: /Media/UHS-website-2019/Patientinformation/Eyes/Dot-card-exercise-2870-PIL.pdf

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Annual report 20-21

Squint in adults - patient information

Nourishing puddings - patient information

Dot card exercise - patient information

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