Cannock Rheumatology Unit

15/01/07 : Dr Thomas Sheeran MBChB, FRCP, MD, Consultant Rheumatologist

Cannock Chase Hospital is a non-acute hospital; by this I mean that we do not have an A+E department and thus all the patients that are admitted have non-acute problems. This helps to provide a relaxed atmosphere for patients that have chronic illnesses. (Do you know of a private hospital that has an A+E department?) (see photo) The rheumatology service has a wider catchment area and covers the "M6 toll corridor" from the M6 to the M42. We also provide rheumatology to patients in North Birmingham, from Good Hope Hospital. We thus have a case mix of patients from rural, urban and inner city areas. The total population served approaches 1,000,000.

Department

The Rheumatology Department is based around Hollybank Ward. This has 22 dedicated rheumatology beds and a day ward. This unit also houses the consultants’ offices, secretarial office, community nursing office, research laboratory, research office and department library. There is also a large patient day room which doubles up as our weekly meeting room.

Staff There are four consultant rheumatologists Dr Tom Price, Dr Diarmuid Mulherin, Dr Venkat Chalam and myself. (See photo). We have four junior doctors (one FY1, two FY2s and one GP trainee). We also have a specialist registrar, two SHOs and a staff grade post.

There are three sets of nurses.
1. Ward nursing staff are all rheumatology trained. Most of our nurses can perform joint injection.
We have a busy day unit where all our outpatient infusions are performed. These infusions include infliximab (an anti-TNF treatment), rituximab (B cell depletion therapy) and also the occasional chemotherapy regime for patients with vasculitis, lung fibrosis and severe Raynauds phenomenon.

2. Community Nurses help to provide continuity of care in the community. As they cover a large geographical area they are often the first point of call for our patients as they look after our departmental help-line. They see patients at home and often perform joint injection in the patient’s home when transportation is difficult.
They are able to prescribe drugs and initiate referrals to other clinicians.

3. Research nurses care for our patients involved in drug trials. We have performed many drug trials over the years. This allows us to judge, first hand, the many powerful drugs that are now in the market.

		Some of our research initiatives become part of our clinical practice. We now have one of the few fracture nurse liaison posts in the country. This position provides the link between A+E (patients fracturing bones) and an assessment for osteoporosis.

Rehabilitation This consists of a number of departments, which include physiotherapy, occupational therapy and speech therapy. We have a large hydrotherapy pool, exercise areas, two gyms and a host of specialist equipment. We have three workshops; the heavy workshop where we have lathes for woodwork drilling equipment for metalwork. We have a light workshop for computing, painting etc. There is also a driving assessment unit in the department.

We also have 2 kitchens (one gas, one electrical) where we can perform formal ADL (Activities of Daily Living) assessments. The occupational therapy department has won top awards for its work with patients.
Osteoporosis

We have two Lunar Prodigy bone scanners which are the latest development in the assessment of patients with osteoporosis. We have a portable ultrasound machine which measures bone density in the heel. This is a screening tool for patients who are unfortunate enough to sustain a fracture and attend the A+E department. We have recently opened a PCT funded dedicated Ibandronate infusion unit.
Clinics

We have weekly clinics in the following areas, Cannock, Stafford, Litchfield, Tamworth and North Birmingham. We have a strong community nursing team that covers all these areas. We run specialist clinics in paediatric rheumatology, osteoporosis, Raynaud’s and connective tissues diseases.

Recent Developments.

We have installed two orthopaedic operating theatres built around a rehabilitation unit. These provide operating time for "cold" joint replacements etc. Patients are moved through the unit as they recover from their surgery. This means 24-48 hours in the monitoring bay where all patients are monitored with booking by the ITU team at Stafford Hospital using the hospital intranet systems. There are a number of rehabilitation bays where the patient, their bed and hospital furniture are moved "en-masse". This is where I would want to have my joints replaced and I’ve got private medical insurance!!
Future Developments.

We are in the final stages of our web site so that you will be able to see the wards and other places mentioned in this brief article first hand. www.midstaffs.nhs.uk.

There are many new biologic treatments available at present and most of the questions in the future will be around when to administer which biologic.