Armed Forces best practice at the Royal Marsden NHS Foundation Trust

Never having served hasn’t held back Anne Howers, Veteran Champion Lead at The Royal Marsden NHS Foundation Trust, in developing a good model of care and support for the Armed Forces community.  What however, is more important is her deep knowledge of the NHS, including what will work in the organisation and who to speak with to get an idea off the ground, and her enthusiasm.

She’s steered the trust through its Veteran Aware accreditation and, with a committed group of people, helped it to gain the Gold Employment Recognition scheme (ERS) from the Ministry of Defence.  Anne has developed relations with accredited NHS trusts in London to share ideas and is working towards setting up Armed Forces links between three specialist cancer centres – The Royal Marsden, the Clatterbridge and the Christie – for support in gaining Silver and Gold ERS.

For her, those who have served should get care tailored to their need. Some of Anne’s respect for the Armed Forces comes from the wartime experiences of her father and particularly her uncle, whose vessel was torpedoed twice while he was serving with the Royal Navy.  “I love being part of what the Armed Forces stands for. The people who have come forward as Veterans Champions in the hospital, who’ve all got an Armed Forces connection, have got nothing but energy to give to the project, and wisdom about the organisation that I don’t have. So, I’m just really the driver and the ideas person and then they latch on to the ideas and together we work out how we can deliver them.”

A paediatric nurse and health visitor by training with a long experience of working in communities before going into nursing management, Anne fell into this field of work after her then Chief Nurse, an Army Reservist himself, suggested her experience and background meant she’d be ideal for developing Veteran Aware accreditation for the Trust.   Part of the work included monthly meetings with the Veterans Covenant Healthcare Alliance’s (VCHA) regional lead Anna-Marie Tipping, who supported The Royal Marsden’s team.

The Trust’s Chief Executive was delighted to sign the Armed Forces Covenant and the trust was awarded Bronze ERS in autumn 2021. This was a proud moment as The Royal Marsden was the 101st Trust to achieve this award, which is especially meaningful as it was the 101st anniversary of the Cenotaph. 

This was a stepping stone to further embed Armed Forces awareness work into the trust’s ethos including working to gain Silver ERS status the following year.

What has been most helpful to Anne is her committed team of 15 Veterans Champions, one of whom is the Volunteers Services Manager. Anne also has the support of the Director of Workforce and Chief Executive at board level.  

The Veteran Aware Champions, who are staff with a connection with the Armed  Forces  either as a reservist, a previous serving officer or through family, and Veteran Support Volunteers , who are volunteers with Armed Forces experience meet regularly and have a co-developed agenda. Everyone is equal in their contribution.  She said: “All of this has led to some really good ideas. This group of wonderful staff and volunteers know how to solve an issue or who to speak to when I’m not getting anywhere!”

They attend a variety of meetings across the trust and know where and when to help promote the Veteran Aware status. The team also engages more Veteran Aware Champions by word of mouth as new staff who have been part of the Armed Forces community join the Trust. Together the champions have a huge knowledge base of experience of working as part of the Armed Forces community and across all areas in the trust.

She recalled: “Thanks to our Voluntary Services Team and wonderful hospital charity, The Royal Marsden Cancer Charity, we gained a grant from the Armed Forces Covenant Fund Trust for £10,000 for one year for Veteran Support Volunteers, at our Chelsea and Sutton site. We could see the volunteer service was thriving so saw an opportunity for this new volunteer role as an addition to the service.”

Along with funding the recruitment of Veteran Support Volunteers, the grant has also funded equipment, including iPads, which have information on support services for the Armed Forces Community uploaded, as well as uniforms and training.  “Our Veteran Support Volunteers befriend patients from the Armed Forces community and support them with attendance at appointments, chaperoning them to and from transport, and support the in collecting their medications. They befriend   them if they’re alone and anxious, which can be particularly important for inpatients who may not have other visitors. The volunteers also provide a telephone support service to patients”.

In terms of publicising Veteran Aware status at the Trust, there is information about revealing Armed Forces status and there is Veteran Aware messaging on recruitment materials. There are also appropriate HR policies with support for staff and their families from the Armed Forces community. For patients, an introductory letter invites them to let the trust know if they are a member of the Armed Forces community so the team can make contact.

Anne said: “We are continually listening and learning from our Armed Forces community and working out how to do things better. For example, we realised we needed to find a way in to talk to patients from the community because, in many cases, they do need help but are unlikely to admit they need support if you ask directly: ‘Would you like some help?’.

This was a lightbulb moment for us. “As a result, we changed the sentence in the patients’ welcome letter from saying, ‘Would you like some help?’ to ‘Please let us know if you would like one of our Veterans Volunteers to visit for a chat help’.  We’ve also learnt to take engagement slowly at our patient’s pace. If someone indicates they want help, the volunteers – who know which ward the patient is on or the outpatient clinic they attend – chat with them, often about the Armed Forces. Slowly they build up a rapport and, in some cases, the patient will say ‘I’m really worried about this or that’ and that is the cue for our volunteers to help them.”

The trust’s support for one patient during the Covid pandemic led to a new support option. A carer contacted The Royal Marsden to say they couldn’t bring a patient at his appointment because they had Covid, so asked if someone could meet the patient off their arranged transport and accompany them to and from the appointment.  She said: “And it was so successful that the carer doesn’t need to come to appointments with the patient anymore, because ongoing support from the volunteer has given him more confidence. The volunteer has even changed when they come to the hospital to be the same day as the patient’s appointments.  

“We’ve just had another patient from the Midlands who was anxious about coming to London, so we asked a volunteer to meet him at the hospital door and to go to appointments with him. The patient felt having another person in the room would give him confidence. They also chatted about the old days during their time in the Armed Forces in between appointments, which helped too.

Raising awareness of the Veterans Aware commitment at The Royal Marsden internally is an ongoing theme. For example, there is still more work to be done to make sure staff remember to identify veterans at an early stage, simply by asking the question about service. “We take it in bite-size pieces because there’s not one size that will fit all the teams,” Anne explains.

One aim has been for The Royal Marsden to support Armed Forces events, though the philosophy is to take things slowly, one step at a time.  

Last year the trust held a Remembrance Day service, across both its sites, which included members of staff and patients together with its hospital choir singing and buglers playing the Last Post at both chapels.

Anne arranged for the service to be streamed so staff on wards and clinics who couldn’t attend in person could still watch, which was a hugely appreciated, with over 200 computers streaming the services, and 100 attending in person.

Looking ahead, Anne is planning to set up a network of patients and staff from the Armed Forces community and organise quarterly events with refreshments and speakers.  It’s clear that Anne has managed to attract a set of committed people to help her deliver the next steps to raise awareness and deliver improvements in care for the Armed Forces community.

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