NSLHD News December 1 2022

Get the latest news from across Northern Sydney Local Health District.


Main story Mental health clinicians in the spotlight The district’s mental health drug and alcohol teams gathered to celebrate their achievements. Page 6 Short blurb Read more on Page x

Support for women with gestational diabetes Page 4

access to inpatient palliative care for community patients Page 3


Message from the board chair Trevor Danos AM

As I look back on 2022, three things feature most prominently in my mind.

• the ongoing rollout and training for the Speaking Up for Safety program

First, it has been an exceptionally challenging year where at times many of us have lost track of time, not helped with the ongoing pandemic, the record rain Sydney has received, coupled with natural disasters and events occurring overseas. I still remember when towards the end of 2021 we thought we had seen the back of the Delta variant of COVID-19 and were expecting things to soon return to normal. And from out of nowhere, came the Omicron variant. But as we prepare to bid farewell to 2022, we should pause to recognise and celebrate the efforts, endurance and resilience of the district’s staff during the year that has been both remarkable and deserving of the highest possible praise. The Board is grateful to each and every one of you who have been such a beacon of professionalism and dedication, routinely putting professional duties ahead of your own personal needs. The Board knows only too well that many of you are very much in need of a well-deserved break. This only highlights the importance of having the best possible holiday at the end of this year, spending time with family and friends, so we can all come back refreshed and recharged for 2023. For those staff who are working over the holidays to continue to care for our patients, I hope you will be afforded some time to rest and recharge as we head into the New Year. Secondly, despite the challenges of 2022, we can look back on many significant achievements within the district. To name but a few:

• the completion of the rebuild of Hornsby Ku- ring-gai Hospital

• the commencement of planning for the new Ryde Hospital

• the launch of the NSLHD 2022-2027 Strategic Plan and the St Leonards Health, Research and Education Precinct Plan

• the hosting of our first NSLHD Consumer Forum

• the restructuring and prioritising of the district’s research efforts, and

• the strengthening of our partnerships with the NORTH Foundation, our university partners, the Sydney North Health Network and a number of NGOs and private hospitals. Another major achievement of 2022 was that we transitioned the leadership of the district from former Chief Executive Deb Willcox to Lee Gregory. A transition of this nature can only occur as successfully and seamlessly as it has because of the strength and talent of the district’s executive team. Thirdly, when we come back in 2023, there are many exciting projects that await. It is a busy pipeline. Some projects will be a continuation of the achievements of 2022 that I have mentioned. Others include working with the Ministry of Health on improved workforce planning and preparing for virtual health, digital health and the better use of big data. I sense that there is a strong desire across our staff and the broader community to take on board the key learnings from the pandemic and to catch up on lost time. Those two factors alone should also ensure it will be a busy, exciting and productive 2023.

• the successful accreditation of four of our hospitals and services

• the impressive and important work we have started and continued in diversity, belonging and inclusion and in planetary health and sustainability

Trevor Danos AM Board Chair Northern Sydney Local Health District



Mona Vale Hospital’s Palliative Care Unit

access to inpatient palliative care for community patients Mona Vale Hospital’s palliative care team is focused on making the transition from home to the palliative care unit easier and more comfortable for patients.

the smooth transition. Over the past year, the unit has admitted 47 per cent of its patients directly from their homes into the unit, which is a significantly higher rate than the Australian average of other inpatient palliative care services sitting at 12.9 per cent. Peter said the high number of community admissions are a testament to the collaborative relationships the unit has developed, alongside the multidisciplinary approach. “The unit has collaborated so strongly with HammondCare, as well as the Northern Beaches Hospital to help make access to the unit as seamless as possible,” he said. “Another reason we are able to do the work we do is because of the multidisciplinary team within the unit: allied health, nursing, medical, pastoral care, ward clerk, cleaners - the amazing care that happens is because of this teamwork.” Alongside making patients’ lives easier whilst in their care, Peter said the unit has also helped many patients leave a lasting legacy. “The unit has become the most frequent site in the district for corneal donation which is a very generous legacy patients can leave – a real gift of sight to other people and we are glad we can help with that,” he said.

The unit, which opened in February 2021, works closely with community palliative care to facilitate patients being admitted directly from their home when they require further treatment, rather than having to present to an emergency department and be admitted through an acute hospital. This not only minimises stress for patients, said the unit’s staff specialist Dr Peter Roach, but it also provides continuity of care and rapid symptom relief when required. “The unit enables this level of care through a range of different means that are all dependant on the patient and their wishes,” he said. “Direct admission from home means fewer hospital transfers for patients and families, as well as more time for the multidisciplinary team to establish a therapeutic relationship with them. “I think this is particularly true for our patients who are at the end of their lives. “It’s an enormous benefit to not have to consider multiple transfers and have one direct place of care.” Peter works with HammondCare’s community palliative care team, alongside his role at Mona Vale Hospital to help ensure



Philanthropic Support for women with gestational diabetes Generous funding provided through the Douglas and Lola Douglas scholarship is Tessa will also be using new artificial intelligence techniques to develop a personalised risk predictive tool for perinatal outcomes.

strengthening evidence around the long term impacts on children born to mothers with obesity and gestational diabetes. Endocrinologist and Kolling Institute researcher Dr Tessa Weir has been able to continue her valuable research as a result of being awarded the scholarship. “I am incredibly grateful for the support provided through the Douglas and Lola Douglas scholarship,” she said. “It has meant I’ve been able to pursue my postgraduate studies and support improvements in the care of women with obesity and gestational diabetes, and their babies. “My hope is to fill the gaps in evidence and generate guidelines and policy to extend prenatal and perinatal obstetric care, particularly for women managing these health challenges. “Our research will involve a systematic review to detail how maternal obesity and gestational diabetes directly affects neonatal outcomes.

“This will also consider the timing of births, with early births linked to many adverse impacts such as developmental delays,” she said. Tessa said it was such an important field of research, with maternal obesity and gestational diabetes contributing to significant, long-term health challenges for unborn children. “We know from earlier research by fellow Kolling researchers A/Professor Sarah Glastras and Professor Carol Pollock that these maternal factors can influence foetal programming, and alter an unborn child’s future metabolic risk. This in turn increases the likelihood of ongoing weight issues,” she said. “The prevalence of child and adolescent obesity is increasing, with an alarming 25 per cent of children in Australia over the healthy weight range. “Childhood obesity is associated with an increased risk of developing cardiovascular disease, chronic kidney disease, diabetes and psychological conditions. “All of these issues can have a life-long impact, compromising quality and even length of life, so it’s tremendously important we drive research progress in this area and broadly improve the quality of care provided to women and their babies. “Overall, this scholarship is not only helping me complete my PhD studies, and broaden my experience as a clinician-researcher, it will also hopefully improve the future health of countless children born to women with gestational diabetes and obesity.”

Dr Tessa Weir

Vale Emer Mary Noone Ryde Hospital nurse Emer Mary Noone sadly passed away on 14 November, 2022. Emer was born in Ireland and did her registered nursing training at Mater Hospital in Dublin and then her midwifery training at Coombe Hospital in Dublin. Emer provided 32 years of service to the Ryde community. She was a clinical nurse specialist (CNS) in the critical care unit often taking on the roles of team leader and acting nurse unit manager. For the last 15 years she was the CNS2 in the cardiac rehabilitation service. She is remembered by staff as a generous, lovely and helpful teammate and an experienced senior staff member and team

leader, and will be deeply missed. Emer leaves behind her sons Dara, Conor and Ross, and her husband Paul. Ryde Hospital and Northern Sydney Local Health District offers their sincere condolences to Emer’s family,

friends and colleagues.

Vale Emer Mary Noone



Hornsby Hospital opens new renal dialysis unit In an historic moment for Hornsby Ku-ring- gai Hospital, the doors to the new renal dialysis unit have opened and for the first time in the hospital’s history, patients have been able to receive dialysis. One of the first patients was Wes, who travels

nephrology clinic. The unit is located in the new building 61, which sits next to the main clinical services building. It was built as part of the NSW Government’s $365 million redevelopment of the hospital.

from Sackville North, in the Hawkesbury region and he is delighted the hospital offers the treatment. For the past 2.5 years, Wes has been making the long journey to Royal North Shore Hospital (RNSH) three times a week. “This will save me $320 in tolls a month and all the money in petrol,” Wes said. The dialysis unit is a 10-chair satellite dialysis unit of RNSH unit will be opened Monday, Wednesday and Friday to start with, but aims to be five days a week next year. The unit’s services include medical and nursing management appropriate for a satellite dialysis unit, including a vascular access and renal clinical nurse consultant vascular access monitoring; dietician, social work, pharmacist, podiatry; renal supportive care clinic; and general

Dialysis patient, Wes

AYAH Appoints Clinical Nurse Educator Amy Dunlop has seen the value high quality nursing care brings to the lives of those with life-limiting illness.

is life affirming for patients and staff alike.” At the AYAH, Amy’s aim is to help build a caring and collaborative community. “I want to help build resilient and capable nurses, supporting them to excel in their practice and deliver excellent care,” she said. Recruitment of staff for AYAH is progressing and most of the positions have been filled including medical specialist, nursing, allied health and support staff.

With a career spanning palliative care, aged care, community health, post anaesthetic recovery, emergency and education, Amy has always been passionate about delivering excellent care to patients and their families. She has recently started in her newest role as clinical nurse educator at the Manly Adolescent and Young Adult Hospice (AYAH). “In this role I am able combine my previous experience in palliative care and education with the chance to be part of developing such an important service,” she said. “I am eager to learn from and with my team members and the adolescents in our care.” Being the first adolescent palliative care unit in Australia, Amy said she is excited to be at the forefront of the speciality. “This is a unique opportunity to support a team of nurses to become Australia’s experts in adolescent palliative care nursing,” she said. “It is a privilege to care for young people and their families facing such immense challenges and I am excited to help create a space that

Amy Dunlop



Smiles were aplenty at the ceremony

Mental health clinicians in the spotlight For the first time in two years, the district’s

said. “You know first-hand the challenges that our hospitals and health services have faced and you have continued to provide the highest quality care and compassion to all who come through our doors needing help. “There has been a lot to celebrate, including the expansion of PACER, which is proving to be such a needed and welcome asset in our community to assist those people in need. Other achievements include the delivery of virtual mental health service and safeguard teams for child youth mental health services.” There were 165 nominations received this year for the MHDA Rewards and Recognition program across eight categories - see the full list of winners below. Support service Indra Bhandari and Phatwaran Thavee, Child and Youth MHS Quality, improvement and innovation Paul Tyne, Child and Youth MHS Unsung Heroes Emily Walters, Child and Youth MHS Rebecca Colegrave, Drug and Alcohol Kiah Robertson, Hornsby Ku-ring-gai MHS Fiona Kearney, Macquarie Hospital Kerry Mawson, MHDA Directorate Patricia Nixon, Northern Beaches MHS Darrel Hannam, North Shore Ryde MHS Stephen McCabe, North Shore Ryde MHS Peo-hong Veigal, Older Persons MHS

mental health drug and alcohol teams gathered in person to celebrate their achievements. The annual event was held at Hornsby RSL where staff enjoyed lunch and some entertainment by former Channel 9’s Today show entertainment reporter Richard Reid, who was MC for the day. Interim Chief Executive Lee Gregory said the past three years had “not been easy times for any of us” and clinicians had seen first-hand how the community has suffered through the pandemic. “We have seen the increase in the number of people experiencing a mental health or substance issue present to our hospitals,” he Staff member of the year (non-management) Lisa Townsend, Child and Youth Mental Health Services (MHS) Staff member of the year, consumer/carer nominated Donna Toll, North Shore Ryde MHS Collaborative team Youth Response Team, Child and Youth MHS Diversity James Hannelly and Michael Troy, North Shore Ryde MHS Manager of the year Anthony Neville, Northern Beaches MHS

Interim CE Lee Gregory (far right) participates in a bongo drum activity as part of the celebrations

Guests were treated to MC Richard Reid



Study finds multiple medications impact ageing and gut health A new study by researchers at the Kolling Institute, in collaboration with the Microbiome composition before starting the medications, and also different to the mice at the same age which were not given any medications throughout the study.

Research Centre, has shown that multiple medication use impacts gut microbiome, and may influence the ageing process. Gizem Gemikonakli, a PhD student at the University of Sydney, said the findings followed a longitudinal, in vivo study. “Interestingly, mice that were given a regimen of five therapeutic medications from middle- age experienced more functional deficits as they grew older, and their gut microbiome was different to mice not taking the medications,” she said. “This project represents an important step towards broadening our knowledge of the interaction between medications, microbiome and the ageing process. “The microbiome is a developing area of research and we don’t quite know what a healthy microbiome looks like. “We do know however, that microbiome affects a wide range of body functions, and is affected by diet, lifestyle factors, disease and medications.” In a previous study published on the same cohort of mice, the Kolling researchers showed that the multiple medication or polypharmacy treatment increased frailty among the mice. Gizem explained that like other studies, they found the diversity of the microbiome was associated with functional measures, including frailty and activities of daily living in mice. “However, in our case it is likely the polypharmacy medications were driving both the microbiome effects and the functional deficits,” she said. At 21 months, which is old age, half of the mice had the medications withdrawn, and their microbiome was collected again three months later. Taking these mice off the multiple medication regimen reversed the changes that initially occurred when they started treatment. The microbiome however did not recover completely. It was different compared to its

Professor Sarah Hilmer, Gizem’s supervisor at the Kolling Institute said the two-way interactions between the gut microbiota and medications are very complex. “Our translational study describes effects of one high risk polypharmacy regimen on the microbiome, and its partial reversibility with de-prescribing,” she said. “This opens up exciting avenues for further research, including understanding the effects of different drugs on the microbiome and understanding how the microbiota impact on drug effects. “Differences in microbiome might explain why some people respond better than others to polypharmacy.”

Gizem Gemikonakli

Hornsby Hospital Mona Vale HOSPITAL nslhd mhda


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NSW Health

Be deadly in your career

A NSW Health Aboriginal Nursing and Midwifery Scholarship provides financial support whilst you study, allowing you to focus on your degree and your journey to becoming a nurse or midwife.

Applications are open 9 January - 5 February 2023.

For more information scan the QR code or Phone 1800 155 325 Email MOH-AboriginalNursing@health.nsw.gov.au

© NSW Ministry of Health. September 2022. SHPN (NMO) 220833

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