Would you like to begin by introducing yourself? What's your role within the service and how long have you been there?
My name is Tina Dutt and I am a Haematologist specialising in haemostasis and thrombosis, based at The Roald Dahl Haemostasis and Thrombosis Centre, Liverpool University Hospitals NHS Foundation Trust. I am also a lecturer for the University of Liverpool and co supervisor for three PhD students
Our Centre provides specialist services for haemophilia, haemoglobinopathies, thrombotic thrombocytopenic purpura (TTP) and a tertiary service for complex thrombosis and obstetric haematology. The unit also hosts a regional reference laboratory and dedicated clinical haematology research team.
I am the Liverpool Specialist Centre Lead for the rare disease TTP. After becoming a consultant in 2013, I set up a regional service for TTP in Liverpool serving the North West of England and North Wales. Since then I have enjoyed working with fellow committed colleagues and NHSE Highly Specialised Services to achieve specialist commissioning of other TTP Specialist Centres nationally.
My other role at Liverpool University Hospitals is as Associate Medical Director for Patient Experience and this represents an area within my clinical practice that I have always felt very strongly about. Together with a dedicated patient experience team, we work hard to consistently provide assurance that as a Trust we are listening to the needs of our patients, families and communities, and actively responding. This is not as easy as it sounds, but we want our patients to be the starting point for everything we do.
Our Centre provides specialist services for haemophilia, haemoglobinopathies, thrombotic thrombocytopenic purpura (TTP) and a tertiary service for complex thrombosis and obstetric haematology. The unit also hosts a regional reference laboratory and dedicated clinical haematology research team.
I am a keen clinical researcher and NIHR Speciality Research Group Lead for Haematology for the North West Coast Clinical Research Network (CRN). This role involves managing our local and regional clinical trials portfolio, and contributing to the wider NIHR vision of improving health through research. As a full-time clinician, I’m a strong advocate of supporting NHS clinicians in the delivery of clinical research as an intrinsic component of excellent patient care.
Could you tell us what sparked your interest in haematology research studies in the first place?
When I joined the team, there was a significant unmet need to increase the delivery of non-malignant haematology research, regionally and nationally. Clinical research appeared to be a detached phenomenon from routine clinical care, and we barely had a few studies on our portfolio to offer to patients. Study setup and recruitment was challenging and there was apprehension in the clinical team about the time and skill required amidst everyday pressures within the NHS.
I was keen to find a way of offering what were exciting research opportunities to our patient groups, often under-served populations, or those with rare conditions.
I was keen to find a way of offering what were exciting research opportunities to our patient groups, often under-served populations, or those with rare conditions. Through investing time with our CRN and cultivating a research positive culture in the centre, the team recognised the benefits of providing unique chances for patients to receive novel therapies and learn more about their condition. The unity between our clinical and research teams became evident to our patients and they too felt more comfortable, trusting teams they were familiar with – it became a win-win formula.
Could you give us an example of how you have shown your commitment to patient safety in your practice?
Soon after becoming a consultant, we experienced the tragic death of a patient arriving into the trust with suspected TTP – a rare, life-threatening blood disorder. I was conscious of fatal delays in TTP diagnosis and treatment occurring across the region and using lessons learnt, I was able to convince our Trust board that a specialist-led regional service for patients with TTP would improve outcomes for this patient group. This served as a spring board for us to make much needed changes to the service model for patients with this rare, but deadly disease.
Since then, patients have benefitted from significantly reduced mortality (~50% to <10%), improved times to treatment and a transformed patient experience. Game-changing service reforms for us at the time included an innovative online regional referral roadmap and diagnostic aid for trusts with suspected cases of TTP (designed in collaboration with NHS Blood and Transplant), emergency ambulance transfer agreement with North West Ambulance service, a new critical care admission policy and 24/7 on-call plasma exchange provision agreement with NHSBT.
The positive impact of investing time to secure commitment from key partners to achieve all of this taught me that when things go wrong, it’s important for everyone to honestly admit that the standard of care is not acceptable, and then come together in finding a solution that is not only affordable, but also what patients deserve.
What has been one of the most relevant achievements in working with communities and patient groups?
I had the fortune of working with the well-known and respected haematologist, late Dr Ade Olujohungbe (1963−2013). Ade was an ambassador for children and adults with sickle cell disease (SCD) before he lost his own life to the disease prematurely in 2014.
At a time of loss for the haematology community, I was acutely aware that we needed to forge better relationships with our patients with haemoglobinopathies to protect them from the potentially fatal consequences of such disorders.
For me, this started from the basics of gaining trust, understanding cultural gaps and actively reaching out to empower young and older people to make better life choices. In collaboration with community leaders, patients, our team and Ade’s family, I led an engagement event attracting many of our patients and their families to the centre. The event was combined with the opening of a new Haemoglobinopathies Transition Service in memory and celebration of Ade and his work in SCD.
Although I am no longer a lead within the haemoglobinopathies team, I would like to think that this served as an important platform for the strong relationships we now share with our haemoglobinopathies patient community.
As a continuing thread, I recently received NIHR funding to explore the perception and experience of clinical research for patients with SCD, and I look forward to using this data to inform how we can improve the research experience for this patient group.
How many people are in your team at the Liverpool University Hospitals NHS Foundation Trust? What are their roles and responsibilities?
Our clinical team includes three full-time NHS consultants (myself, Dr David Simcox and Dr Cathy Farrelly), one academic consultant (Professor Toh), one part NHS/NHSBT consultant (Dr Callaghan) and one part NHS/Liverpool School of Tropical Medicine consultant (Professor Bates), a team of specialist nurses, advanced nurse practitioners, healthcare assistants, research nurses, registrars and our PhD students. We are supported by our coagulation specials lab, university research team and the Clerical & Data team.
There is a great sense of family between the team and our patients and this is probably the underlying reason for our drive and passion whilst working often under challenging circumstances.
Whilst delivering a diverse set of clinical services under one umbrella, I can honestly say that the whole team are great at embracing each of these clinical areas unreservedly and irrespective of their specialist interest or specific role. There is a great sense of family between the team and our patients and this is probably the underlying reason for our drive and passion whilst working often under challenging circumstances. I always say if you enjoy what you do, you’re more likely to do it well!
Could you describe an average week for you and your team?
As a relatively small team with well-defined lead areas of clinical responsibility we all have our individual timetables, however, we enjoy meeting as a group a few times a week, currently more often virtually!
In addition to our own weekly clinics, we have a weekly clinical handover, grand ward round and multidisciplinary team (MDT) meeting. This means that although patients generally tend to see the team familiar to their disease process, treatment decisions are regularly discussed in the wider group and therefore the more complex patients are usually well known to the whole team.
I’d say at least once week a complex clinical case is sent to test the team, for example refractory TTP, acquired haemophilia or complex thrombosis.
Regulars in an average week for me would include my regional thrombotic microangiopathies clinic, complex thrombosis clinic, ward round and MDTs. As a tertiary centre and the haematology service for a 1,500 bedded university trust we deliver a significant amount of consultative advice; this includes support for our neighbouring Heart and Chest Centre, Liverpool Women’s Hospital, Walton Neurological Centre, and surrounding region. Other teams I meet with regularly include our research team, the lab, psychology team and our PhD students.
I’d say at least once week a complex clinical case is sent to test the team, for example refractory TTP, acquired haemophilia or complex thrombosis. I’d like to think this keeps our neurons synapsing and thinking of better ways of how to deal with these challenges!
How has COVID-19 affected your work? What steps have you taken to overcome the challenges?
Some of the responses to COVID-19 we have all made have actually benefitted the system and patients. The footfall of patients into the centre is now hopefully improved in terms of only those needing to attend for physical review visiting and reduced waiting times for those who can have their bloods done and then wait for their review in the comfort of their home. We had been planning such changes for years and then COVID-19 came and waved its wand overnight!
A further dimension to our thrombosis work has included managing the response to COVID-19-associated coagulopathy, evolving anticoagulation regimens, platform clinical trials and managing vaccine-induced immune thrombotic thrombocytopenia. Of course, much of this remains an evolving area of work and focus for haematology as an international community.
What advice would you give to someone wanting to get more involved in medical research or quality improvement projects relating to patient safety?
Keeping our patients safe is every clinician’s aim. Being involved in research or a quality improvement project that improves safety therefore is hugely rewarding.
I’m a great advocate of supporting clinicians to be research active. It is undoubtedly a challenge for NHS clinicians to build in the time required to incorporate research into routine patient care, however the benefits are invaluable for patients and advancing medicine.
Caught up in the pressures of the clinical world, there is the misconception that high-quality research relies only on our academics, scientists and pharma. My PhD was a basic science project looking at signalling pathways of activated protein C and one of the greatest take away learnings from the experience was an appreciation of the value of translational research. Without understanding what the need is at the bedside, any work at the bench is effectively redundant.
I’m a great advocate of supporting clinicians to be research active. It is undoubtedly a challenge for NHS clinicians to build in the time required to incorporate research into routine patient care, however the benefits are invaluable for patients and advancing medicine. Mentoring our trainees as future researchers and often those closest to the patients is crucial and I’m proud to say in haematology we have a great trainee network known as the Haem STARs – who are evidence of such benefits.
What are you focusing on now as the next step in your career?
In my role as Associate Medical Director for Patient Experience at our Trust, I’m keen that we find ways of continuously improving experience for vulnerable patient groups such as those with rare disease, those from ethnic minorities and other under-represented groups. Having worked with NHSE, NICE and the Royal Colleges, I understand the extra mile needed for us all to successfully address the health inequalities that exist in society. Henceforth, I am hoping to develop more innovative ways of combining patient safety and patient experience, sharing insights from wider forums nationally and internationally to improve national and global health.
As Chief Investigator for The coNneCT Study (The Neurological Complications of TTP), I am hopeful that over the next couple of years analysis of the findings from this national study will enable us to introduce more personalised support for patients experiencing long term neurocognitive and psychological symptoms so that they can live more fulfilling lives.
I am hoping to develop more innovative ways of combining patient safety and patient experience, sharing insights from wider forums nationally and internationally to improve national and global health.
To contribute meaningfully to patient care in my career means also considering one’s own wellbeing and longevity! It’s hard to slow down when you’re running with missions that you feel so passionately about. But it’s also important not to forget enjoying being your own woman, being a mother, enjoying time with your family and the beautiful world around you. Hopefully every future step will be a recipe of all of the above, in all of the right proportions!
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