RJAH hospital, Shropshire

PUBLISHED: 19:23 07 February 2010 | UPDATED: 16:17 20 February 2013

Known locally as 'The Orthopaedic and more precisely as the Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust (RJAH), the multiplicity of buildings on an old army military hospital site near Oswestry has a history.......

Many things and people have made it famous over the years. It was the world's first open air hospital. It has unusual ultra clean air operating theatres based on a German design. It was founded by Agnes Hunt, who was made a Dame Commander of the Order of the British Empire in 1926, and who died in 1948. Robert Jones, a famous pioneering orthopaedic surgeon who was knighted in 1917 and died in 1933, subsequently joined her. He was also instrumental in the establishment of Alder Hey Children's Hospital and shared a common interest with Agnes Hunt in treating children. Today, The Orthopaedic provides planned orthopaedic surgery and musculoskeletal medical services for all age ranges and its staff have particular areas of expertise including spinal injuries and disorders affecting muscular development. Its reputation for innovation and research in orthopaedics extends around the globe. The spinal research team was recently awarded a 200,000 grant as part of the 2.9 million European Commission Genodisc genetic research project to prevent acute back pain becoming a chronic disability. The beginnings were much humbler. Agnes Hunt contracted septicaemia and infective arthritis of the hip joint at the age of nine and spent much of the rest of her life in pain and using a stick or crutches. Nevertheless, she qualified as a nurse at the Salop Infirmary in 1891 and went on to meet fellow nurse, Emily Goodford (Goody'), with whom she would form a 30-year friendship and working relationship. Together they opened the Baschurch Home as a convalescent home for the Salop Infirmary. As the upstairs wards were not easily accessible by disabled children, they built open-air ground floor wards from some disused stables - effectively a shed with an open side. The Great War brought many military casualties, some disgusted at first by the open-air wards. These were, however, found to aid recuperation and the concept would be transferred to Shropshire Orthopaedic Hospital, which was officially opened on the present site in 1921. By this time, Robert Jones was closely involved with the hospital. Born in Rhyl, Jones was greatly influenced by his bonesetter uncle, Hugh Owen Thomas, and after qualifying as a doctor worked as his assistant for some time. Jones would go on to become known as the 'Father of Orthopaedics' and even today, trainees in orthopaedics at the RJAH consult his original notes and findings. He met Agnes Hunt when she consulted him about her hip condition and he subsequently became the Honorary Surgeon at the Baschurch Home and then at the Shropshire Orthopaedic Hospital. Readers should appreciate that the treatment of disease or damage to bones or joints was rudimentary compared to now. Patients might spend many months or even years in bed and surgical appliances were crude devices.

The Shropshire Orthopaedic Hospital, which was renamed The Robert Jones and Agnes Hunt Orthopaedic Hospital in 1933, was constantly breaking new ground as massage treatment and exercise therapy were introduced in the early years, followed by an after-care scheme. Then a Cripples' Training College was opened to help patients become self-supporting and further developments followed. In 1948, half the hospital was destroyed in a fire while later in that year it became part of the NHS. From the 1960s onwards, many new centres have been opened at the RJAH including the Charles Salt Research Centre, the Midlands Centre for Spinal Injuries, the Institute of Orthopaedics, the Orthotic Research and Locomotor Assessment Unit, the Centre for Spinal Studies and the Leopold Muller Arthritis Research Centre. The research undertaken in these various centres is, to use a common phrase, ground breaking. For example, Professor James Richardson is a Consultant Orthopaedic Surgeon/Professor of Orthopaedics at RJAH. He specialises in hip and knee replacement, stem cell therapy, autologous chondrocyte cell implantation (treatment of cartilage damage in the knee), and problems with fractures and infection. A trial in stem cell therapy for the non-union of fractures is being undertaken at RJAH and is the first such trial with patients. Loraine Holland, from London, had a fracture which would not heal and read about the trial in a national newspaper. She came to The Orthopaedic and was treated successfully. Treating sports injuries is another speciality at the RJAH, with a team of experts led by Mr Dai Rees and Mr Simon Roberts, consultant orthopaedic and sports injury surgeons. Mr Roberts says: "Our practice is entirely sports injuries, but this includes caring for the musculoskeletal problems of active people of all ages. We don't do any joint replacements so we can specialise and improve the treatment which we can offer." Most of their work is minimally invasive surgery of the knee, shoulder and ankle for problems of joint instability, ligament and cartilage problems and joint surface defects. The sports injuries team has treated players from most of the premiership football and super league rugby teams over the past decade and athletes are now being referred from abroad. Simon Roberts says: "The experience gained in treating elite athletes is helping us find the best treatments for sports enthusiasts of all ages and abilities." Developments at the RJAH continue apace. At the end of last year, the TORCH building (The Orthopaedic Research for Children Centre) opened. This is a unique centre - the only one of its kind dedicated to assessing children with mobility problems. The Orthopaedic is a centre of excellence for the treatment of both cerebral palsy and muscular dystrophy and there's a hi-tech gait laboratory inside the TORCH building which is used to assess walking problems, particularly in children. Remarkably perhaps, and as an indication of the high standing of the RJAH and its staff within the community, the TORCH building was built with charitable money, much of which was raised locally for

various causes. In July, new modular theatres were brought on site and lifted into place with a 500-tonne capacity crane. These are now the new Short Stay Theatre Unit. Theatres are something of a talking point at the RJAH. As a result of dedication and an idea conceived by Professor Brian O'Connor, the hospital proudly possesses an innovative theatre unit, built in the 1991 at a cost of around 7 million, which is the only one of its type in the UK. Known as the barn theatre, it is based on a German design and has seven operating cabins (glass-walled enclosures), each weighing five tonnes, suspended 60mm from the floor - to maintain constant air flow. These uber-clean theatres account for the very low infection rates and in some ways resonate with the open-air wards of the past. It's not all bricks and mortar at The Orthopaedic. One of the largest employers in the area, the hospital has around 1,200 staff including some highly skilled consultants and scientists. Indeed, the RJAH is a pretty healthy place - for two years running there has been no MRSA there and only seven cases of Clostridium Difficile in the past 12 months. Against the all-important performance targets, the Orthopaedic does very well. More patients are being treated yet waiting times have been much reduced and in the National Inpatient Survey, it was voted 'Best Hospital'. In 2010, the RJAH will seek to achieve Foundation Trust status, which will place it amongst the best performing hospitals in the country It's not all pioneering research either - The Orthopaedic is a hard working hospital. The main types of operations are hip and knee replacements - more than 2,000 such procedures were performed last year. Specialists treat all orthopaedic conditions, with dedicated teams for each

area of the body. The Trust also has a rheumatology service, mainly for arthritis sufferers and a bone service for osteoporosis and also a highly specialised bone tumour service. In addition, 10 per cent of the UK's orthopaedic surgeons are trained at the RJAH and placements are offered for students across a range of disciplines. So-called 24-hour hips are an example of how pushing the boundaries of clinical practice remain a focus at RJAH. In most hospitals, hip surgery would involve a stay of around five days. At The Orthopaedic they have reduced this to just 24 hours for some patients. This is only possible because of the specialised approach to anaesthesia undertaken at RJAH, the low infection rates and the ultra-clean operating theatres. A new anaesthetic is being used - it is pumped directly into the joint and remains there for some hours afterwards thus considerably reducing pain following the operation. This in turn means that the physiotherapists are able to start working with the patient much sooner. Feedback from patients about the procedure has been excellent and it has attracted interest

nationally. In due course, the pioneering process may be applied to other procedures and could be rolled out across the country. Another example of The Orthopaedic being at the leading edge is a specialist technique called selective dorsal rhizotomy - which in the UK can only be done at RJAH. Ricky Balshaw, a patient from Telford with cerebral palsy, was treated with this technique and went on to win a silver medal in dressage at the 2008

Paralympics. Volunteers have always been closely associated with the RJAH as far back as the Baschurch Home. In 1907, donations included fruit, eggs, rabbits and clothes. A network of voluntary committees helped raise funds for rebuilding the hospital before the Second World War and volunteer work continued even after the hospital came under the umbrella of the NHS. In 1961, The League of Friends to The Robert Jones and Agnes Hunt Orthopaedic and District Hospital NHS Trust was set up as a registered charity - and had more than a thousand founder members. Today, there are branches of the League of Friends in places from Bala to Welshpool and the Oswestry Rheumatology Association is also a branch. Members of the League have run the hospital shop from 1963 and together with other voluntary organisations they provide services such as a coffee shop, help desk, trolley service to the wards and flower arranging as well as support and friendship to patients and ex-patients. Each year, the members organise a League of Friends annual fundraising Summer Fair and this June hospital staff again held a combined 'behind the scenes' event on the same day. The keyhole surgery stand, manned by the sports injury team, allowed children to try their hand at minimally invasive surgery with the aid of real time video by practising removing seeds from a red pepper, through a very small incision. Meanwhile, the League of Friends' programme included a treasure hunt quiz, stalls, refreshments, model aircraft and vintage cars. The money this brought in added to the 3.5 million already raised by the Friends. Undoubtedly, the greatest fund-raising achievement to date was to provide 1.3 million towards the 1.5 million cost of a new therapeutic swimming pool opened in 2005. It replaced a 1966 vintage pool for which the League had raised 22,000. More recently, the League spent 50,000 on Fluorescent In Situ Hybridisation tumour analysis equipment in the Department of Pathology and a further 15,000 for pain relief pumps. To help the League of Friends or make a donation to The Orthopaedic hospital, contact the League of Friends Office (telephone: 01691 404401 or 01691 404527) or see the hospital website www.rjah.nhs.uk Another recent development from charitable funding (County Air Ambulance Trust) is the provision of a helipad and covered walkway at the RJAH. With landing lights for 24-hour access, the helipad makes transfer to and from the hospital more comfortable for patients and The Orthopaedic is the first in the country to benefit from this funding.

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