Louise Gallagher tells Caroline Holland why she was happy to step out of the rat race and into 'Putney time.'

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It's a fact universally acknowledged - within the dental profession - that a dental nurse is indispensable to the smooth operation of a dental surgery. At the Royal Hospital for Neuro-disability, Louise Gallagher is not just indispensable, she is axiomatic to the dental service.

Working fulltime at the hospital in Putney south west London, she assists four part-time dentists and undertakes the administration which is essential to keep the dental surgery ticking over.

It's as different as it's possible to be from the typical dental practice. Fortunately for the staff, targets and clawback are replaced by an implicit recognition that everyone is doing their best.

Theirs is the first dental surgery I have been to which has no dental chair. Most of the hospital's patients are brought to the appointment in a wheelchair and treated in a 'wheelchair tipper' located in the middle of the room. Louise believes the tipper may be the first ever in a UK dental surgery.

When patients are mobile, they walk into the surgery and are seated in the surgery wheelchair for the duration of the appointment. Another point of difference with conventional dentistry is the higher than average number of patients who require sedation for their treatment. Sometimes joint medical and dental procedures are carried out with doctors, such as administering Botox to patients suffering from trismus or excessive drooling.

Another key point of difference is time-keeping. While high street dental surgeries must at least try to run to time, that kind of pressure would be intolerable at RHN. Affectionately, they call it Putney time. It can take hours to get the residents up and breakfasted every morning so the first appointment is set for 10am. Often, says Louise, she will go up to the ward to help bring the patient down as porters are busy. Everyone is on the same side at RHN.

The care shown for the patients is second to none. Before a tour of the hospital, Louise outlines the variety of conditions and accidents which might have brought their patient to the hospital:

  • An accident - car, bike, falling off a ladder

  • An assault leading to brain injury

  • A progressive neurological condition

  • A spinal injury

  • A brain tumour

  • Locked-in syndrome

  • Oxygen deprivation after a heart attack and CPR

The hospital has a rehabilitation service on one end and the long-term service at the other. Patients are likely to enter into the rehabilitation service where they will be provided with an impressive range of therapies - speech and language, physiotherapy, music, art and occupational therapy. The goal is to enable these patients to improve enough to return home or transfer to a community care facility.

Louise describes what it's like to see a patient who has previously been immobile walk into the dental surgery. 'You share their pride and sense of achievement. It's wonderful to see.'

All patients will have a 'communication passport' tied to their wheelchair. This provides a mini profile of the person to allow personal interaction

These patients, fortunate by the standards of others at RHN, may be rehabilitated enough for appropriate discharge.

Once they are based in the RHN, residents are automatically patients of the in house dental surgery. Louise will see new arrivals on the ward and learn a bit about them before booking them in for an appointment. All patients will have a 'communication passport' tied to their wheelchair in addition to a computerised record. This provides a mini profile of the person, their likes and dislikes, their interests or hobbies. While many do not have the powers of speech, they can understand what is being said and staff do their best to chat in a personal way.

Said Louise: 'It's very interesting working here. You never see the same thing and you belong to a wider and very friendly team.' Part of her role is educating the nurses and healthcare assistants in 'Mouth Care Matters', enabling them to help the resdents with their oral health or spot if there is an oral problem.

While we were on our tour of the hospital, we went to see an edentulous resident for whom Mili Doshi, the dentist on duty on the day I visited, had made new dentures. As we approached her wheelchair, she gave Mili and Louise a big, rewarding grin. She could not speak but, she did not need words to make her delight known.

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Louise and Mili in surgery

Mili described a day when a man who could not speak saw the word 'dental' on her uniform. None of the ward team realised that he had an implant-retained denture in his mouth which badly needed removing and cleaning. He gesticulated at Mili and indicated his mouth and she understood she should take a look. She saw the denture and helped remove it and get it cleaned. A great result but perhaps an indication of the challenges facing carers when older patients have benefited from complex dentistry.

Everywhere we went in the hospital, Louise and Mili are greeted. Louise continued: 'There is no hierarchy in this hospital and no-one thinks they are better than anyone else.' When a new nurse joins the rehabilitation service, Louise is part of the induction programme, teaching them how to look in a patient's mouth and outlining the oral problems they should look out for. She will also go to the ward when there is a new patient and assess their dental needs and organise an appointment in the dental surgery when necessary.

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A life size cut-out of Matron Sorin with inspiring words

The hospital is a magnificent Victorian building with wide corridors, large stately rooms with fireplace and stucco panels and terraces with views over London. As Louise moves around the building, she sees all the activities that go on for the residents - art, music, yoga, or a film club. Residents' rooms are bright and decorated with pictures and flowers and many look out over wonderful gardens.

She loves working at the RHN, a job she saw advertised by chance. At the time she was working in the Community Dental Service. Since arriving in Putney, where she is closer to home, she has gained additional qualifications and is now doing an NVQ in management and leadership.

Louise never needs to question the value she gives to the residents of this remarkable institution or the service she works in. She sees it reflected every day she is at work, most importantly in the recognition she gets from the three dentists she works for and to whom she is ….indispensable.