Ruislip Residents’ Association is a member of The Community Voice, an umbrella organisation concerned exclusively with NHS services in a wide circle around Mount Vernon Hospital. One of our delegates is its Chairman and the other is its Vice Chairman. Through that organisation, we are kept up to date on local NHS issues.This website has separate pages for different local NHS services. Click on the linkages below for detailed information and reports.
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National and Regional
- National online survey for dementia patients diagnosed in last two years and their carers: This notes experiences of diagnosis, support and awareness. It is open until 31st January 2017.
- London Child and Adolescent Mental Health Services: This service currently has higher waiting times than planned despite increased investment. This affects achievement of 18 week referral to treatment target for these young patients.
- Apprenticeships: The Government’s Apprenticeship Reform Programme aims to achieve 3 million apprenticeships by 2020. The Apprenticeship Levy operates from April 2017. Employers, both public and private, with pay bills over £3m per year, will pay 0.5% of each month’s pay bill plus 10% from the Government, from which the employer can fund training costs from registered providers. The Hillingdon Hospitals Trust has already started 40 apprenticeships and is planning more – health care assistant support workers, a chef, and business and administration workers.
- Harrow and Hillingdon Mental Health Services: Services in these London Boroughs remain chronically less successful than other areas served by Central & North West London FT. Under achievements against targets over at least the last four months are attributed to various factors including patients not engaging with the service, staff sickness, staff shortages and poor data quality.
Royal Brompton & Harefield FT
- Congenital Heart Disease (CHD) Proposals: Following an exchange of correspondence with NHS England and on the advice of Counsel the Trust decided not to launch a Judicial Review on these proposals and it intends to work collaboratively with NHSE throughout the consultation process, but it has written to NHSE notifying it of the Trust’s concerns with its proposals.
- Recruitment of Harefield Consultants: In line with increasing activity across the Transplant and Mechanical Support service of Harefield Hospital, the Trust is recruiting for two Consultant Transplant and Cardiac Surgeons – one is a new post, the other is a replacement. It is also recruiting for a Consultant Thoracic Surgeon at Harefield, which is a replacement post.
The Hillingdon Hospitals NHS FT
- Joint pathology service with Imperial College Healthcare Trust + Chelsea & Westminster FT: Hub (Charing Cross Hospital) and spoke model, began in September, with only urgent tests locally.
- New outpatient pharmacy: This will greatly reduce waiting times for patients.
- Blue light ambulances at Hillingdon Hospital: Blue light ambulance concerns have been reviewed as part of an extensive review of pressures on the Urgent and Emergency Care Services at this hospital. A sustained and continuing rise in the volume of high-priority ambulances was considered largely appropriate by both LAS and THH clinicians.
- Staffing levels: Average fill rates were over ninety percent against planned levels. The need for additional staffing at night, to maintain patient safety and comfort, remained a feature across both sites. Paget Ward has continued to be used as additional capacity for inpatients in addition to functioning as a day care unit. Compared to last October there was a net increase of 180 whole time equivalent staff, primarily spread across the clinical divisions.
Hillingdon Clinical Commissioning Group
- Moves towards greater CCG autonomy: All 8 NW London CCGs are now applying for fully delegated Primary Care Commissioning, to provide greater autonomy from NHS England from 1st April 2017, a year ahead of other CCGs. Potential conflicts of interest are recognised as a risk of full delegation but NHS England has produced extensive guidance which prescribes establishment of a Primary Care Commissioning Committee chaired by a lay member and with lay and executive majority to mitigate this issue.
- Integrated performance: Key performance challenges include London Ambulance Service response times, A&E four hour waits, referral to treatment 52 week waiters, cancer treatment waiters, MRSA, Child & Adolescent Mental Health Services (CAMHS), Musculoskeletal Community Physiotherapy services and NHS 111 call back times.
- Identification of patients with atrial fibrillation: The Board’s application for funding for a pharmacist to identify these patients in GP lists has been successful - so that these patients can be prescribed improved medication to reduce their risk of suffering a stroke. The project is expected to come into operation early in the New Year.
Items of particular interest from the papers for the meeting are noted below but this is not a report of the meeting itself.
London Ambulance Service: This is the busiest emergency ambulance service in the UK .
It was reported in June that mental health continued to feature prominently in the work of LAS and six mental health nurses had been appointed to support the teams from the clinical hub.
It was also noted that staffing had been a big issue that was likely to continue given the shortage of paramedics, but LAS had a robust recruitment plan with more joiners than leavers.
Defibrillators in Hillingdon schools: All the Borough’s primary and secondary schools have been equipped with defibrillators.
Central & North West London NHS FT: The Trust employs 7000 staff to provide over 300 different health services across 150 sites. Approximately 1000 CNWL staff work in Hillingdon.
In Hillingdon its mental health services include inpatient and community services for adults, older adults, children and adolescents, specialist memory services, psychiatric liaison services with in-reach to Hillingdon Hospital A&E and wards, mental health rehabilitation services, and addiction services.
Its community physical health services include the Rapid Response Service, speech and language therapy, community dentistry, specialist wound care, adult rehabilitation services, wheelchair service, health visiting, Hillingdon Centre for Independent Living, Looked After Children specialist team, community based palliative care team, inpatient intermediate care in Hawthorn Ward on its Hillingdon Hospital site, podiatry and musculo-skeletal physiotherapy.
Royal Brompton & Harefield NHS FT: This is the largest specialist heart and lung centre in the UK and amongst the largest in Europe. It works from two sites the Royal Brompton in Chelsea, West London and Harefield Hospital in Hillingdon.
Investment plans are in place to expand capacity by 20% at Harefield Hospital in three phases. Phase1: An additional 6 critical care beds, a new scanning centre and a new 18 bed inpatient ward (Holly Ward) completed early 2015.
Phase 2: An endoscopy / minor procedures facility and more day case / short stay beds and a daycare lounge, plus Oak Ward to be rebuilt on two storeys with 20 additional beds, reconfiguration of the hospital entrance, and the lodge house to be converted for up to four patients who are medically but not socially fit for discharge.
Phase 3: A new three storey graduated care unit, an imaging centre and bringing together 48 critical care and high dependency beds, with completion in the next 3-4 years.
The Hillingdon Hospitals NHS FT: The Trust has been awarded £12.4m from the Dept. of Health to re-engineer its Emergency Care Department at Hillingdon Hospital – the second largest successful bid awarded to a London Trust as part of the allocation to England. This is the biggest development on the site for 40 years.
As part of North West London’s Shaping a Healthier Future the Trust expects £17m for backlog maintenance work plus £23m for theatre upgrade, the expansion of A&E, maternity and critical care services. £741k of Government funding has been used to modernise ten delivery suites in the Maternity Department and additional funding is expected to increase the Trust’s maternity capacity.
Local Medial Committees: London has 27 LMCs. These are elected committees of GPs enshrined in statute. They represent GPs and practice teams in negotiations with decision makers from the NHS and local government.
Care Quality Commission (CQC): This inspects all health and social care services in England and takes enforcement action to ensure people receive safe and effective care. It inspects hospitals, community health services, care homes, GPs, and dental practices.
Julie Sands, Head of Primary Care North West London, NHS England, was guest speaker at the May 2015 meeting of The Community Voice, of which we are a member. Her address included:
a. Primary Care NHS England has a statutory duty to work with local Clinical Commissioning Groups (CCGs) to provide the best care for patients.
b. Primary Care North West London serves a population of 1.9 million people, and is responsible for 8 CCGs - Brent, Central London, Ealing, Hammersmith & Fulham, Harrow, Hillingdon, Hounslow and West London - with a total of 400 contracts. GP practices work with the CCGs to provide Primary Care for the local population.
c. Formerly GP contracts required only core services - treatment of sick people, chronically ill patients, the terminally
ill, and services such as cervical and other screening programmes.
d. However, nationally in 2015-2016 GP practices are expected to provide the following services:
Childhood immunisations, ‘flu and pneumonia vaccinations.
Diagnosis & support of dementia patients, including care plans – a government drive for early diagnosis of
dementia provides GPs with clinical "tools" and training in diagnosing dementia.
Health checks for those with learning disabilities.
- GPs should:
Avoid unplanned admissions and be proactive in the care of vulnerable people by helping them to care for themselves.
Meet the reasonable needs of their patients for home visits, nurse appointments, appointments to see a GP on the day requested, and to make appointments for a particular GP in advance.
- GPs will also be encouraged to extend the opening hours of their practices, possibly achieved by forming a network with other local practices to improve opening hours and weekend surgeries.
Additions to GPs’ 2015-16 contracts include:
Every patient, including children, should have a named GP taking responsibility for that patient.
By 31st March 2016, GP practices must publish on internet the number of full and part time GPs in 2014-15 in their practice, and their average net earnings, including contracted / salaried GPs.
Extended online patient access to services, including medical records, and appointment booking - pilot schemes already use Skype and emails to set up patients’ appointments.CCGs, as commissioners, must receive and assess the plans of each practice for out of hours services. If not satisfied, the CCG can nominate an Out of Hours Practitioner for that practice.
A Patient Participation Group (PPG) should be set up in each practice to discuss benefits for the patients and to make improvements to the practice.
- NHS England will review GP practices at the end of 2015-2016, with action if necessary.
The speaker then invited questions. Audience members expressed their concerns about GP services and posed many questions, leading to the following comments from the speaker:
Some GP practices were good and some not so good. Single GP practices, which cannot provide all the services required, are being encouraged to see the benefits of working in a larger organisation, but as each GP surgery has its own contract it is difficult to fulfil this.
Many GPs do not wish to merge or work within networks and many are coming up for retirement.
More surgeries are needed because of more people, but land is not always available. This is a National problem. Health Education England is working with CCGs to try to address the problem. GPs are to be given more training in diagnosing dementia and each GP practice should have a specialist in psychiatric problems, either a doctor or a nurse practitioner.
The Speaker was thanked by James Kincaid, followed by resounding applause from the audience.
Dr. Rowan Hillson MBE, former national Tsar for Diabetes, spoke about diabetes at the December 2014 meeting of The Community Voice, making the following points:
a. Diabetes is a chronic multisystem disorder characterised by a persistently high blood glucose level, due to a malfunction in the pancreas and it is a life changing condition. The incidence of the disease is increasing from 1.3m people in 2003 to 2.7m people in 2013, and the prevalence of the disease is nearly 4 times higher than the prevalence of all cancers combined. Patients affected deserve the highest personalised care, no matter where that is given, by the best trained experts in diabetes, who continually update their knowledge of research and new treatments for the disease.
b. Diabetes is a common and chronic disease and can have many and varied complications, affecting eyes, major organs of the body, skin, bones, muscles and feet, and those with diabetes may need psychological support to help them cope with the distress and disability of this life changing disease.
c. Diabetes UK’s website lists the 15 essentials for diabetes care including eye testing, BP checks, blood tests, and urine testing - which can show up minute traces of diabetes. Foot care tests should be carried out by trained staff on an annual basis, and many of them could be carried out by the GP or Practice Nurse, or during Hospital appointments when attending with other concerns.
d. When a patient is initially diagnosed with Diabetes, structured diabetes guidelines on lifestyle should be given, such as healthy eating, regular exercise, foot care and a no smoking regime advised. An ongoing care plan, tailored to each individual's need, should be drawn up, with the patient's agreement, but some patients may not wish to have this done. However, patients who do not have regular checks risk hidden diabetic tissue damage such as kidney problems, leading to dialysis, to regulate their kidneys, so it is essential that patients, once diagnosed, have regular checks to monitor their condition.
e. Foot care is vital for Diabetes sufferers and they must learn how to look after their feet by keeping them clean and dry, and, every day, by looking for colour changes, skin breaks or even ulcers, and by touching them to check sensation. There are 61,000 people who have diabetes with a foot ulcer at any time and 7-10/10,000 have a major amputation, the risk being 20 times that of a non-diabetic person, although up to 80% could have been avoided with the proper and correct care.
f. There are many types of Diabetes, which can be inherited. Type 1 needs to be treated with insulin by injection. Type 2 can be associated with obesity, and is mainly treated with tablets at first although many people later need injections of insulin or other glucose-lowering medication. Some patients may control the disease with diet alone. Some find it helpful to test their own glucose levels with a finger prick test.
g. Insulin for injection to replace or add to the body's own insulin, was first processed from pigs, but is now processed from a yeast or bacteria. There is much research being carried out. Inhaled insulin has been developed but is not available in UK. Oral preparations are only in the development stage. Insulin must be given by injection; pre-loaded insulin pens and a continuous glucose pump systems are used.
h. Non-insulin glucose-lowering medications work in different ways in the body. Some reduce appetite or reduce or change the absorption of glucose in the body. Others alter the production of insulin in different ways. Some non-insulin glucose-lowering treatment is given as tablets, some by injections.
i. There is a pancreatic islet cell transplant programme in the UK for Type 1 diabetes patients who are having major problems controlling their blood glucose. Pancreas transplants can also be carried out, usually simultaneously with kidney transplants. Both have varying degrees of success. There is also a programme looking at the use of the patient's stem cells, which shows success in tests on mice, and is in the early stage of research.
j. Concerns were raised by the members that patients, particularly those with learning difficulties, are not always given the information about diabetes by their GP practices. They were advised to raise the issue with GPs and to press for more information about testing from the GP or practice nurse. More information can be found on the Diabetes UK website, including the 15 care essentials, or by telephoning the Diabetes UK care line (0345 123 2399), or asking local chemists.
Donald Edwards thanked the speaker on behalf of the members, who responded with applause.
1. Overview of this meeting, which was held in public: The Board comprises ten voting members – 7 Councillors, CCG Chairman, Healthwatch Chairman and the Council’s Deputy Chief Executive - and a number of non-voting members including Council Officers and co-opted members representing NHS Trusts, nominally the Chief Executives of Central & North West London FT, The Hillingdon Hospitals FT, and Royal Brompton & Harefield FT.It was assumed that Board Members had read the papers. There were no presentations or summaries, but the person leading each item was able to add brief comments and to answer questions. Members of the public, who had not read the papers in advance, found it difficult to follow some items. Various officials sat in the public gallery. Hillingdon CCG’s Finance Officer was called to the table to clarify some financial points.
At this meeting there was little or no discussion of any agenda item. Only the Chairman and Councillors asked questions. In each case the Chairman then asked “Do we agree the recommendations?” which closed that item. None of the hospital representatives said a word.This was a fast, brief, meeting - lasting barely 40 minutes. One further item was to be discussed in Part II.
2. Decisions agreed:
a. Joint Health & Wellbeing Strategy 2014-16: This integrates the work of the Better Care Fund, Public Health activity and new requirements of the Care Act 2014 and instructs officers and partners to work together to complete a refreshed action plan. A (further?) refreshed action plan is to be presented to the Board in December 2014. The identified priorities are:
- Children engaged in risky behaviour
- Physical activity
- Adult and Child Mental Health
- Type 2 diabetes
- Increasing child population and Maternity Services
- Older People including sight loss
- Dental Health
b. Noting of Hillingdon Clinical Commissioning Group’s key areas of work: These were reported as:
- Primary Care Co-Commissioning
- Integration of Services
- A&E Changes
- Commissioning Support Service Transition
c. Noting of Hillingdon Clinical Commissioning Group’s Finance Update: The Chairman expressed difficulty in understanding the various references to deficits in the papers, which was explained as differences in the way that NHS accountancy works!
The 14/15 plan would have resulted in a deficit of £25.6m but after application of the NWL Financial strategy the CCG was able to set a balanced budget, although this would leave a residual underlying deficit of £7m at end of year.
d. Noting of Healthwatch Hillingdon update: This overviewed activities from April to June 2014.
e. Noting of an update on allocation of S106 Health Facilities Contributions: Extensions to four GP surgeries are now largely completed and extension of the Hesa Health Centre in Hayes is underway. Tenders for the new Yiewsley Health Centre have been received and S106 contributions identified. The St Andrews Park developer is released from the obligation to provide an on-site healthcare facility, after paying over £624k – the Council would consider a loan to the CCG to secure a site for an Uxbridge health hub. Other suggestions for S106 contributions include extending other GP surgeries and possibly pharmacies.
f. Pharmaceutical Needs Assessment: It was agreed that provision in Hillingdon is good. The full document will be open to consultation for 60 days from 24th September.
g. Board Planner & Future Agenda Items: Items were agreed for 11th Dec. 2014 and 17th March 2015.
This meeting, with Chairman Cllr John Riley, covered local health services and had senior representatives present from Central and North West London FT (CNWL), Hillingdon Clinical Commissioning Group (CCG), Hillingdon Healthwatch, Royal Brompton & Harefield FT, The Hillingdon Hospitals FT (THH). It also considered reports from the London Ambulance Service (LAS), the Care Quality Commission (CQC) and the Local Medical Committee (LMC). The notes below are items of particular interest – not a summary of the meeting.
Hayes Town Medical Centre: This Centre was established in 2009 to provide a GP service for registered patients and a walk-in centre for patients not registered with a practice. The contract for walk-in services awarded to Bondcare Medical services expires on 30th September 2014. Following public consultation in 2012, feedback from outreach work, and a recent options appraisal, it is now proposed to let the walk-in service close. The GP service for registered patients will continue to operate, as will the Orchard practice which is also located in the Hesa Centre. The new 111 telephone service and the Urgent Care Centre at Hillingdon Hospital will continue to provide services for unregistered patients.
Hillingdon Urgent Care Centre: This now treats and discharges over 60% of all patients who attend either the UCC or Hillingdon A&E Department.
Hillingdon CCG: This CCG, like all CCGs, is overseen by NHS England - which also commissions GPs, pharmacy, dentists and specialist services (those needed by relatively few people). The CCG commissions community health and hospital services for Hillingdon people including mental health and learning disability services. The CCG is working with Hillingdon Council and voluntary and community sector organisations to provide services covering health and social care. An application has been made to the Better Care Fund for services initially targeted at services for people aged over 65 years.
CCG pilots in the south of Hillingdon for self management of long-term conditions: The three pilots provide self-management advice and techniques for patients with chronic obstructive pulmonary disease, asthma, and diabetes.
CNWL: This trust employs around 7,000 staff and over 300 different health services across 150 sites. In Hillingdon it has around 1,000 staff delivering services in patients’ homes, schools, GP practices, health centres etc. In 2013-14 it supported almost 72,000 people with their physical health needs (approx 25% of the Hillingdon population).
It provides inpatient and community based mental health services for adults and children. It received 14,000 Hillingdon referrals for these services last year, supported 10,000 people and provided hospital care for 561 patients. Its memory service waiting times are now only 1 – 2 weeks. Those with a diagnosis of dementia start treatment which is monitored for 3 months before discharge to primary care.
Its community physical health services include the rapid response service, speech and language therapy, specialist community dentistry, adult district nursing, school nursing service, health visiting, wheel chair service, specialist community paediatricians, community based palliative care – and others.
Royal Brompton & Harefield FT: This is the largest specialist heart and lung centre in the UK and amongst the largest in Europe.
THH: Last year the Trust had a turnover of £190m. It employs over 2500 staff, delivering services to people from Hillingdon and surrounding areas, a total catchment of about 350,000 people. Last year 4,205 babies were delivered at Hillingdon Hospital.
LAS: This is the busiest ambulance service in the UK. It is the only NHS Trust that covers the whole of London. It has over 5,000 staff.
CQC: The CQC will inspect around 25% of Hillingdon GP practices in September 2014 and corresponding out of hours services.
LMC: Since 1911 LMCs have been elected committees of GPs, enshrined in statute, representing GPs in negotiations with decision makers. They represent all GPs in their geographic areas, which are coterminous with historic healthcare administrative areas. There are 27 LMCs across London.
Always dial 999 if you fear a life is at risk - a potential heart attack, or stroke, major bleeding or serious injury
Dial 111 if you are uncertain what to do - you will receive advice and also a priority appointment if you are advised to go to an Urgent Care Centre
- Book to see a GP: For any non-urgent health concerns
- Minor Injuries Unit, such as Mount Vernon MIU: For cuts, burns,scalds, mild head and body injuries, removal of foreign bodies from eyes, nose or ears, fractures and sprains, insect or animal bites - but MIUs do not treat children under 4 years old, nor children needing x-rays.
- Urgent Care Centre, such as the UCC at the entrance to Hillingdon Hospital's Emergency Department: For minor injuries (as above) and minor illnesses that need immediate attention by a GP or senior nurse.
- Emergency Department of hospital: Access at Hillingdon Hospital is via UCC or ambulance - this is the right option for children under 4 years, children needing x-rays, and for adults with major illness or injury
You could be advised to use homely remedies already in your own medicine cupboard, advised to see your own GP, or to go to a hospital service or Urgent Care Centre, but if the issue is serious an ambulance could be on its way before you put the 'phone down.
There have been bad reports in newspapers and on TV about the 111 service in some parts of the country, but local reports in North West London are that the service here is good.
Community Voice, of which Ruislip Residents' Association is a member, is monitoring this issue. It welcomes comments on this new service, which is easily done if you are reading this page. You can send us an email by clicking the envelope at the bottom of the page and we will pass on your report.