During 2011 Central & North West London Foundation Trust moved its headquarters from Mornington Crescent to a building near Warren Street Underground Station. This serves as the hub from which over 3,000 staff are controlled. Originally the Trust provided only mental health services but it did so for a large swathe of North West and Central London, including Hillingdon and Harrow. It provides inpatient services on the Hillingdon Hospital site. In 2010 it branched out into provision of community health services. responding to the NHS requirement that Primary Care Trusts must no longer both commission and provide services. Hillingdon Community Health amalgamated with CNWL in early 2011 and subsequently CNWL also became responsible for community health services in Camden.
This page will contain items related to CNWL Board meetings and mental health services. Items related to Hillingdon's NHS community services will be shown on our Community Health Services page.
The notes below are points of particular interest – they are not a summary of the meetingThe Francis Report: The Board consensus was that CNWL procedures are sufficient to protect the Trust from the risks identified in this report.
September 2012 Hillingdon Community Health Patient Experience Survey: This survey covered patients using both general health services in Hillingdon and mental health services. There were 670 responses, a response rate of 30.2%, of whom 60% were female, 65% White British and 66% aged over 51 years. Responses were very positive, with 94% rating their experience as good or excellent.
Quarterly report on complaints: There were 85 complaints, 9 referred to the ombudsman and 384 PALS queries. The majority related to care and treatment, staff attitude, communication and appointments. A few examples were provided, showing outcomes. Nine legal claims were noted, each with brief details – 8 related to Mental Health and Allied services (3 assaults on staff, 3 for unlawful detention, 2 for injury during restraint). There was also one claim against Community Services for injury caused by catching a falling patient – this claim is being reviewed.
The JADE patient records computer system: Some problems were noted which are still being addressed. The delay in getting this system in place continues to cause concern.
Performance: All Monitor targets are being met but Hillingdon had some problems with delayed transfers of care and 7 day follow-up after discharge.
Draft Annual Plan: This is being finalised for presentation to the May Board meeting
Finance: The Trust was in line with its in-year predictions and it expects to achieve its planned end-of-year targets. Two Hillingdon debts were more than 90 days overdue - £129k of disputed continuing care funding from Hillingdon Council, and £102k from Hillingdon PCT.
Draft budget: This was approved - it does not include any elements relating to the transfer of Milton Keynes Services to CNWL. It was disappointing that noting that omission was the only reference to CNWL becoming newly responsible for community health services in Milton Keynes - which is an interesting development.
National Safety Thermometer: The Trust has not achieved this target due to confusion over this metric, as was the case amongst most other Trusts in London (including The Hillingdon Hospitals Trust which was particularly cited in the Health Service Journal – to that Trust’s consternation).
New crisis telephone line for out of hours use: A new out-of hours urgent advice line was launched on 25th February – Tel: 0800 0234 650. – together with new crisis cards. Old crisis cards should be destroyed.
It appears that all 13 London Boroughs for which CNWL provides services have been given the same crisis telephone number, which has only one line, but if that line is engaged a call will be diverted to an answer-phone for someone to ‘phone back within an hour.
Millhouse, Uxbridge: This CNWL adult centre has no out-of-hours ‘phone message for anyone who ‘phones after 5pm – this problem was reported to a CNWL official after the Board meeting.
A few points with particular relevance for people in Hillingdon are indicated below:
At month 6 the Trust met all Monitor’s key financial targets.
Safeguarding in Hillingdon:
Overall compliance with mandatory training for children’s safeguarding is clearly improving:
Level 1: 95% with 3% booked
Level 2: non-clinical staff 93% with 2% booked; clinical staff 76% with 16% booked
Level 3: 81% with 14% booked.
The electronic system of patients’ records is progressing. Manual systems will continue to be used until March 2013.
Do not attend appointments:
The target for DNAs at first appointment is maximum 15% but the current rate is 27% in Brent, 22% in Kensington and Chelsea and 18% in both Harrow and Westminster. For follow up appointments the rate is Hillingdon 20% and Harrow 16%.
Areas noted for improvement included:
Patients receiving personal care plans – target 95% but only 75% achieved
Involving patients in their care plans – target 65%, achieved 52%
Patients receiving medical health assessment after admission - target 95%, achieved 76%
(but for nursing assessment - target 95%, achieved 93%)
CNWL is one of the largest trusts in London offering health and social care services across eleven boroughs and serving diverse communities with over 100 first languages spoken.
Eleven areas of concern will be the responsibility of named senior staff:
- Reduction in number of falls
- Reduction of problems connected to transfers and discharges
- Reduction in avoidable pressure ulcers
- Reduction of medication administration problems
- Reduction of waiting times for discharge
- Fewer wheelchair complaints
- Improved information sharing
- Transitions in care pathways
- Physical health in the mental health context
- Safer patients
- Protecting staff from violence
The workforce grew to 5,159 by the end of March 2012. The staff vacancy rate at that date was 12.5%, a slight improvement, but still a matter of concern, particularly as this led to the use of temporary staff. There were three areas of very high vacancy, which included the Hillingdon Adults Section – this section also had the highest sickness rate in the Trust at 5.6%. However, through forward planning, the Trust successfully met the challenges posed by the Olympics.
It was noted that GPs often lack awareness and training on this issue.
Robyn Doran, Director of Operations & Partnerships, and Sarah Rushton, Interim Associate Director of Quality and Service Improvement, both of Central and North West London NHS Foundation Trust spoke about mental health issues at the September 2012 meeting of The Community Voice, of which we are a member.
Robyn Doran first explained that she would be speaking only about mental health services, which her Trust provides in many London Boroughs including Hillingdon. She would not be speaking about Hillingdon’s community services that her Trust provides via Hillingdon Community Health.
She had many years of experience as a nurse before undertaking her current role and has seen many changes, but more lie ahead. Mental health services are not yet subject to payment by results, but that will come.
Service line management is already in operation. She spoke of the assessment team at Mill House and the enhanced liaison service in A&E at both Northwick Park Hospital and Hillingdon Hospital. She also noted the work of the Recovery Team at Mead House, working under the Trust’s Care Programme.
CNWL has an excellent relationship with Hillingdon Mind, a much valued resource for local patients.
Working across many Boroughs her Trust is sadly aware that Hillingdon has more limited Psychology services than are provided in other Boroughs, but this problem is currently being challenged.
Services for elderly patients suffering memory problems are an increasing part of the Trust’s work. Other services include child and adolescent services, particularly early intervention for young people with psychosis problems, and help for those needing drug and alcohol services.
Day services are now provided in new ways. The CNWL Recovery College helps patients and carers to rebuild their lives through seeing themselves as students gaining skills. Courses are led by staff co-facilitated by patients and former patients who have themselves experienced mental health problems.
Sarah Rushton then spoke about changes to improve access to out of hours services, covering 5pm – 8.30am on weekdays and also all day at weekends and on Bank Holidays.
A crisis card has been developed to provided details about the patient’s or carer’s needs, as well as noting how to access help in an emergency.
A single 0800 telephone number will be introduced in Spring 2013, providing free calls from land-line telephones. Staffed by an experienced nurse, this will help patients, families or carers facing any mental health crisis other than those related to drugs or alcohol. At busy times callers may have to wait for a return call, but this should be within 20 minutes.
As there was no time for questions, it was agreed that the chairman would relay any questions from the audience to the speakers for written responses.
The two speakers were thanked by Graham Bartram and applauded by the audience
The last meetings in public in 2012 are on Wednesday 12th September and Wednesday 14th November, both starting at 9am. However, it may always be wise to check that meetings are taking place, either by looking on the Trust's website or be telephoning 020 3214 5700.
Board papers are available at the meetings. The Trust provides mental health services for much of North West London as well as Community Health Services for Hillingdon and Camden, so agendas are very wide ranging.
The Community Voice, of which we are a member, tries to be represented at all the CNWL Board meetings held in public. However, it would be good to see more people sitting in the public gallery listening to the proceedings and asking questions - the Chairman usually allows this at the end of meetings held in public.
- Phone number for crisis support:
- This aims to involve service users in planning their care and to improve the number who have a written care plan.
Dr James Warner, Clinical Director for Healthy Ageing, Central & North West London FT made a big impression on his audience at this meeting.
He was immensely informative but very informal. Those who heard him will not forget his talk. These notes try to capture the main points of his address
a. Dementia caused Dr Warner’s own father to decline to a shadow of his former self. It can afflict anyone. Everyone experiences mild memory loss as years advance - that is normal ageing. However, dementia is more than memory loss, involving difficulties with language and recognition of faces, difficulty with problem solving, planning and organisation, as well as changes in behaviour, emotions, personality and interests.
b. An early sign is impaired recall of recent events, such as what happened yesterday. Memory loss increases until even close family members are not recognised. Development may be slow over months or years. Typically functions such as ability to dress and feed oneself are gradually lost and incontinence develops.
c. Worldwide, dementia is a huge problem. Today ¾ million people suffer from it in UK and this is expected to rise to over a million by 2020, afflicting one in five people aged over 80 years. Of those who live to 65 years, one third will die with dementia. Dementia is now becoming a problem for developing countries too.