This Trust provides most of Hillingdon’s NHS hospital services, in one of its two hospitals.· Hillingdon Hospital’s Accident and Emergency Department provides all emergency care, as Mount Vernon does not have an A & E Department, but most of the Trust’s elective surgery is performed at the Mount Vernon Treatment Centre.·
This page will focus on news from Hillingdon Hospital and the Trust’s Board Meetings held in public. News of the Treatment Centre will appear on the Mount Vernon Hospital page.
National Items1. .Third Runway at Heathrow: The Chairman made clear that his Board has no views on the merit of the Government’s recent decision to build a third Heathrow runway, but it will cite that decision as an additional justification for a rebuild of Hillingdon Hospital, which is in any case in dire need of rebuilding due to age and estate inadequacies. He noted that the hospital will face all the demands of a bigger local workforce both during and after the runway’s construction.
2. NHS Finances 2015-1 6: The NHS budget of £116.4billion had to cope with nearly 23million A&E attendances (the highest number ever), 14 million GP referrals to acute hospitals, almost 6 million hospital admissions, 19 million first outpatient attendances and more than 9 million calls to ambulance switchboards. Local authorities spent £13.8 billion on adult social care services, covering short and long term care for more than a million people By the end of 2015-16 NHS providers had overspent their budgets by £2.45 billion. Local authorities were reported to have spent £168 million more than they budgeted for.
3. Nursing Home beds: In the past the growth in people needing care has been met by the growth in bed numbers in nursing homes, but this has come to a halt in the last 16 months. Profit margins have reduced due to pressures on fees available, compounded by the impact of the national living wage.- so the number of available beds has reduced with knockon effects across the whole health and care system - more emergency admissions to A&E, more delays for people ready to leave hospital and more pressure on other services.
4. Training places for doctors: The number of medical training places is to be expanded from September 2018 with the government funding an additional 1,500 student places each year, but there may be a requirement to work a minimum period in the NHS following graduation.
Hillingdon Hospital Items1. Opening of the Peter Pan Ward Extension: The official opening on 22nd October was performed by Boris Johnson MP for Uxbridge and South Ruislip. It was followed by a tour of the new Pharmacy and the new Paediatric A&E.
2. Increased car parking charges: The new parking fees are in the process of implementation. There have been no resultant problems.
3. A&E Performance: The 95% four hour standard could not be met in September. A&E arrivals increased by 7.6% compared with a year ago, paediatric activity was up 14% and blue light ambulances were up by 19.9%. Since 2013 the average number of patients per day has risen from 148 to 178 and the number of blue light ambulances from 5.3 to 10 – all with no expansion of physical capacity.
4. Improvements in A&E: There is now a supernumerary band 7 clinician on every A&E shift and two new triage rooms. Significant investment has been provided to expand the Clinical Decision Unit, due to open in December 2016, and to increase staffing. Other schemes are planned but are still to be implemented. A key constraint is bed availability. By reducing length of stay on wards it is hoped to increase capacity by the equivalent of 43 beds.
5. 7 Day Service Pilot: As part of the Trust’s North West London early adopter status for 7 day standards, it has put in a proposal to run a pilot about the number of consultants needed to meet the standard for ongoing consultant review. This project will take place on Grange Ward.
6. Proposed new role for Edmunds Ward: If agreed this step-down project will be run by GPs and Social Services, providing the equivalent of nursing home care for patients on discharge.
7. Finance: The Trust ended September with a year to date surplus of £61k, £84k behind plan. The Finance Director noted that if everything went well The Trust might break even at year end in March 2017 but it risked a deficit in excess of £6m, particularly as some possible funding depends on achieving very challenging targets.
1. Operation of NHS Improvement’s Single Oversight Framework: This will start on 1st October 2016, using the Care Quality Commission’s most recent assessments of whether a provider’s care is safe, effective, caring and responsive, and where available, delivery of the four priority standards for 7-day hospital services.
There will be four possible outcomes:
1. Maximum autonomy 2. Targeted support 3. Mandated support 4. Special measures. Finance assessment will include use of agency staff.
2. Health Research: The Dept. of Health has announced a five year, £816 million investment in health research – the largest ever investment into health research. Mental health research will get nearly £70million, dementia over £45 million and deafness over £15million. It is estimated that for every £1 the Dept. of Health invests, hospitals / universities will generate £6 from public research funders, charities and industry. The UK is already a world leader in pioneering medical breakthroughs and this record investment will ensure this strong tradition continues.
Hillingdon General Items
1. Services for children / young people with mental illness: Hillingdon Healthwatch has published “Listen to Me”, a report on young people’s mental illness, noting that uncertain funding, lack of early intervention and fragmentation reduce the effectivenss of services and it calls for a joint approach to provide improvements. Hillingdon Clinical Commissioning Group and London Borough of Hillingdon have incorporated various “Listen to Me” recommendations into the Joint Social Emotional Wellbeing and Mental Health Strategy 2015-2018.
Hillingdon Hospital Items
1. Staffing: In common with many other providers the Trust has high vacancy and turnover rates. The Trust aims to become an employer of choice by transforming the way it attracts high quality safe and compassionate staff. In August the Trust had 2,944 staff in post, an increase of 3% over the last year. In August the Trust was unable to achieve the £985,400 ceiling target for agency expenditure set by NHS Improvement – the actual cost was £1,300,237. Compared to last year there was a net increase of 268 whole time equivalent staff.
2. Infections: No cases of clostridium difficile were reported in August but two had been reported in September – they will be reviewed with commissioners to determine whether or not they were avoidable, which impacts on the Monitor quality governance rating.
3. The post 48 hours MRSA bacteraemia reported and attributed to the Trust in June was the first such case since July 2014.
4. Pressure ulcers: The rate in August was 1.2 per 1000 bed-days, which is above the hospital’s target of 1.0 but the year to date rate remains on track.
5. Patient falls: The August rate reached 4.7 per 1000 bed-days against the Trust target of 3.9. The year to date rate of 4.4 is also outside the Trust’s own target, but is lower than the most recently published national figures. Movement sensors are to be trialled on high risk wards.
6. Finance: In August the deficit was £439k, £52k worse than plan, with year to date a deficit of £2,705k, £65k better than plan. Medical, nursing and health care assistant pay causes particular concern.
7. Births: At 385 these were 6 less than August last year and year to date 211 higher, including 153 more births from Ealing. Maternity transferred from Ealing Hospital in July last year.
8. New GP outpatient referrals: At 476 these were 8.4% higher than August last year.
9. A&E attendances: An increase of 271 was 3.9% up on August last year and 2678, 7.6% higher year to date, an average of an additional 18 patients per day compared with last year and 28 additional patients per day compared with 2014. Expansion of ambulatory care has prevented more emergency admissions.
- 1. NHS Improvement Single Oversight Framework: This replaces earlier monitoring plans for NHS providers. It will go live in September/October 2016 and will rate all organisations on a score of 1 to 4 (1 being best) to identify potential support needs for NHS providers. It will have five themes:
- Quality of Care: Related to CQC assessment and implementing 7 day services
- Finance and Use of Resources: Control totals and the Carter Review recommendations.
- Operational Performance: A&E, 18 weeks, 62 day cancer waits and other targets.
- Strategic Change: New models of care and devolution
- Leadership / improvement capability: Building on existing tools / working with CQC
- Deficits in the NHS: According to the latest figures by NHS Improvement, the NHS providers had a deficit of £2.45 billion for 2015/16, around £650million more than was planned and nearly three times higher than in 2014/15. Nearly two-thirds of all providers reported a deficit last year, but mental health, community and specialist providers collectively reported a surplus for the year.
NW London Items
- NHS NW London: The NHS in North West London delivers care to a population of 2 million people spanning 8 London boroughs and over 400 GP practices. The Shaping a Healthier Future (SaHF) programme is led by the 8 North West London CCGs through their Strategy and Transformation team. The team’s provisional Strategy and Transformation Plan (STP) was submitted to NHS England, as required, on 30th June. That plan is now available to view on the Healthier NW London website. The final STP is required by 21st October and the team is asking for feedback from partners – staff, health services, local government and the public by Friday 9th September.
Hillingdon Hospital Items
- Infections: One case of clostridium difficile in July brought the year total to 2 cases, well within the target of maximum 8 cases. Only one of the seven reported pre-48 hour MRSA bacteraemia cases has been assigned to the trust, and that one was a true contaminant, meaning that the blood sample was contaminated, not that the patient had a blood stream infection. The Trust’s only true bacteraemia case since July 2014 arose in June 2016.
- Pressure ulcers: The rate in July was 0.8 per 1000 bed days, well within target; the all day training events for Registered Nurses continue to be well attended.
- Falls: The year to date position is 4.3 per 1000 bed days which is lower than national averages published in 2010 and 2015. The July rate was 3.6 per 1000 bed days.
The Trust is developing a three year recruitment and retention strategy, with input from staff across the organisation, to address short term staffing pressures and to develop mechanisms to improve retention and support the shift to new roles and ways of working in the longer term.
- Finances: The Trust ended July with an in month deficit of £152k, £130k behind plan but the year to date deficit was £148k, £47k better than plan, due to receipt of Sustainability and Transformation funding. Substantive, bank and agency expenditure have all increased compared to April and May. Medical pay costs continue to rise.
- Secretary of State for Health and Shadow: Jeremy Hunt remains Secretary of State for Health in the May government. Diane Abbott has been appointed shadow health secretary.
- Junior Doctors’ Contract: Despite the Junior Doctors rejection of the new contract the Department of Health proposes to employ new doctors on this contract when they take up posts from October 2016. The terms of the new contract have been agreed by the British Medical Association, the Government and NHS Employers.
- Merging of Back Office Functions and care services: NHS Improvement has given all NHS trusts a month to produce plans for merging back office and pathology services across neighbouring trusts to improve efficiency and reduce costs. Trusts also have until the end of July to identify care services dependent on use of locums which can be merged to save costs. The provider sector’s end of year deficit is expected to drop from around £550m to about £250m as a result of these measures. North West London already has plans to merge pathology across its sector.
- Care Fund Gap: The previous government allowed councils to increase council tax by 2% in 2016/17 to spend on social care services and most have done so, but a national gap of nearly £1bn remains. This is due to an ageing population and the cost of meeting the National Living Wage. Services are likely to be reduced, including closure of day centres, cuts in the number of people receiving care services and cuts in the hours of care provided in people’s homes. Fees may also be increased. The Hillingdon Hospitals FT will work closely with the London Borough of Hillingdon through its Health and Wellbeing Board. The Trust is aware that research shows that demand for hospital services is likely to increase when social care services are reduced.
- Kings Fund Review of Clinical Commissioning: This has found that the CCG’s clinically led model is at risk if three external barriers are not addressed:
- CCGs lack the autonomy to involve GPs effectively in decisions about local services.
- Limited resources prevent high quality clinically led commissioning functions.
- Financial pressures force CCGs to make tough decisions without the support of politicians and NHS England to persuade the public that such decisions are necessary.
This Trust has a strong relationship with Hillingdon CCG and recognises its problems.
Hillingdon Hospital Items
- Trust’s 2016/17 Strategy: NHS Improvement has revised the Trust’s Control Total to £5.05m, giving access to the Sustainability and Transformation Fund (STF) based on:
- A £1.9m deficit - later changed to £4.8m surplus after STF funding of £6.7m
- Delivery of performance trajectories
- Working with commissioners to deliver the local Sustainability and Transformation Plan.
- Scores for Condition, Maintenance & Appearance and Dementia improved by over 5%
- Greatest improvement was 18% in Dementia at Mount Vernon
- Scores for Privacy, Dignity & Wellbeing fell on both sites, but by less that 1%
- Ealing transfer: Transfer of paediatric services was completed on 1st July and the new Paediatric A&E is expected to open on 19th July. The extension of Peter Pan Ward is expected by the end of September.
- A&E Demand: Up to end of June type 1 A&E activity increased by about 9% compared with last year, paediatric attendances increased by 10% and blue light ambulances by 25%, leading to failure of the target to treat and discharge 95% of patients within four hours.
- Patient Led Assessment of the Care Environment (PLACE) 2016:
- Scores for Condition, Maintenance & Appearance, and Dementia improved by over 5%
- Greatest improvement was 18%, in Dementia at Mount Vernon
- Scores for Privacy, Dignity & Wellbeing fell on both sites, but by less that 1%
Pressure ulcers: 0.8 per 1000 bed-days in May takes the yearly rate within target.
Falls: Falls reduced to 5.6 per 1000 bed-days in May - above the Trust’s own target but lower than the national average according to two national surveys.
Accident & Emergency activity: In May attendances increased by 11.4% overall and paediatrics by 16.6%. Those over 65 rose by 11.3 % and over 80 year olds rose by 19%. Emergency Department attendances increased by 892 in May compared with last year, equating to an average of 32 more patients per day than in 2014. The expansion of ambulatory care has prevented an increase in emergency admissions.
Ambulance activity: May blue light arrivals rose by 23.7%, non-blue light arrivals by 7.5%.
Staffing trends: Staff vacancy in May was 7.32% (1.32% down from last year), sickness was 3.24% (down from April and same period last year). Temporary staffing was 16% less than a year ago, plus a shift from agency to bank staff use, with a total staff of 2,962 an increase of 6% over last year.
Finances: The May deficit was £579k, but this was £50k better than plan, making the year to date deficit £1,882k which is £610k worse then plan. The surplus that the Trust is required to make in year has been revised to £4.8m.
Births: At 409 this was 89 higher than in May last year – a year to date increase of 146 of which 96 relate to Ealing babies following reconfiguration of Ealing services.
GP outpatient referrals: These rose by 15.7%, 952 more new patients than last May.
Board meeting of The Hillingdon Hospitals NHS FT on 25th May 2016
2. Delays discharging patients from hospitals: These reached record levels with nearly 170,000 days of delays because of lack of support in the community.
3. Poor ambulance support times: Ambulances only responded to two in three of the most serious calls within 8 minutes, the 10th month in a row that this target has been missed.
4. Routine operations jumped by 4% year on year: But, by March 2016, 8.5% of patients had been waiting more than 18 weeks, the worst level since records began in 2012.
5. Poor achievement of A&E targets: Only four hospitals in England hit targets in the period January - March 2016.
6. Junior doctors strike: NHS England says waiting times have grown as a result of the strikes.
- Finance: At end of April the deficit was £1,303k, £660k behind plan, leading to risk ratings of 1 for every metric. The additional costs related to emergency activity and loss of income due to the junior doctors strikes contributed to this unhappy outcome.
- Births: 407 births in April were 57 higher than last year, due to increased births from Ealing following the reconfiguration of maternity services.
- Staffing levels and beds: Mount Vernon Hospital has no vacancies and no starters or leavers. In contrast Hillingdon Hospital has 107 qualified nurse vacancies, with 12 starters and 6 leavers, plus 32 Health Care Assistant vacancies with 5 starters and 2 leavers.
Compared to last year the Trust has 190 whole time equivalent substantive staff and 88 fewer non-substantive staff – and 7 fewer beds due to the closure of 29 beds on Edmunds ward and 8 additional beds open on Daniels ward plus 14 additional beds for emergency activity.
- GP outpatient referrals: In comparison with April last year, these rose to 540 this year (8.6%).
- Infections: There were no April cases of clostridium difficilel, but two cases of MRSA blood infection, within 48 hours of admission, for which responsibility will be decided by arbitration.
- Hospital acquired pressure ulcers: This was slightly above target in April. Enhanced training for nursing staff is starting in May at Bucks New University.
- Patient falls: The rate rose to 5.9 per 1000 bed days in April, the highest for many months, but is still lower than the national average published by the Royal College for 2015, which was 6.6.
2. Patients waiting over 18 weeks to start treatment: Latest NHS England data shows 63,580 patients waiting over the target of 18 weeks, the largest number ever.
3. Ambulance response times: In February the ten regional ambulance services reached only 68% of Red 1 patients, those with most serious need such as cardiac arrest, within 8 minutes instead of the 75% target, and for Red 2 calls, to less serious but still life threatening illnesses, only 60.3% were reached within 8 minutes, the lowest since records began and well below the 75% target.
4. Waits to see a GP: Research found 14.2m patients waited a week to see their doctor last year, around 500,000 more than the previous year. The research concluded that the number of GPs has not kept pace with the ageing population, more GPs opt for early retirement, and these factors combine with failure to attract graduate medics into GP careers.
5. Nurse training: According to the Dept of Health, two thirds of applicants for nurse training are currently rejected. 10,000 new training places are expected by 2020. Plans include a new nursing associate role, between care assistants and registered nurses, on which consultation is underway.
1. Finance: Following Hillingdon CCG’s help, the Trust ended 2015-16 with a deficit of £1.5m, mainly due to pay costs – compared to March last year there is a net increase of 89 members of staff. It will submit a deficit plan for 2016-17 hoping to obtain additional funding to enable it to achieve a surplus at end of year, but its underlying deficit would still need to be addressed.
2. Junior doctors’ strike: The picket line at Hillingdon Hospital was good humoured. Consultants ensured that all urgent procedures were undertaken, although routine operations and outpatient appointments had to be postponed. The full impact will be assessed at next month’s Board Meeting.
3. Transfers from Ealing Hospital: Maternity services have transferred successfully. Paediatric services are expected to follow in June 2016. A business case has been put to Shaping a Healthier Future to fund seven additional paediatric consultants. An additional ten paediatric nurses have already been recruited.
4. A&E issues:
Hillingdon has 14 majors cubicles in A&E, making it the smallest A&E in North West London, so doctors may be available but with no cubicle free for them to see patients. An extension to A&E is being planned.
Hillingdon CCG is to fund two geriatricians for A&E for Monday to Friday presence. Interviews are scheduled for May 2016.
Blue light activity has increased by 53% over the last two years.
5. Over 65s non-elective admissions 3.5% down: This Better Care Fund target has been achieved.
6. Car parking at Hillingdon Hospital: The Trust has worked with Hillingdon Council to combat cars queuing on the main road, so cars are to be allowed into the car park rather than holding them at the bar. Drivers will then have 15 minutes to find a parking space before having to pay to exit. An additional 48 car parking spaces are being introduced as agreed last December – staff criteria for permission to park is being increased from one mile to three miles, in line with other hospital trusts.
7. Pharmacy at Hillingdon Hospital: Expansion plans are expected to be in force in November 2016, funded by Hillingdon CCG, to provide separate dispensing points for in-patients and out patients, which should greatly reduce the time to dispense prescribed medications.
- 1. National A&E performance: 175,000 more A&E attendances were seen in January 2016 than in the same period last year, an increase of over 10%.
- 2. National NHS finances: To end of December 2015 the NHS deficit was £2.26bn, £622m worse than plan. Of 240 providers, 179 reported a deficit. The poor performance was driven by use of agency staff, delayed transfers of care and failure to deliver planned cost improvement schemes.
- 3. Approach to openness: The Department of Health has published a league table and rated each trust against a criteria; this Trust was rated as Good.
- 4. Variation in NHS Trust Boards: 68% hold monthly Board meetings, which means about one in three do not meet monthly. The typical Trust has five Board Committees.
- 1. Junior doctors’ strike: The two day strike on 9th and 10th March led to cancellation of 300 outpatient appointments, of the 3000 usually seen in that time, and six day case operations were rescheduled.
- 2. Staffing levels: Mount Vernon Hospital has achieved both day and night staffing levels and has no vacancies for Registered Nurses, Registered Midwives and Health Care Assistants. In contrast Hillingdon Hospital has 98 vacancies for RN/RMs and 15 HCAs.
Between January and February the overall vacancy rate fell from 10.26% to 9.18%. The total bank / agency spend in February decreased by 12% versus the same period in 2015.
- 3. Pressure ulcers: The year to date rate for February was slightly above target. The tissue Viability Nurse is arranging study sessions with Bucks New University, to start in May.
- 4. Patient falls: With 4.8 falls per 1000 bed days, the target of 3.9 falls was not achieved in February, but the Trust’s rate remains lower than the national average of 6.6, which was reported by the Royal College of Physicians in 2015 .
- 5. Clostridium difficile infections: Of the 12 cases reported by the Trust only one has been attributed to a lapse in care due to antimicrobial prescribing, with one other case still to be agreed - only cases due to such lapses are counted against the Trust by its commissioners.
- 6. A&E target to treat, admit or discharge 95% of patients within four hours: Only 85% was achieved in February, with a year to date position of 92.78%. On average there were 178 type 1 attendances per day, an increase of 22% compared with last year, including more patients aged over 65 years and over 80 years. There was a 53% increase in blue light ambulance activity, which is being reviewed in detail. Despite using all escalation capacity, patients were regularly lodged in the department waiting for beds to become available.
- 7. Finances: The year-end revenue forecast remains a deficit of £1.5m. The February year to date deficit was £1,396k, driven by £4.2m adverse pay expenditure. Compared to February 2015 there was an increase of 159 whole time equivalent staff. Due to closure of Edmunds Ward, fewer beds were open, but the transfer of maternity activity from Ealing and the sharp increase in the use of 1:1 Nurses for higher risk patients contributed to the need for more staff as well as CQC and shaping a Healthier future related quality investments.
Year-end forecast capital expenditure has been reduced by £900k, to reflect slippage on the paediatric scheme - expenditure is moved from this year into the first half of 2016/17.
- 8. Births: At end of February births to date were 547 higher than last year, of which 525 were attributed to the transfer of maternity services from Ealing Hospital.
- 9. Charitable Funds: There are 49 funds totalling £919k of which £876k relates to patients, £43k to staff and £26k is restricted to specific purposes. £25k has been approved for refurbishment of staff rest areas. The policy of ethical investment excludes investment in either the tobacco industry or the production or sale of alcohol.