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.
New Admissions Unit: The Emergency Care Project is progressing with £12.36m from the Dept of Health. This includes reconfiguration of the A&E Department, a new Urgent Care Centre and an adjacent Admissions Ward with 45 to 50 bed, which will allow some patients to bypass A&E with direct admission to an acute medical bed. The paediatric area will be redesigned and Endoscopy will be relocated. Improvement is expected in patient admission, diagnosis and discharge.
Cleaning and Catering contracts: The Board will bring these services in-house when the Sodexho contract ends on 31st October 2012. This is expected to be more cost effective, with cleaning / catering staff more integrated in the hospital teams. The current contract for provision of ready-made patient meals is being market tested, to ensure best value and high quality.
Finances: At the end of February the Trust’s financial risk rating remained at 3 and all the other financial requirements of the Trust’s terms of authorisation were being met. Financial performance for the month was a deficit of £143k, matching the original plan, despite efficiency savings being below planned levels and clinical revenue still being heavily suppressed due to local commissioning caps. The year-end targets are still achievable but are extremely challenging. The non-cash revenue gain of £1.3m from the donation of the Postgraduate Education Centre to the Trust from the charity that built and ran it will be accounted for in March 2012.
Bed occupancy: Winter plans based on previous experience expected a peak demand in January but this was delayed until February and early March – a mild winter and low levels of ‘flu contributed to the reduced demand in January, which was echoed in neighbouring trusts. Increased demand later led to no elective cancellations despite increased admissions. Continued focus on discharge planning and reduced admissions has facilitated the closure of Grange Ward.
Chief Executive:
David McVittie is leaving the Trust after eleven successful years in post, during which time the Trust has moved from financial deficit to a consistent record of balancing its books, and from an abysmal mortality rate to a position in the top quartile in the country, as well as becoming a national leader in a number of new clinical procedures. The Community Voice, of which RRA is a member, recorded its thanks to him for his work at Hillingdon Hospital in the message book that was presented to him as part of his farewell party on 29th February.
The good news is that David McVittie is not moving far. He is going to Northwick Park Hospital as Transition Director and Chief Executive Designate for the proposed merger of North West London Hospital NHS Trust with Ealing Hospital NHS Trust. Many Ruislip people are Northwick Park patients so it is reassuring that this hospital is to be led by a known and locally respected new leader. He has already said that he looks forward to visiting The Community Voice in his new role, when he has had time to assess his new responsibilities.
Shane Degaris, Deputy Chief Executive, will act as Chief Executive of the Hillingdon Hospital Trust until that post is filled, which is expected to be in several months’ time.
Infections:
The Trust has had 24 cases of clostridium difficile year to 29th February, which is within target, but there is no complacency as infections can arise suddenly.
Caesarean rate:
At 30.34% there was a small rise in the caesarean rate in January, which was disappointing as the rate remains above its target of <27%.
Finance:
Financial performance for the month was a surplus of £49k, £121k behind the original plan. Overseas visitor income was lower than expected.
The year to date deficit was reduced to £1,069k.
In addition to the grant of £1.2m from the Department of Health from its Access Initiative Fund, the Trust has secured a capital bid of £12.4m to reconfigure the A&E department, which is most welcome.
However, clinical revenue is still heavily suppressed due to the increasing impact of local commissioning caps. This continues to be a significant issue impacting on the Trust’s short and long-term financial viability. As at January 2012 the Trust has raised over-performance invoices of £2.1m with North West London Commissioners for quarters 1 to 3.
Savings remain on course to achieve at least the minimum required for the Trust to achieve its re-forecast year-end income and expenditure position, which is extremely challenging but still achievable.
The total cost of discretionary pay reduced from a monthly 20/22 average of £237k to £189k and the total cost of monthly agency pay fell from £186k to £116k.
The Trust’s financial risk rating remained at 3. and all other financial requirement’s of the Trust’s authorisation were being met at the end of January 2012.
Social Workers:
There have been high level discussions with Hillingdon Social Services. There are still no Hillingdon social workers based in the Trust’s hospitals, but social workers based in the Civic Centre visit the hospitals, when possible. This lack of on-site service impacts on patients’ discharge arrangements.
Reattendance rates:
This is 8.8%, higher than the Trust would like, but there is a core of frequent attenders with both mental health and physical disorders – if the 10 patients that most frequently attend were excluded, the rate would drop to 4.6%.
Infections:
The Trust has reported a fifth case of MRSA bacteraemia, against its target of three, but it is appealing on inclusion of the two most recent cases, which are for the same complex patient, who has had a number of admissions throughout the year and in total has recorded six MRSA bacteraemia on separate occasions.
The Trust has had 22 cases of clostridium difficile year to date, which is within target, but the risk of repeated norovirus infection at this time of year is high, so there is no complacency
Caesarean rate:
At 28.5% this remains above target of <27%, but is lower than previously
Finance:
Better than plan performance in December improved the Trust’s financial position, reducing the year to date deficit to £1,118k, the Trust has been granted £1.2m from the Department of Health from its Access Initiative Fund. Local contract caps on what the Trust can charge commissioners this year has resulted in a significant amount of work being done where payment is being challenged – net negative impact for December was £2m. However, the Trust is still forecasting break-even at year end, despite increasing workload and the challenges. Both agency pay and discretionary pay reduced from the same months last year
Winter planning:
The Trust has continued to work with the London Borough of Hillingdon. However, there are increasing concerns regarding social care provision as LBH has withdrawn social worker presence from the hospital, which impacts adversely on patient assessment and discharge from hospital.
Leaving Hospital Project:
This covers two pilots wards, one surgical, one medical with a plan to roll out later in the year. This includes medicine management, accurate coding and liaison with GPs, but it is being kept as simple as possible, to avoid the outcome being marred by complexity.
First Contact Project:
This is focused on Out Patients Department, with emphasis on understanding the ‘did not attend’ rates and identifying measurable outcomes, as well as focus on letters to GPs and patients.
Ward visits by Board Members:
Board Members are now re-introducing ward visits. Their findings will be collated and presented to future Board Meetings held in public.
Provision for mental health patients in A&E:
These patients awaiting assessment are accommodated in a relatively isolated unit which is hard to monitor. There have been over 130 incidents in the last 12 months where mental health patients have absconded from A&E. Two of these absconded and committed suicide. Better accommodation and a better process for assessment are being explored.
New parking arrangements and charges:
Fines for parking transgressions are being levied - £35 if paid within 14 days or £50 if not then paid. 12 hour tickets are being extended to 14 hours to accommodate staff working 12 hour shifts. There have been some complaints from people who previously parked on grass outside proper parking spaces.
New publicity posters about parking charges:
A3 laminated posters are to be displayed in both hospitals, noting the new tariffs but also showing the concessions for frequent attenders, wheither as visitors or as patients.
Parking ticket machines at the Woodlands Centre, Hillingdon:
A review of ticket machines in that area will be undertaken with a view to improving the provision.
Staff car sharing events:
Events are being held to introduce staff to other staff members who might possibly be able to share travel arrangements. These events will take place on 9th February and 13th March at Hillingdon Hospital and on 23rd February and 15th March at Mount Vernon.
Additional staff car parking:
The Crown in Colham Green Road, Hillingdon, has changed its policy and is now in discussion with the Trust about the possibility of providing some staff parking on that site – good news for everyone if it succeeds, as every staff member parking off-site leaves an additional parking space for patients and visitors.
The December 2011 Board Meeting in public was shorter than usual, with no great surprises.
In hospital death rates
As in-hospital death rates have been falling, Dr Foster re-based its data in September. Hillingdon’s rating for the last 12 months, 102.2, was slightly above national average, but two areas, A&E and well babies, were significantly better than average and a number of departments have recently achieved a lower death rate.
Finance:
At end of November the Trust ‘s financial risk rating fell to 2, but the score is expected to return to 3 (the requirement for foundation trusts) at the end of December. The current reduction is expected to have no adverse impact as the Trust is on quarterly appraisal by Monitor. The year-to-date financial performance was a deficit of £1,129k, £3,219k behind plan, with efficiency savings £2.855k behind plan
The Board was asked to note “local contract caps on what the Trust can charge commissioners this year has resulted in a significant amount of work being done but not expected to be paid for. At £1.9m so far, this is clearly a crucial business issue for the Trust, impacting on its ongoing financial viability”.
Winter planning
Grange Ward is to be re-opened in preparation for winter pressures.
Mandatory staff training
The Trust’s current compliance rate is 71.5%. There has been sustained improvement over the last two years but more needs to be done. A number of measures are in place to improve compliance,
A benchmarking was recently undertaken across London hospitals – but only a few responded. Of those that did, two had achieved over 80% compliance, three had around 70% (similar to THH), and three had compliance between 50-65%.
(Lay people find this difficult to understand as “mandatory” and “statutory” imply essential, but NHS spokespeople, in several trusts, suggest that the training requirements apply to broad categories of staff, for some of whom the relevance is obscure)
From 1st January 2012 Hillingdon and Mount Vernon visitors’ car parking charges will rise. The new prices are based on the average price across England in NHS hospitals. Hillingdon Hospital will provide 10 minutes free and Mount Vernon Hospital, (a bigger site with pay and display system), will have 30 minutes free.
Because the two sites have different payment systems their charging is slightly different, although broadly similar. The new Mount Vernon charges are shown on our Mount Vernon page.
Hillingdon Hospital Pay on Exit Charges from January 2012:
|
10 mins - 30 mins |
£1.50 |
|
30 mins - 60 mins |
£2.50 |
|
1 hour – 1.5 hours |
£3.00 |
|
1.5 hours – 2 hours |
£3.40 |
|
2 hours – 10 hours |
£5.00 |
|
10 hours – 24 hours |
£10.00 |
|
Each extra 24 hours |
£20.00 |
Concessions:
Disabled parking - free
Weekly visitor permits - £12
Monthly visitor permits - £25
Frequent cancer treatment £1
Refurbishment of Main Entrance at Hillingdon Hospital:
The main reception desk has been repositioned and the coffee shop extended
Survey of Doctors in Training 2011/12
Four Hillingdon Departments are in the top 12 in the country in a survey run by the General Medical Council – geriatrics, general surgery, diabetes, endocrinology – and others were in the top 25% too. This will help the Trust to be allocated medical trainees in future.
IT strategy
The Trust expects to invest around £11m in IT over the next five years. The Patient Administration System will be upgraded in January. Bed management will be rolled out early in 2012. All hardware devices will be replaced within five years. An electronic patient record system is expected in 2015.
Performance
Infections are within targets, with three cases of MRSA bacteraemia to date – MRSA screening has exceeded 90% since August - and 18 cases of clostridium difficile to the end of October. The caesarean rate has increased to 34% against a target below 27%. A new Surgical Geriatric post is expected to help patients who are unfit for surgery after breaking hips in falls.
Finance:
The Trust is still financially risk rated at 3, required by its authorisation as a foundation trust, despite local contract caps leading to much work being done without payment. In October elective activity and A&E admissions were high and other services average but efficiency savings were less than planned. Achieving 4% saving this year is challenging. Many controls are in place. Clinical Divisions now have monthly financial reviews; booking agency staff must be authorised by an Executive Director; all one to one nursing is authorised by the Director or Deputy Director of Nursing. A car parking review expects staff parking to rise from £1 daily to £2.50 and patient parking to rise to probably £5 for over two hours at Hillingdon Hospital with a slightly different tariff at Mount Vernon because of its different payment system. No increase is expected for disabled or concessionary parking.
Winter planning
To meet seasonal surges due to influenza and bad weather, an additional 50 beds are planned. Other plans include the Urgent Care Centre extending its hours to 2am. There is a divert policy across North West London for hospitals to provide mutual support when needed.
Annual Charities Report
Funds have been used to purchase medical equipment, enhance patient and staff environment and to train personnel. The long-term policy is to reduce the balance to below £500,000. In the current year, expenditure was £382k, income was £405k and the balance increased from £588k to £620k.
