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.
“Putting People First”: This initiative, launched by the Trust on 28th November, was attended by Board Members and top management, to emphasise the importance of improving the experience of its patients, particularly the elderly, pregnant mothers, those with dementia and those with long-term conditions. The message, which is expected to cascade from top to bottom of the Trust, holds no surprises, only what patients have always expected – personal care responding to the patient’s needs - not only excellent treatment but also kindness, compassion and good communication.
As part of earlier initiatives the Trust has recently set up a Glaucoma User Forum, a Black Minority Ethnic Age UK Hillingdon Forum, and a Starlight Pantomime to provide a positive hospital experience for oncology children and their families. All these will impact on the experience of patients within the Trust.
Performance: There was a steep climb in the number of admissions in October (the latest data available), with a record 71 admissions against a predicted 52, which led to Churchill and Lister Wards being temporarily re-opened. However, overall occupied bed-days were below that of last year, despite increased volumes of activity. During October there was a 9.3% increase in patients arriving by ambulance, 2253 compared with 2062 last October.
External inspection: The August report of the Emergency Care Intensive Support Team (ECIST), a Dept. of Health team, supported the Rapid Assessment and Triage model currently being rolled out in the Emergency Department which ensures that senior clinical decision makers see patients as soon as possible on their admission. ECIST supported development of frail elderly services in the department as more over 75s have been admitted during the last two years. However it identified opportunities aiming to discharge 65% of non-elective admission within two midnights or less.
Finances: The Trust has maintained its financial risk rating at 3 as required for its foundation trust status. Higher than planned activity, with revenue increase by 4.5% compared with last October, was almost entirely offsetting the Trust’s efficiency savings shortfall. This was achieved with 40 fewer whole time equivalent staff. Year to date there were 127 more births than for the same period last year, an increase of 5.3%. However, the cumulative level of readmissions for the period increased by 3.9%, generating £1.5m of unfunded activity.
Emergency Readmissions: This is a particular issue as there is no payment to the Trust for patients readmitted within 30 days of discharge. Hillingdon Clinical Commissioning Group audited the 59 such patients readmitted by the Trust in July and the Trust audited all 68 such patients. Resultant developments already bear fruit - some indicated below - October readmissions dropped from 13.7% last year to 7.4% in 2012.
- A joint bid to the Integrated Care Pilot to explore early discharge support and a falls prevention service.
- The Leaving Hospital Leaflet now advises call the GP for advice after 24 hours from discharge.
- A&E discharge summaries are being electronically written - easier to read than hand written notes!
- Patients thought to be within the last 12 months of life are being registered as needing special care.
- Joint care plans are being developed for patients discharged after surgery.
- Joint care plans are also being developed for frail elderly patients living independently at home.
Retirement of Medical Director:
Dr. Susan LaBrooy is retiring in December. Dr Richard Grocott-Mason is currently in the process of taking on her role as Medical Director.
The Risk Rating remained at 3, as required by Monitor. Year-to-date actual performance for August was a deficit of £1,292k, which was £180k better than expected at this point in the year, but all Divisions under-delivered against their efficiency savings plans, with a year-to-date shortfall of £219k.
Readmissions increased by 111 spells, an increase of 8.4% compared to last year. However, in an attempt to reduce readmissions, NHS rules base maximum payment for this year's readmissions on 73% of the readmissions last year - any readmissions above that 73% have to be done without payment. So, the actual readmissions this year have obliged the Hillingdon Hospital Trust to provide unfunded work worth £1.2m.
Department of Health Guidance does not expect the commissioner (the Primary Care Trust or the Clinical Commissioning Group) to profit from work being done in hospital without payment - the money saved from non-payment is supposed to be invested in health services in the community. In theory this is sensible, because readmissions to hospital often arise because care in the community is inadequate. However, to date no evidence has been produced to show what has happened to the savings arising from non-payment for Hillingdon Hospital readmissions, and there is no evidence that it has been used to improve local community health services. Sadly, if not ring-fenced, such "savings" can easily get "lost" in the commissioners' other financial problems.
Improving care for dementia patients:
The League of Friends and The Comforts Fund have provided new clocks in a number of wards and public areas which are easy to read and display the date and time. Wards have devised drinking glasses for patients with different needs – green for dementia patients, as green is easy to see – red for patients who need encouragement to drink – weighted cups for patients with Parkinson's Disease
- Free 20 minute drop off points
- Free parking for disabled Blue Badge holders in either designated disabled parking spaces or if these are not available in general parking spaces
- Weekly parking permits for £12
- Monthly parking permits for £25 • Parking for cancer patients at £1 a day
- Patients who have arrived for their outpatient appointment to find it has been cancelled are entitled to free exit
The hospital’s Parking Offices are situated at:
Security Room at Hillingdon Hospital
Main reception at Mount Vernon Hospital
Financial performance for July was a surplus of £548k, £121k behind plan leading to a year-to-date deficit of £58k, £5k behind plan.
Births and day cases year-to-date were significantly higher than last year, outpatient and A&E attendances showed steady growth, but emergency admissions marginally reduced, particularly for short-stay patients.
The Trust has won contracts for community ophthalmology services in Hillingdon worth £2.2m over five years and for community pathology work in Hounslow valued at £6m over three years.
New catering and cleaning contracts:
Four nationally established catering providers are tendering to provide patients’ meals for the Trust. Food tasting sessions were held on August 24th with evaluation by members of the Board, Trust Governors, patient groups, nursing staff, dieticians and infection control staff . Evaluation scoring was based 45% on financial criteria, with 55% covering menu composition, nutritional analysis, tasting, packaging, safety and hygiene, and sustainability factors.
The retail catering consultant appointed in June has been working with the existing restaurant managers and teams to develop proposals on pricing, product range and restaurant layout. To support this work a survey was undertaken of user views and the results are being analysed.
An event is being planned for staff and public involvement representatives in September to review the current cleaning service provision.
Sodexo staff briefings in August were very well attended and there appears to be good support for the transfer to the Trust. There is also good support from the unions. The new design of uniforms for the transferring staff was well received. So, the project is on track with wide engagement of staff and stakeholders.
New method of assessing patients in A&E:
Starting as a trial on 22nd August, the Trust has introduced a new method of rapid assessment and treatment. Every patient arriving in the majors area of the A&E Department will be seen by a senior medical officer on arrival, instead of being seen by a nurse.
London Ambulance Service pilot scheme for mental health patients:
The Trust is working with LAS on a scheme to screen mental health patients to identify alternate care provision outside the acute setting
Trust Open Day:
In place of its Annual Members Meeting, the Trust is holding its first Open Day on Monday 24th September 2012 at Hillingdon Hospital, from 2pm – 5pm followed by presentations in the Lecture Theatre and an evening session where visitors can meet the Governors and hear presentations from the Chief Executive and Finance Director. The Open Day will showcase many areas including its Emergency Department redevelopment, Maternity, Rapid Recovery, The NHS NW London proposals for “Shaping a Healthier Future”, Capital Investment Schemes, Infection Control, Recruitment, and CARES – its new culture and values initiative.
Hillingdon Hospital’s emergency care reconfiguration: The Outline Business Case will be presented in July. Existing equipment will be transferred where possible and a review is in progress to identify what else is needed. The needs of wheel chair users are being identified, also the needs of hard of hearing and sight impaired patients.
Cleaning and catering contracts: The exit of Sodexo from Hillingdon and Mount Vernon hospitals is underway. Four nationally established catering providers have expressed interest in tendering for the new catering contract, which is likely to be awarded in September, but in-house catering staff will provide breakfasts, snacks and beverages. The cleaning contract ends on 31st October and a seamless transition is being planned. The changes will be monitored and evaluated after six months and a year.
Ambulance arrivals: There was an increase of 7% in arrivals at Hillingdon Hospital between March and May 2012, believe triggered by the new 111 ‘phone advice service. Croydon Health Services NHS Trust has reported a 17% increase in ambulance arrivals since the 111 service was introduced there.
Hospital Standardised Mortality Ratio (HSMR): For the year to March 2012, Hillingdon Hospitals overall HSMR remained below the national average, and no specialty area had higher than expected mortality rates. The Trust ranked 83rd out of 147 national NHS trusts. An alternative evaluation, the Standardised Hospital Mortality Index (SHMI), includes in-patients receiving palliative care and those who die within 30 days of discharge. The Trust’s current SHMI value remains significantly below the national average, comparable to local peers and within the upper quartile nationally.
New website: The new public website takes account of the needs of people who view it from mobile ‘phones. It includes sections on “Trust Performance” and “Patient Safety”.
“Care Campaign”: The Trust has signed up to the Nurse Standard and Patients Association “Care Campaign”, which recognises four fundamental aspects of care:
- C communicate with compassion
- A assist with toileting, ensuring dignity
- R relieve pain effectively
- E encourage adequate nutrition
The aim is for nurses to observe the CARE list and for patients to use it to challenge poor care.
Board Members’ monthly unannounced visits to Wards: The fifth “Ward to Board” visits were to Alexandra Ward and Katherine Ward, which led to minor suggestions for improvements.
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.
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.
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.
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%.
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.
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.