This page will contain local overview information, such as reports on local NHS services from Hillingdon’s External Scrutiny Committee; this Committee is set up by Hillingdon Borough Council and all its members are Hillingdon Councillors.
The page will also contain information about neighbouring NHS services, including Northwick Park Hospital and Watford General Hospital, which are sometimes used by Hillingdon residents.
Last year’s priorities included:
- Mental health training for all front-line staff
- Reports to GPs when falls were treated without hospital attendance
- A focus on end of life care.
- A quality dashboard with 44 indicators provided comparison with other ambulance services – LAS came top for 13 indicators and in the upper quartile for 22 indicators.
This year’s the priority focus on:
- Mental health issues
- The Olympics
- Diabetes
- Alcohol issues.
The agenda had 36 items and the paperwork was over 1.5 inches thick so this is a brief summary !!
Visits to wards / departments.
The Board Members divide into pairs of an Executive Member plus a Non-Executive Member and each pair visits one part of the hospital prior to the meeting. In all cases the Board heard of the positive, enthusiastic, pro-active attitude of the staff. Some service provision is being impeded by I.T. limitations, which are being dealt with, but a new server and software is needed. In the Stroke Unit the main issue is over utilization – targets cannot be reached unless there is more spare capacity, but that depends on being able to release patients and move them on promptly and that move is often blocked.
Chief Executive’s. report.
He was very satisfied – the Trust is in a better place than was expected 12 months ago. Progress towards Foundation Trust status is going well and has the support of East of England Strategic Health Authority.
Finance.
High volumes of work mean more income so the Trust is in a more comfortable position. End of year surplus is expected to be £3.6M (slightly less than expected due to extra interest payments on loans, due to the need to defer rescheduling of these loans to fit in with the expected date of authorisation as a FT). Planned surplus for 2012/13 is £2.8M. This is after planned cost saving measures of £11.6M have been achieved.
The ‘Big Ask’ programme is being changed to a ‘Getting Better’ initiative. This is considered to be an important psychological change, since it broadens the initiative from just cost savings to service improvement ideas as well.
The CT scanner at Hemel Hempsted needs replacing. Although this cannot be done in the short term there are plans to bring in a mobile unit when needed – this can be done with a delay of only a day or so.
Performance.
- Accident & Emergency four hour wait target of 95% is being achieved, despite high volumes of work in January and February.
- The 18 week referral to in-patient admission target of 90% was achieved up to January but dipped slightly in February. Some departments struggle to achieve this, but overall the trust expects to achieve this by the end of year.
- MRSA – None in January or February. The annual total is one against a trajectory of four.
- C. Diff. – 2 cases in Jan. and 3 in Feb. making the annual total 14 against a trajectory of 33. However the 3in Feb means that this target will still be failed since there is a monthly target of less than 3 (as well as the annual target of less than 33) despite the fact that the infection is more prevalent in the winter – crazy !
- Nursing quality measures such as slips and falls, pressure ulcers, medication errors, nutrition, and normal deliveries in maternity remain consistent with previous reporting periods.
David McVittie is leaving The Hillingdon Hospitals NHS Foundation Trust after eleven successful years in post in order to take up the role of Transition Director and Chief Executive Designate for the proposed merger of North West London Hospitals NHS Trust with Ealing Hospital NHS Trust. He expects to be based in Northwick Park Hospital.
The Community Voice, of which we are a member, monitors all meetings in public of the Board of North West London Hospitals Trust, so watch this space for further developments. Many Ruislip people are patients at this hospital, so its services are very important to us.
The Chairman’s term of office expires 31/3/12 and the post is currently being advertised.
The Medical Director has been appointed Associate Medical Director at NHS Midlands and East covering the East of England. He will retain his clinical responsibilities at the Trust.
The Trust’s application for Foundation status has been strengthened and will go to the Applications Committee in February.
Among items in the Trust’s annual report on the Charitable Fund:
- The Charity paid out £1.241m in year 2010/11, including a final payment of £295k for the cyberknife project at the Mount Vernon Cancer Centre and £42k for scalp coolers - which can stop hair falling out after some chemotherapy treatments.
- In year 2010/11 the Charity received £1.211m of donations and legacy and investment income of £85k.
- Much of the Board meeting related to the Lister Hospital and the Queen Elizabeth II Hospital in St Albans.
- There was a presentation on the Full Business Case for new operating theatres and new ward block at the Lister Hospital – cost £39.1m. Theatres cost approx £1000 per hour. More emergency theatres mean quicker treatment, earlier discharge, reduction in the number of operations after 2200 hours and lost theatre time would be reduced by having patients on the same floor as theatres.
Finance: The reduced level of private cancer patients continues to affect income.
There was a discussion on the responsibilities of Directors in relation to Health and Safety.
Metropolitan Line to Watford Junction Station: The proposed diversion of the Metropolitan Line to Watford Junction has recently been agreed and is expected to be operational by 1st January 2016. This is great news for Watford General Hospital as the plans include a new station to serve the Watford Health Campus, to the benefit of both that hospital and Watford Football Club.
Progress towards other plans for Watford Health Campus: Five major construction companies are interested in building the proposed new road to serve the Watford Health Campus. Work is expected to start in September or October 2012. When open this road will greatly improve access to Watford General Hospital. The hospital will be rebuilt in phases. The first phase will be the building of a multi-storey car park. It may be six or seven years before rebuilding is complete.
Progress toward foundation trust status: The West Herts. Hospital NHS Trust is progressing towards achieving this objective and it hopes to be ready to apply to the Department of Health by 1st March 2012. The earliest possible authorisation date is September 2012. In answer to questioning, assurances were given that, if that status were obtained, the Board would continue to hold Board Meetings in public.
Performance indicators: Overall the Trust is performing very well, notably against key 18 weeks and A&E targets, where there have been dramatic improvements in dealing with all emergency work. MRSA and clostridium difficile remain at record low levels – MRSA one case against target of maximum four in year, and nine c. diff. cases against annual trajectory of 33. Letchmore Ward continues to have one side-room ring-fenced for patients with c. diff. associated diarrhoea. Also, for the first time for several months, all cancer targets were met for the month of December.
The Red Suite, with surge capacity, continues to be used extensively. In early January emergency admissions reached a level which required the Trust once again, reluctantly, to occupy the Catheter Laboratory too. However, the Trust has been able to achieve its admission targets, despite the upward trend in attendances.
Maternity and neo-natal provision: In 2011 the Trust undertook a ¾ million pound project to provide additional capacity for these services at Watford General Hospital. The completed project provides a new Triage Bay and Transitional Care Unit in addition to extra bed capacity on the delivery suite and in both the ante and post natal wards. The Trust is expecting to care for 5.900 deliveries per year.
Finance: The Trust expects to achieve its planned surplus of £3.6m (plus a technical gain of £1.5m bringing the total up to £5.1m) in 2011/12.
The contract negotiation process has just started for 2012/13, in order to have contracts agreed in March. Representatives of Herts Valley CCG will be involved in the negotiations, which will be largely driven by PCT staff while the CCG is being established.
The Trust has the basis for a strong plan for next year, which will be developed over the next two months. It is hoped to produce a budget for the Board to approve in March. An overall financial risk rating of 3 has been achieved this year and is expected to be maintained next year – a requirement for achieving FT status,
Finance.
The joint PCT/CCG budget to date shows an underspend of £4.2M which is projected to be £6.8M by the end of the year. It was agreed to release £6M for use. There is also £12.1M still uncommitted from the Transformation Reserve.
Performance.
Overall satisfactory, with just 4 key indicators needing further attention.
When a range of indicators related to infection control, referral to treatment and cancer waiting times are compared across the 39 PCTs in this SHA cluster, HPCT is rated 5th overall.
The focus of the report for this meeting was on ‘healthy living’ including ‘smoking’ (ahead of target to meet the 2011/2012 smoking cessation target); ‘breast feeding’ (above the national and regional figures) and ‘health checks’ (underachieving due to poor data returns from some GP practices).
Commissioning.
Part 1. : The areas funded include “preventative services for older and vulnerable people”, “careers’ support”, “counselling”, “sexual health” and “support to military personnel and their families”. Funding is from Health and Community Services (£13M), HPCT (£1.3M) and Herts County Council (undeclared in this report). To put this is context the HPCT contribution is about one third of a days overall budget for the PCT.
Part 2. : End of Life Care. There is a target of 40% for people who die at home (including care home). Year to date figure is 37% (34% for year 2010/11). A strategy group has been set up to deal with this. However concern was expressed that this ‘top down’ figure does not necessarily reflect patients’ wishes.
Part 3. : Out of Hours GP services. Consistently over 95% compliant with the National Quality Standards and with locally agreed commissioner requirements.
Clinical Commissioning Group (CCG) report.
There are 3 in Hertfordshire. The one which covers South West Herts (specifically the Watford and Three Rivers area but also extends to St. Albans) is called “Herts Valleys CCG”. The board is almost complete (a nurse and doctor member still need to be appointed) and they are on track to be authorised without conditions in Oct 2012. Confident that satisfactory progress is being made in taking over their new roles as the NHS changes are implemented.
Strategy Implementation.
Report mostly concerned with the QEII and Lister hospitals redevelopments.
In West Herts a group has been set up to deal with the remaining issues for the redevelopment of the Hemel Hempstead hospital.
Neither of the two merging trusts believes it is capable of achieving foundation trust status alone - Ealing Hospital is too small and North West London Hospitals has long-standing financial problems.· However, they believe that by merging together they will be able to meet foundation trust requirements.· The stakes are high as Trusts not achieving foundation trust status are threatened with amalgamation or closure.
This proposed merger will be of particular interest to patients of Northwick Park Hospital and Central Middlesex Hospital, which together form North West London Hospitals Trust. Northwick Park is a popular local hospital providing a very wide range of services - it incorporates St Mark's Hospital and it provides one of the eight Hyper-Acute Stroke Units in London. Its easy access from the Metropolitan Line Station makes it convenient for many Hillingdon residents.
Introduction :
- No ward/dept. visits due to other meetings – will resume before next Board meeting.
- Costs have been reduced from 101% to 94% of the national average.
- Procedures which the trust has developed for dealing with ‘never events’ are highly regarded and are in demand from other hospital trusts e.g. Allenbrooks.
- Confirmed that there are no ‘hidden waiters’ i.e. people who have missed the 18 week target and for whom there is reduced incentive to process urgently.
- Application for Foundation Trust status is on schedule.
Chief Executive Report.
Good performance on Infection Control, most A&E indicators and the 18 week treatment targets. Less satisfactory on the A&E time to treatment and the 2 week and 62 day cancer targets. The former is improving and should be on target by the year end. The 62 day cancer target only involves a few patients and so a low percentage can be misleading unless individual circumstances are taken into account which usually is not possible.
Finance.
Surplus to Oct of £1.7M against a forecast of £1.4M. There continues to be an issue over the cost of agency (not ‘bank’) doctors who cost the trust significantly more than if they were on the payroll. This is due (if I understand the situation correctly) to these people setting themselves up as a limited company for tax purposes with the agency. There is also an issue over some consultants who are being paid for more than 10 sessions per week where the extra sessions can be administration or research. Concern was also expressed that there is no consultant cover overnight but there was also recognition that many worked long into the evenings beyond their contracted hours.
Infection Control.
MRSA – 1 in Sept giving a total to date of 1 against a trajectory for the year of 4.
C. Diff. – None during Sept. and Oct. Total to date is 7 against a trajectory of 33.
MSSA – 2 in Sept. and 5 in Oct. But all were community acquired.
Nursing Quality Indicators.
Continuing good trends on issues such as ‘slips, trips and falls’, ‘commode cleanliness’, ‘hospital acquired pressure ulcers’. A new indicator of ‘normal births’ shows a decline from 61% in June to 51% in Sept. The target is 60% and this is being investigated.
Complaints.
A new initiative is for a non-executive director to carry out a detailed review of the complaints received in a given month. For August there were 67 (65 in 2010) from 80,000 patient/visitor events. 40 were available for reading. (A further 6 were actually commendations for excellent service !!). The review concluded that the replies were comprehensive with an excellent level of detail (up to 9 pages), with personal apologies from named individuals.
Mortality.
This is getting complex with a third index being introduced by DoH which measures things differently e.g. making no allowance for palliative care and including deaths within 30 days of discharge. On the Dr. Foster index the current score is 87 (100 is the benchmark – below is good !). On the new index the score is 106.
Pathology.
A national initiative (the Carter Review) has recommended that Pathology services are centralised into hubs serving several hospitals. Great concern was expressed that the quality of service (especially for the infection control teams) will be seriously prejudiced since samples will travel up to Bedford. There will be redundancies and there is a serious staff morale problem.
