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.
Finances of Herts. Valleys CCG (HVCCG), which covers the south of Herts.
At the locality level there is an underspend of £855k. However it is only the Watford & Three Rivers locality which is underspending – the global underspend is only achieved by including £4.8m of unallocated reserve.
Performance of HVCCG
Authorisation has been granted for this CCG to take over responsibility for its area fully from HPCT on April 1st, but with a number of conditions. It is expected that these will be implemented in time. Concern was expressed that the pressure on Watford General Hospital has meant that on a number of occasions it has been necessary to close the St. Albans Minor Injury Unit in order to provide extra staff capacity at Watford.
Continuing problems at Watford General Hospital, in respect of:
(a) A&E performance
(b) cancer patient survey
(c) maternity services and
(d) C-diff infections.
(e) Pressure ulcers
Transition Assurance.There is general satisfaction with the way the transition to CCGs is being managed, with confidence that all tasks will be completed on time
New Chief Executive for the West Hertfordshire Hospitals Trust (WHHT): Ms. Sam Jones, is due to commence work with the Trust on 01/02/ 2013.Progress towards Foundation Trust status: The Board’s earlier application has been rejected because a new Chief Executive has only just been appointed and the WHHT financial situation causes concerns. The earliest it can reapply is 2014. Many other Trusts had had similar rejections and in 2012 only 3 Health Trusts were granted FT status as against 13 in 2009.
Infections: There was only one case of Clostridium Difficile in December and none at all in January, but with 34 cases to date, the Trust has already exceeded its annual target of 33 cases and it is likely to face a fine of up to £600,000, although it hopes the fine will be reduced to reflect its lower numbers of cases compared with earlier years. There were no cases of MRSA in November or December. Legionella bacteria was found in the plumbing in the ITU department - 27 plumbers worked through the night to overcome this problem.
David McVittie, Chief Executive of this trust was guest speaker at the December meeting 2012 of The Community Voice, of which we are a member. He came as an old friend, who had visited Community Voice many times before as Chief Executive of The Hillingdon Hospital FT. This was his first visit in his new role.
He spoke of the proposed merger of his new trust with Ealing Hospital NHS Trust. His trust is large, but with financial problems. Ealing Hospital is medium size, too small for foundation status alone, but it already provides community services for Brent and Harrow, which enhances the prospect of a successful merger with his own trust. Together, these two trusts can support each other, and together they provide a good population-base for enhanced services.
Initially they would share back-office tasks, to their financial advantage, but there would be very few short-term service changes. Long term, the merger would allow consolidation of services, with major emergency services only at Northwick Park Hospital, but with elective and local services at all three hospitals – Ealing, Central Middlesex and Northwick Park.
The merger would strengthen small departments. He cited the two small Radiology Departments which together could offer better consultant on-call arrangements and greater opportunities for clinical sub-specialisation. Similar considerations would apply to the two Urology Departments.
Commercially only 30% of mergers prove successful and the NHS has met similar problems, particularly where short-term expectations have demanded too much, but despite early problems many NHS mergers have led to thriving organisation long-term, such as University College Hospital London. The inherent advantages of bigger hospitals have promoted many mergers over the years - when the NHS was formed there were over 1000 hospitals, but there are now only about 350 in the whole country.
In March 2012, when he joined North West London Hospitals Trust, formal consent for the merger with Ealing Hospital Trust was expected within the next month, for implementation in July 2013 – but financial problems intervened and proposals from NHS North West London for changes to local NHS services held major implications for both trusts.
Until the outcome of “Shaping a Healthier Future” is finally agreed there is unlikely to be any final decision on the merger of the two trusts. They are still intent on merging and are trying to run together, but this poses legal problems. Also, the future uncertainties are causing blight, with impact on staff morale and loss of valuable staff members.The merger still presents challenges – echoed by other newly merged trusts, such as Barts Health - but it also offers real opportunities. The speaker wants to prove that the merger can be a success.
Here is the text of a letter from the two Chief Executives about the proposed merger
Tuesday 2 October 2012
Final Full Business Case for the proposed merger of Ealing Hospital NHS Trust and The North West London Hospitals NHS Trust
We are writing to inform you that we plan to seek approval for the final Full Business Case (FBC) for the proposed merger of our Trusts from our Boards on Tuesday 16 October (Ealing Hospital NHS Trust) and Wednesday 17 October (The North West London Hospitals NHS Trust).
The content of the FBC remains largely the same as when we published the draft version in June, when our Boards discussed the business case in detail. However, this is an important milestone for our organisations and, indeed, the final step in the approval process for our Trusts’ Boards.
Assuming our Boards approve the FBC, the business case would need approval from NHS North West London, NHS London and the Department of Health. The final decision rests with the Department of Health and, if given the go ahead, the new London North West Healthcare NHS Trust would become a legal entity on 1 April 2013.
The provisional timetable is:
• NHS London Board (public) on 25 October
• Department of Health Transactions Board (November/December)
• If approved, merger completed on 1 April 2013
The Board meetings will be held in public on Tuesday 16 October at 9.00am at Ealing Hospital, Postgraduate Lecture Theatre on Level 3, Uxbridge Road, Southall, UB1 3HW and on Wednesday 17 October at 10.00am at Northwick Park Hospital, Research and Development Boardroom, Level 7, Maternity Unit, Watford Road, Harrow HA1 3UJ.
Copies of the FBC will be available on both Trust websites by Friday 12 October and the merger site www.nwlh.nhs.uk/stronger-together
We will of course write to you again should there be significant changes to the provisional timeline above. Please feel free to contact our offices if you would like to discuss this in the meantime.
Ealing Hospital NHS Trust
The North West London Hospitals NHS Trust
The Chairman opened the meeting with praise for Jan Filochowski, Chief Executive. This was his last AGM with the Trust - he has been newly appointed as Chief Executive of Great Ormond Street Hospital.
Jan reviewed the activities of the year – all previously reported to The Community Voice - followed by Anna Anderson who noted that the Trust had now produced a financial surplus for five consecutive years.
The most informative session concerned plans for the future of the Watford Health Campus, outlined by Leigh Thomas, Development Director Kier Property, the company appointed to undertake the work, whose presentation was assisted by contributions from the project’s architect.
The total project has many dimensions in a number of phases. The contract is expected to be finalised in December 2012. There will be stakeholder engagement from January to June 2013. Planning permission is expected in November 2013. Work will start on site in January 2014 with upgrading of the car park facilities in the first phase. The car park will be built into the hill with foundations to support subsequent building of a new hospital on top, when that is possible.
Funding of a new hospital is expected on an ad hoc basis, in phases, with maternity, women’s and children’s facilities as the first priority. There is a lot of political support for a new hospital and the Chairman expressed confidence that a new hospital will be achieved. However decisions on size, number of beds and other details will be left as late as possible as future needs remain uncertain in the current NHS climate. There is plenty of space to meet whatever needs emerge and there will be full public consultation in due course.
A large area of allotments is built into the plan to allow flexibility for future hospital use if needed. The whole area plan includes a lot of green areas and a lake, visible from the hospital, but there will also be provision for residential housing – high quality homes and family housing – as well as commercial and retail property. Many nationally prominent organisations will be involved and considerable new employment potential is expected.
The new road and bridge planning submission is expected in July 2014
The new Metropolitan rail link and station are expected to open in 2016.
NB Points of interest are noted from the papers as we were not represented at the meeting. Items noted in the separate report on the Trust’s AGM will not be repeated here.
Watford Health Campus:
Planning application for the initial construction will be lodged in Spring 2013, with construction planned for 2013/14 for the car park and residential scheme behind the current pathology building and the new road. The rail bridge and first stage of the road are likely to be completed by late 2014, with the new car park operational in 2015.
The light industrial area will be developed on land towards the bottom of the site. Development of the office and retail buildings will be in the zone at the Vicarage Road end of the site.
The Unit houses beds that originated in the Northwood & Pinner Community Hospital. When they were moved there the Community Voice was given an undertaking by Hillingdon PCT and Hillingdon Hospital Trust that if the beds could not return to their original site then purpose built accommodation on the Mount Vernon site would be provided at the earliest opportunity – an historic fact not drawn to the attention of Hillingdon's External Scrutiny Meeting (ESC) when it was updated about the Unit at its meeting in September 2012.
The old promise has never been acknowledged by the current holders of responsibility within the PCT and Hillingdon Hospital Trust and current financial constraints make implementation of that promise increasingly unlikely within the foreseeable future.
Against that background the ESC received a written report which outlines the proposal to move the beds from Mount Vernon to the Woodlands Centre on the Hillingdon Hospital site. That Centre is part of the Central & North West London NHS FT, the trust responsible for Hillingdon Community Health which provides all community NHS services in Hillingdon, including the Northwood & Pinner Unit.
The case for moving the Unit to the proposed site is compelling. The existing beds are in two ten bed open wards, plus two single rooms for isolation purposes, with no day room or outdoor facilities, which despite every effort is not ideal for patients. Currently there is an opportunity to move to the proposed site, which would offer single and double bedded rooms, plus day room facilities and an enclosed garden, on a site adjacent to both the dementia and mental health facilities provided by CNWL and the acute clinical facilities available from Hillingdon Hospital. Clearly there would be advantages for patients but the down-side would be loss of historic continuity and longer journeys for visitors of patients from the north of the Borough, which are quoted as 60% of the recent intake.
This large document, with over 300 A4 pages, was presented by Hillingdon’s Director of Public Health, Dr Ellis Friedman, on 10th July 2012 in the Civic Centre, Uxbridge. In addressing his audience he explained that this report was prepared bearing in mind that the NHS is in transition. New people who become responsible for public health and NHS services will benefit from the Annual Report as a reference document, which presents a broad and historical view of public health issues within the Borough.
Starting with a list of contributors and a contents list, there is both a foreword and an introduction by the Director of Public Health. That is followed by a second introduction by the former Mayor, Cllr Mary O’Connor. There is then a list of reference documents, followed by the body of the report, which has six chapters, most of which contain a number of specific articles composed by a range of authors:
- Guiding Principles
- Health of Children
- Screening and Immunisation
- Health of Adults and Older People
- The Health of the Environment
- Health of the Community.
Most chapters have three themes:
- The historical background
- A summary of the Marmot Report where applicable.
- Recommendations for implementation in Hillingdon
The Report is a comprehensive document with some refreshing insights such as “A surprising amount of services offered by the NHS are not of proven value. Often prevention is a better strategy than treatment … “.
The avowed aims of the Report are to improve the health and wellbeing of the population and to reduce health inequalities.
Each of the many articles appears to have been lovingly created by its author, with the intention of providing a full review of evidence for a particular aspect of the report. The document will undoubtedly be useful for professional reference. However, its length is likely to limit its readership, as well as making it expensive to reproduce. It is therefore unlikely to have wide distribution in its initial form, but a summary version might attract wider professional interest and tempt the general public to explore its contents.