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.
Mr Manolis Heliotis, Clinical Director for Head and Neck, North West London Hospitals NHS Trust, spoke to The Community Voice in September 2013. The main points of his address are summarised below:He started by explaining that his background is Greek. As a Director of the North West London Hospitals Foundation Trust he currently has substantial administrative responsibilities for Head and Neck services – the biggest in London – as well as his hospital’s Ear Nose and Throat services, but his major role is as a surgeon at Northwick Park Hospital.
His patients sometimes come from far away. Patients from abroad bring the NHS a sound income.
His department engages in both extensive research and training programmes, covering many head and neck problems such as congenital deformities, trauma injuries and reconstruction following cancer. It has a national reputation and is at the forefront in developing new treatments.
The North West London programme “Shaping a Healthier Future” proposes centralisation of major services in order to respond to demand and improve the services available. In the speaker’s own hospital major surgery is provided only at Northwick Park Hospital, where the necessary resources are based, but considerable preliminary and post-operative services are provided in local hospitals over a wide area. Investigations are usually undertaken at Northwick Park, and also inpatient surgery, but day-surgery is often undertaken at local hospitals. His Department has five maxillo-facial surgeons, who work closely with dentists, and they have video links to other hospitals.
London is divided into four sectors for major trauma injuries. St Georges Hospital covers the South West Sector; Kings Hospital covers the South East; The Royal London Hospital covers the North East; St Mary’s Hospital covers the North West. Ambulances take trauma patients to one of these trauma centres, which provide orthopaedic surgeons, neuro-surgeons, maxillo-facial surgeons, vascular surgeons and other specialists.
A slide was shown indicating the wide area covered by the Northwick Park’s maxillo-facial service and this was followed by a short video of operations in progress.
Mr Heliotis then answered a wide range of questions, which raised the following interesting comments:
His department has links with most local hospitals, but it does not cover spinal or ophthalmological conditions, so it rarely works with the Royal National Orthopaedic Hospital at Stanmore.
Despite current NHS financial difficulties, the NHS is better provided with equipment than the private sector, and a concentration of experts making a good case for new equipment is usually successful in obtaining the resources. However shortage of nurses and support staff can cause problems.
Cleft lip and palate services were are one time provided at Mount Vernon Hospital and Community Voice supported patients in opposing their loss from the site. However, eight national centres were introduced. Currently Great Ormond Street Hospital provides services for this group of children, with links to Northwick Park for adult patients.
Although there have been facial transplants, these remain at a pioneering stage of development.
A number of members gave testimony of good services received by patients.
The speaker was thanked on behalf of the audience by the Vice Chairman, James Kincaid, which was endorsed by loud applause. However it was noted that a long-standing member, Owen Cock, had wanted to give this vote of thanks as he was personally very grateful to the speaker as a patient, but unfortunately he was unable to attend.
1. This AGM was held at Northwick Park Hospital on 18th July 2013.
2. There were few members of the public present – probably less than twenty.
3. After the Chairman, Peter Worthington, had opened the meeting the Chief Executive, David McVittie, gave his report in which he noted:
- The Trusts serves a population of half a million people in Brent and Harrow.
- In 21012-13 its budget was £380m.
- It employs 4770 members of staff.
- It provides centres of excellence for stroke, vascular services, and maxillofacial services and also provides regional rehabilitation services.
- Its stroke team was the British Medical Journal’s Clinical Leadership Team of 2012
- 92% of its patients would recommend its services to family and friends.
- Its mortality rates are amongst the lowest in the country
- It stroke services rank amongst the best in England
- It took part in one of the biggest integrated care pilots in the country
- Its hemato-oncology department is one of the top research centres in UK.
- The Trust’s proposed merger with Ealing Hospital NHS Trust is progressing well and this will merge local community and acute services
- The Trust has a £50m building programme including £14m to rebuild theatres and £21m to rebuild the emergency department.
- In looking ahead the focus is on quality and safety, improving patients’ experience and satisfaction, developing the workforce and ensuring financial sustainability.
4. A presentation was then given by two consultant physicians from the Stroke Unit, Dr Joe Devine and Raj Bathula, in which they noted:
- The Unit was set up after the Darzi report - it is one of eight Hyper-Acute Stroke Units in London
- It opened in February 2010 and has 6-8 admissions per day.
- It has specialist stroke nurses and thrombolysis 24/7, with consultants rounds every day.
- It has Transient Ischaemic Attack clinics every day, with carotid artery imaging and surgery available every day too.
- Both admissions for stroke and attendance at TIA clinics rise every year. In 2012 it had a total of 1321 patients, the highest number for any of the London HASUs.
5. The Finance Director, Kishamer Sidhu, gave his report, noting that the trust did not meet its three year statutory break-even target but that it expects to balance its books when it has merged with Ealing Hospital NHS Trust.
6. This was followed by a question and answer session.
This meeting was held at Northwick Park Hospital.
Income and Expenditure (I & E) budget for 2013/4 envisages a final deficit of £20.3m, very much as last year, except that the Trust’s QIPP plan requires savings of £17m. After 2 months, indications are that the control total deficit is £394m less than budgetted, while the savings plan looks to be lagging behind, having achieved only 3.65% of its total target for the year. As the Finance Director said with masterly understatement, “requires further action”.
2. Shaping a Healthy Future (SaHF)
Work continues on this project, alongside (or despite) Ealing’s continuing efforts to avoid closure of its A& E facility, with two OBCs required by September:
1) developing emergency and maternity services at NPH; and
2) in conjunction with Brent CCG, plans for elective services at CMH.
3. Merger with Ealing:
The target date for merging is still April 2014, with however some continuing uncertainties over costs of such as the preparation of the FBC. Some cost support is being discussed with CCGs, particularly Brent .
There were no cases of either MRSA or C-diff. in the past month.
5. Accident & Emergency:
There was a lengthy but inconclusive discussion of ways and means of mitigating A & E delays revealing a stepping up of recruitment efforts in nursing but no immediate solutions beyond the marginal increases in emergency beds which D. McVittie referred to at Joan’s and my recent meeting. It looks like hopes are being pinned on the opening of the new and substantially enlarged A & E scheduled for April 2014.
6. Towards Foundation Trusts status:
Non-FT hospitals such as NWLHT are, from April last, required to submit self-certifications on a monthly basis to the NHS Trust Development Authority (NTDA) as to their progress in surmounting obstacles en route to FT status. The latest such has been accepted subject to attention being paid to some areas of clinical non-compliance which had warranted amber rather than green “traffic lights” and which are in process of being recalibrated, whatever that may mean!
Footnote from Health Service Journal 5.7.2013:
This Trust has proposed a £17.4m saving plan for 2013-14 and £12.4m of the sum has been identified with £631,000 delivered so far, but the latter figure is £58,000 behind target.
Introduction: Nick Barton, Chief Executive of Action on Addiction, spoke to the Community Voice in May 2013. The vision of Action on Addiction is to free victims from addiction and its effects. There are many strands to its actions – research, prevention, education, treatment, rehabilitation, and support for families, particularly children. It trains people working with addicts and their families and it campaigns on behalf of people who suffer as a result of addiction.
Addiction is driven by a conscious or unconscious urge to feel different. This causes an intense relationship with the substance or behaviour, which leads to many harmful consequences.
Families face chronic stress with daily hassles, relationships that deteriorate, great uncertainty and threats of many kinds. Family members feel disempowered.
The speaker would focus on the families of addicts, the impact of addiction on them, the help available, why so little help is available, plus the particular help provided by Action on Addiction.
Graham Hawkes, Chief Executive Officer, HealthWatch Hillingdon, spoke to The Community Voice at its April meeting in 2013. He noted that there had been many changes in official public representation within the NHS in recent years, ending with Local Involvement Networks set up in 2008 for three years, which were extended to the end of March 2013.
Some LINks were successful, but some were not. A major problem was that Local Authorities had to set up LINks via Hosts, which in some cases took most of the available funding, leaving very little resources for active work.
That applied in Hillingdon until 2009 when the original Host was decommissioned and Hillingdon LINk under a new Host was able to operate more independently. It then controlled its own work and set up premises in a shop in the Pavilion Mall, Uxbridge, which proved very successful.
Having shop premises in a busy retail area allowed close contact with the public, a feature enjoyed by very few LINKs. Engagement with the public varied greatly. Some LINks operated out of obscure offices. Oxford LINk bought a bus to take to different venues to help it meet its public
However, for Hillingdon LINk, limited funding and reliance on volunteers gave constraints to the activities it could pursue. Volunteers although willing lacked the training of professionals and some were less reliable.
Healthwatch Hillingdon came into being on 1st April 2013, with a wider remit than Hillingdon LINk. It must monitor local health and social service for both adults and children and help those services to meet the needs of the public, but some details of its new responsibility for children’s services are still to be resolved.
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.