Health

NHS Hillingdon, our Primary Care Trust, is now confident that it will break-even financially over the current year, which ends on 31^st March. This will enable the PCT to qualify for wipe-out of its£19m historic debt and release us from paying back nearly £8m annually, which has crippled our local health care for years.

In contrast The Hillingdon Hospital Trust is still battling to end the year without a deficit. However there is some good news as the Trust is now providing some services for Ealing as well as Hillingdon, which is a positive step forward. It is still hoping to achieve Foundation Trust status later this year and aims to be a major acute hospital for London.

On performance, the Hospital is well within target for infections and is meeting targets to deal with A&E patients within four hours, and the two week wait for breast cancer symptoms (it continues to phone patients before appointments to reduce the “do not attend” rates); also 90% of women receive 1:1 care in labour. However, the managerial cleaning audit has reported a disappointing reduction in standards, which is being investigated, and January’s bad weather led to cancelled operations - so the Trust is unlikely to meet that target for the current year; some of the extra beds opened to meet the January pressures are still open.

At Mount Vernon, restructuring of clinical divisions has led to the site no longer having a General Manager. The role of Nursing Services Manager at Mount Vernon has been extended to take in site management issues. (We have asked that information on how to contact her be made widely available).

Looking ahead is uncertain, but hospital activity and head counts are expected to reduce with more services delivered in the community. Financial challenges are expected, but there are still aspirations for a new ward block for Hillingdon Hospital, and hopes for a move towards 100% single rooms for patients.

The PCT aims to have three polysystems by 2013. In 2010/11 it will work towards a polysystem for Hayes based on the Hesa Centre. At Hillingdon Hospital A&E it will set up a GP-led Health Centre, as the polyclinic hub for Uxbridge and West Drayton. Plans for the north of the Borough are less developed.

The guest speaker at the Community Voice in February was Dr. Peter Ostler, Director of Mount Vernon Cancer Centre, who is always a popular visitor. He brought much good news about the Cancer centre, which is very dear to all our members.

The new £1.43m Chemotherapy Suite, paid for by charitable donations, opened on 1^st February. It has three assessment rooms with 19 treatment chairs and two beds, which allows six patients to be involved in trial treatments whilst 16 receive traditional chemotherapy. However, the reception area still needs to be rebuilt and the garden has to be developed.

Another charitable introduction, Cyberknife, which cost £4m, will be operational at Mount Vernon by Autumn 2010, the first such facility in the UK within the NHS. This very complex form of radiotherapy is controlled robotically and is extremely precise. It will allow some patients to be treated for whom no treatment was previously possible, and others will be able to have fewer, more intense, shorter treatments. Perhaps 50 patients will be treated with it in the first year, growing eventually to possibly 150 per year.

The Cancer Centre needs a research partner in order to secure future research grants. Five prestigious organisations bid for this role and it chose The Royal Marsden Hospital and the Institute of Cancer Research. Final details of the partnership are expected by the end of March.

The next Cancer Centre project will be the rebuilding of its old wards, followed by replacement of two of its nine linaccs. These could be at Mount Vernon or possibly on a satellite site at Luton or Stevenage. One project leads on to the next. These are exciting times!

Clarification

Both Hillingdon Hospital and NHS Hillingdon held Board Meetings at the end of January, which completely confused your humble web editor. So to clarify :

Finance
December financial performance improved but the Trust remains in deficit by £494k which is £2,128k behind plan. The year end forecast surplus has been dropped to £0.1m

Stroke Unit accreditation
The Hillingdon Hospital Stroke Unit has achieved accrediatation by the North West London Cardiac and Stroke Network and the North West London Commissioning Partnership, with glowing comments both about the staff and the service The new stroke beds will be opening in a phased approach, to a maximum of 24 beds.

Emergency care
December snow brought twice the usual volume of trauma patients, putting pressure on surgical beds. The range of temperatures saw an increase in cardiac, stroke and respiratory patients. The Trust opened an extra 50 beds to accommodate the increase in activity, which added to the pressures on hospital staff.

The Trust performed better in December than November but, in common with other hospitals and every Strategic Health Authority, failed to meet the 4 hour A&E target for the month overall. Of the 23 London trusts with an A&E department three are not meeting the target year to date and eleven did not perfom above 98% during December. However Hillingon Hospital has achieved 98.2% for the whole year to date, a better position than it had at the same time last year.

Fractured neck of femur has better outcome if operated on within 48 hours of admission. There has been significant improvement in care of these patients with over 90% of patients now being operated on within 48 hours.

The second week in January saw 43 patients suffering delayed transfers of care whilst waiting for either residential placement or Social Services home care packages. The Trust’s working relationship with the Borough Council required senior input, but this led to systems for more careful monitoring and for the Trust to work more effectively with the Borough.

Cancelled operations
In December, 18 operations were cancelled on the day of operation for non-clinical reasons – four because other operations took longer than expected, six due to no beds because of winter pressures, and seven for assorted reasons including sickness, weather related accidents and lack of specialist equipment. Elective operations on the Hillingdon site remain sensitive to bed pressures, but this risk does not arise for operations at Mount Vernon Treatment Centre.

Two week wait for breast cancer patients
The Trust is performing well despite not achieving this target - 84% of patients were being seen within 14 days, and those who exceeded that timescale had either changed their appointments or did not wish to attend within that period. In comparison, the national average achieves only 57.3% of patients being seen within target

Cancer Survivorship Programme:
A national project is looking at the long term consequences of cancer and its treatment. The Hillingdon Hospital Lung Cancer Team has been successful in its bid to become a National Test Site.

Finance
Month 9 of the financial year showed a slight improvement, reducing the year-to-date deficit to £1,264m, and allowing the PCT to forecast breakeven by en do year..

As a result of a 5.1% uplift, NHS Hillingdon will receive an allocation of £399.3m for 2010/11 after repaying £7.7m of its legacy debt plus £700k interest, a total loss of £8.4m from local NHS services. Having taken account of its many expected costs, before any investments, the PCT estimates that it needs to find savings of £12m within that year.

The NHS Operating Framework and NHS planning guidance for 2010/11 has set an equally challenging framework for providers of NHS services. The PCT’s major provider, The Hillingdon Hospital, which has a current budget of £173m, will have to find £6m just to cover inflationary pressures and the PCT’s efficiency plan will reduce THH’s income by about a further £3m.

However, 2011/12 will be much worse, demanding unprecedented efficiency and requiring redesign of care pathways to move care out of hospitals into the community – but simply relocating services will not drive down costs. Radical changes lie ahead.

Feedback from NHS London on the PCT’s December submission on its commissioning strategy highlighted many gaps, noting that its polysystem strategy lacks “affordability analysis” for provision of three polysystems each with a polyclinic offering urgent care facilities 12 hours a day 7 days a week – a revised final plan was required by 25^th January.

Provision of NHS acute hospitals
The North West London Commissioning Partnership’s 2009 Review concluded that the sector, covering eight PCTs - Brent Teaching PCT, Ealing, Hammersmith and Fulham, Harrow, Hillingdon, Hounslow, Kensington & Chelsea, Westminster PCTs - should be served by no more than three major acute hospitals to carry out the more complex emergency work including emergency surgery and inpatient paediatric medical care.

Local hospitals will concentrate on providing high quality non-complex medical care, A&E and critical care, with some designated as surgical centres or polysystem hubs. The sector sees significant potential in vertical integration of local hospitals with community services and/or with the major acute hospitals.

Further appraisal of acute provider options is expected to produce concrete proposals by the end of March. Public consultation is expected in the autumn of 2010.

Primary Care Advisors first Report
Individual GP practices are free to determine the extent of services they wish to offer and as a result there is wide variation in patient experience and satisfaction. Primary Care Advisors engage with GPs to improve services beyond the minimum standards of the General Medical Services contract and to deliver the PCT’s Primary Care strategy. A benchmarking exercise has been undertaken covering the following factors:
Financial / Access and Responsiveness / Referrals / Unscheduled Care / immunisation and Screening Targets / Quality and Outcomes

The Primary Care Advisors identify examples of good practice and broaden their use. Bespoke training for reception staff is being offered. Work is underway to extend surgery hours, improve support in the community for frequent A&E and Urgent Care users, improve on-line facilities, and incentivise GPs to offer better services and to engage with Practice Based Commissioning to manage demand and redesign clinical pathways.

National Patient Survey Quarters 1 & 2 2009/10 on satisfaction with access to GPs
Each GP Practice is evaluated on patient satisfaction with: ability to book ahead / see GP in 48 hours / see preferred GP / get telephone access / opening hours. Sheets are available on request to Joan Davis (see below), showing details for each GP practice in Hillingdon.

Daniel Ward at Mount Vernon Hospital
Closure of this ward is still underway. Patients have individualised discharge plans. Three patients are expected to remain in hospital care. Details have still to be resolved.

An excellent speaker, a captivated audience and a topical subject all contributed to this successful meeting, sealed afterwards with mince pies and seasonal drinks.

Dr. Roni Saha is a Darzi Fellow and Senior Registrar in Diabetes, Endocrinology and Medicine at Hillingdon Hospital, so he spoke with authority. He noted that diabetes is a life-long condition, caused by lack of insulin, a hormone secreted by the pancreas.

There are two types of diabetes. Type1 hits children and young people with extreme thirst, weight loss, tiredness and excessive urine. Onset can be swift and quickly fatal. Immediate treatment with injected insulin is essential.

Around 90% of diabetics have Type 2 diabetes, with older onset and similar milder symptoms, but it may be undetected for years. It is initially treated by control of diet, lifestyle and tablets.

In 2008 there were 2.5 million diabetics in the country. Hillingdon has 12,000 diabetics, 6% of the population, which is higher than the national average. Most are cared for by GPs, practice nurses, or by specialist diabetes nurses in the community.

Self-help is important. Patients can control diet, wound care and lifestyle. Drinking enough to avoid dehydration is important. Eating little and often is beneficial. Eating early in the day is better than a main meal later. Exercise burns off excess energy.

Doctors have many tools. Tablets can control liver production of sugar, stimulate production of insulin, encourage muscles to use more sugar, or control appetite. Insulin can be injected. There are new treatments, such as surgery to reduce stomach size. Ongoing research on transplant of pancreatic or stem cells is contentious. Hillingdon is fortunate in having a lot of local expertise.

Patients with high level blood sugar may not feel unwell, but low blood sugar causes dangerous symptoms such as confusion and shakiness – which must be addressed by swift intake of sugar.

Diabetes has serious complications – kidney disease, blindness, infections, foot ulcers, stroke and heart disease, particularly angina. Long term care is essential for all diabetic patients.

Quality of care and outcomes vary across London, with many causes - different lifestyles, differences in GPs’ care, different prevalence in racial groups. In Hillingdon, life expectancy varies by 6 or 7 years. One in five hospital in-patients has diabetes, so hospital care is a factor too.

Diabetes UK, a charity, raises awareness and is a great source of information via leaflets and its website. Better education is vital.

The Trust is doing well financially although marginally in deficit. Operating costs are high due to greater than expected growth in activity, particularly in A & E attendances and new outpatient referrals. Use of high cost drugs is having an impact too.

Infection control has improved over the last year, which is good news. This year so far there have been eight case of MRSA bacteraemia, which is within the current year’s target, but no one is complacent. Clostridium difficile is decreasing too.

Hillingdon Hospital’s staff includes 36% from a minority ethnic background, a higher percentage than either London hospitals (29% in 2007) or the local population. The Borough has 28% from an ethnic minority, set to rise to 37% by 2020. The hospital staff remains mainly female, although men are now 23% compared with 15% a year ago. Most staff are in the older age group, with 60% aged over 45 years.

In the Trust’s surveys of patients, the most satisfied group describe themselves as mixed race, followed by the white group. Black and Black British gave slightly less favourable responses. Men and women gave similar responses and there was little difference between the various age groups. The Trust is now taking a hard look at satisfying patients – which is good news for us all.

At the November meeting of The Community Voice, of which RRA is a member, there was a long and vigorous discussion about the closure of Daniel Ward, the continuing care ward at Mount Vernon Hospital, which has provided excellent long-term care for patients with very complex needs. Some patients have lived on the ward for many years. Last December the ward was closed to new patients. Now NHS Hillingdon wants to move the last eight patients to nursing homes, but this is a contentious issue as neither the patients, their relatives, nor the staff want this to happen.

An impassioned range of views was expressed about whether the ward should be closed - but there was unanimous concern for the last eight patients who are still being nursed on that ward and the Executive agreed to take the issue forward. Subsequently a number of questions were put to NHS Hillingdon and copies of the response are available on request.

A key concern was the precise intentions of NHS Hillingdon. Verbal assurances given at September and October Board Meetings had not been fully reflected in the Minutes. Therefore a written request was submitted for an amendment to be made to those Minutes at the November Meeting. As a result an amendment was agreed for documentation in the Board's November Minutes, to verify the following:

“A geriatric consultant is to meet each individual affected, individual nursing requirements for continued care are to be assessed, and discussions are to be held with each patient’s relatives. It was premature to define a timeline, this series of meetings is expected to be completed before the end of 2009, and eventual outcomes confirmed in the New Year. The PCT undertakes to continue to fund NHS care for these patients as long as they continue to meet the criteria for continuing care patients. We would only move patients to accommodation that provided appropriate care in locations agreed with patients’ relatives.”

This very emotive issue will continue to raise many questions and concerns, which The Community Voice and RRA will attempt to address.

London PCTs are working together in sectors. Our North West London sector includes six Primary Care Trusts – Brent, Ealing, Hammersmith and Fulham, Harrow, Hillingdon, Hounslow, Kensington and Chelsea, Westminster – who will contract as one body with hospitals that provide local NHS acute services. Half of Hillingdon PCT’s budget will be handled by the new Partnership.

The whole NHS is facing smaller incomes in the years ahead. NHS Hillingdon has paid dearly for past financial failures and is determined to meet the new challenges. In the last two years it broke even despite repaying £20 million towards its historic debt and interest, but this came at a cost. Hillingdon is behind other PCTs in investments in new services, including polyclinics. Significant investments in IT and estates are needed to support improvements in productivity to release funds to meet the new financial threats. The PCT continues to struggle to balance its books while repaying £7.7 million per year of its debt – a vital requirement for the last £19 million of debt to be written off in 2011.

Some local GPs have failed to give their patients adequate services and they now risk naming and shaming. Hillingdon was rated “Poor” in the national 2009 GP Patient survey, which looked at availability of GP telephone consultations, patient care by GPs practice nurses and receptionists, waiting times for appointments, cleanliness, and out hours services. In the survey, only one in five Hillingdon practices achieved the national average of 91% for patient satisfaction. Now the PCT is to encourage patients to contact PALS to record shortcomings and to post comments on the NHS Choices website and the PCT’s own website. So, in future, GPs who ignore patients’ concerns will do so at their peril.

A number of new faces will shortly be joining NHS Hilingdon. Senior staff vacancies were condemned by KPMG in its assessment of how the PCT should move forward. A new Medical Director has already been appointed, to take up post in December, and other posts are being advertised including a new Public Health Director - for the first time a joint appointment with Hillingdon Borough - also a new Communications Director and several other senior posts. These appointments will ease pressure on existing staff, who have struggled to cover vacancies for far too long. Being cynical, but possibly realistic, unpaid salaries have helped the PCT's finances, but the cost has been high.

So, as we approach a New Year and the start of a new decade, change is in the air.

Care Quality Commission’s Annual Health checks
The Trust again scored “Good” for both quality of services and for quality of financial management. This is good news but now the Trust is working to achieve “Excellent” next year,

Hillingdon Hospital Trust is to pioneer enhanced recovery for colorectal surgery and hysterectomy patients
The Trust is already recognised as a leader in helping hip and knee patients recover after surgery. Now it has put in a successful bid to take part in the Department of Health’s Enhanced Recovery Partnership programme, initially focusing on colorectal surgery and hysterectomy patients. This programme carries no DH funding, but there is substantial management support. The Trust expects to see reduced lengths of stay for patients, shorter waiting times for operations, fewer infections, better clinical outcomes and faster patient recovery. Good news for everyone!

Re-opening of Fleming Ward
This ward has been completely refurbished. It will be occupied by the Emergency Assessment Unit from early November.

Swine Flu preparations
Swine flu is expected to surge during this winter. As part of its preparations to tackle that risk, the Trust’s front-line staff, including A&E and maternity staff, have now been vaccinated against this flu as well as other forms of influenza.

Finance
The Trust’s financial performance in September was better than expected so it made a small surplus, reducing its in-year deficit to £145k, just over £1k behind plan for this point in time. This improved position is due to an increase in elective and outpatient activity, which has brought additional income.

By the end of November, bank staff are to be paid weekly. This is expected to increase the willingness of staff to work part shifts – and it is hoped that this will reduce expenditure on more costly agency staff.

Single sex accommodation
The Trust has been working hard to meet the standards laid down in NHS London’s 2007 guidance on single sex accommodation. A site visit to assess compliance took place on 13^th October. Initial feedback was very positive, with a request to use the Trust’s documentary evidence as an exemplar for the Department of Health.

However, in the specialist areas of coronary care and intensive care it has not always been possible to offer single sex accommodation, so additional measures have been put in place to maintain the privacy and dignity of patients within those units.

Firstly money
The Trust ended July with a surplus of £269k and it now forecasts ending the financial year next March with a surplus of £1.65 m. So, it expects to meet its statutory requirement to break even, and also to meet the requirements of NHS London. However, the Trust expected and wanted to have a bigger surplus, to allow greater flexibility if problems arise. Why are its profits down? Inpatient activity was low in July, operating costs continued to grow at a faster rate than income and planned efficiency savings were not achieved. To combat these issues and to meet the cost of paying for the new Mount Vernon Treatment Centre, the Board resolved to reduce use of agency staff and to avoid working outside normal hours. To achieve this will need the co-operation of staff at all levels of the workforce.

Infections? Mortality rates?
Good news on both these important issues – the Trust has had only two MRSA bacteraemia cases since 1^st April, so is well within its annual target of maximum 12 cases, and its standard mortality rate at 69.5 is way below 100, the average for hospitals in England

Children’s services
An action plan is in place to address training problems highlighted by the recent Care Quality Commission Review. Additional training for staff treating children outside the main paediatric area is being introduced and also more training in paediatric pain management . Changes are being made to ensure that consultants have appropriate volumes of paediatric activity to maintain their skills and expertise..

European Working time Directive
The requirement for junior doctors to work no more than 48 hours per week has now been met. This was achieved only by successfully recruiting an additional orthopaedic Senior House Officer and by a dispensation that two General Surgery rotas be allowed to work up to 52 hours per week.

The Community Voice does not meet again until September and so our next mailing will be in the middle of August.

Our Autumn programme has some treats ahead. On Thursday 3^rd September, at 7.45pm in the Post Graduate Centre Mount Vernon, the guest speaker will be Robert Bell, Chief Executive Officer of Royal Brompton and Harefield Hospitals Foundation Trust, speaking about the impact that the Trust’s newly acquired foundation trust status will have on its future plans, particularly the future of Harefield Hospital.

On 1st October, same time and venue, we look forward to hearing Dr Tony Stern tell us about exciting new developments being introduced at Northwood Health Centre and he will also share his vision for how tele-medicine will transform primary NHS services.

On Guy Fawkes night, 5^th November, we will welcome Edwin Aird, Head of Physics at the Mount Vernon Cancer Centre, who will explain the recent advances in cancer treatment, which will bring new hope to patients in the years ahead.

December will bring another good speaker and a chance to socialise afterwards as we welcome in the festive season. How the years fly!

Where else can ordinary people hear and question speakers of this calibre? These meetings will be of interest to both members and non-members, so come along and swell the audience.

Visitors are always welcome and we do not pressurise them to become members, but of course we are delighted if they want to do so. Meetings are free and the car park barrier is usually up when we leave, providing free parking too.

The mysteries of the Care Quality Commission were unravelled at the July meeting of The Community Voice, in Northwood, when Tracy-Jane Norton was guest speaker. She explained that the CQC amalgamated the Healthcare Commission, the Commission of Social Care Inspection and the Mental Health Act Commission, and it hopes to build on the best work of all three. For the first time common quality standards are applied to providers of health and social services.

The CQC’s vision is to encourage high quality health and social care and to support people to live healthy and independent lives, based on informed decisions that are responsive to their individual needs.

CQC sees itself as a critical friend, which is a two-way process. It judges Local Authorities and Primary Care Trusts, which arrange services for their communities, and also the organisations providing care. It assesses both services and pathways of care, and it is concerned with protection of the rights of people detained under the Mental Health Act. It ensures essential common quality standards are observed and that health and adult social services work together.

CQC gathers evidence from service users, carers, the public, national surveys, regulators and from its own inspections and investigation. It has the ability to administer fines, issue public warnings, to close unsatisfactory facilities and not to register providers that fail to meet its standards. From April 2009 it registers NHS providers and from April 2010 it will also register health and social care providers and probably Primary Care providers too from April 2011.

Human rights are at the heart of CQC’s work. It expects its information to be independent, fair, accurate, easy to access, and it hopes that it will be trusted, so that it will help people to judge the quality of their local health and adult social care services.

CQC operates in nine regions, matching Government Office and Strategic Health Authority boundaries, and in 150 local areas matching PCT and Local Authority boundaries.

Firstly, same faces, but new names and new roles
Hillingdon PCT is now known as NHS Hillingdon, bringing it into line with other PCs that have made a similar name change. Until a few days ago its Chairman was Mike Robinson, but he has now moved over to Hillingdon Hospital as Interim Chairman there, with Mike Whitlam taking over as Interim Chairman of NHS Hillingdon. It is like playing musical chairs!

30^th June PCT Board report on finance
As part of the process for paying off the last £19m of its historic debt, the PCT has to satisfy the other London PCTs that it will not get into financial trouble again so it has been told to put its house in order in various ways, including improving its relationship with Hillingdon Hospital. Is popping the PCT Chairman into the hospital part of that package? Of course no one chooses to comment!

PCT performance and targets
In June Board papers, neither routine ambulance response times nor A&E waiting times quite met targets but both were moving in that direction. Hillingdon still fails to achieve targets for chlamydia, staff satisfaction, teenage pregnancy and a number of other performance issues including primary care access, cardiovascular mortality, childhood immunisations and breast feeding targets.

Swine Flu
Although the World Health Organisation has declared a pandemic globally, the UK had not yet done so nationally. Hillingdon has had a small number of mild cases of swine flu, but it is well prepared for a local escalation it that happens.

Healthcare for London public consultation on stroke and trauma proposals
Over 9000 individuals responded to the consultation plus 602 organisations. The majority endorsed the preferred options – four major trauma centres including St Mary’s Hospital – 8 hyper acute stroke centres, including Charing Cross Hospital and Northwick Park Hospital, plus over 20 local stroke units, including Hillingdon Hospital.

It is relevant that Hillingdon PCT currently has about one major trauma case per month, currently treated at Charing Cross Hospital. However Hillingdon has more stroke cases, about 300 per month of which 75 would benefit from thrombolysis – currently these patients are treated at Hillingdon Hospital, which can guarantee a CT scan within 30 minutes only from 9am to 5pm, Monday to Friday, so it does not meet the 24 hours / 7 days a week criteria for designation as a hyper acute stroke centre, and hence it is expected to be a stroke unit concentrating on follow-up care.

Tony Valentine’s resignation
The Trust’s Chairman, Tony Valentine, will be retiring on 1^st July, a month sooner than expected, to allow the incoming Chairman to input into preparations for becoming a foundation trust.

Official opening of Bevan Ward, Hillingdon Hospital
Ann Keen MP, Parliamentary Under-Secretary for Health, opened Bevan Ward officially on Thursday 11^th June. She praised Aneurin Bevan’s vision for the NHS and those who planned Bevan Ward, named in his honour.

National Patient’s Survey
The Chief Executive, David McVittie, expressed disappointment that the national patient survey 2008 was not as good as the Trust had hoped to achieve. An action plan is being drawn up to tackle patients’ concerns.

Flu Pandemic
Swine flu is now classed as pandemic, but fortunately the symptoms are usually mild. Both Hillingdon Hospital and Hillingdon PCT are well prepared if a more virulent form emerges later.

Infections
Hillingdon Hospital had no MRSA bacteraemia cases in April or May. All elective patients are now screened for the infection before admission.
The Trust is working hard to reduce its number of cases of clostridium difficile. It faces a financial penalty of £100,000 for every case above its target of 127 cases for the whole year!

Single sex wards and facilities
The Trust received a grant of over £2 million to improve its single sex facilities. However, it is difficult to adapt an old building, so Pinewood Ward is now being used only by female patients.

Negotiations are underway between the Mount Vernon Cancer Centre and its preferred bidder as an academic partner, the Institute of Cancer Research and the Royal Marsden Hospital Trust.

The Mount Vernon Project is looking at experiences in the USA, Australia and Norway to see what it can learn.

The University of Pittsburgh Medical Centre in the USA has over 40 satellites in the USA and two satellites in Ireland. Telecommunications are used to diagnose patients and to draw up their treatment plans.

The UK has no satellite systems in operation but the Christie Hospital Foundation Trust in Manchester expects to open a satellite in Oldham in 2011.

Cost, staffing and high quality patient care are the key factors in choice. The first section of the study is expected to report by the end of July 2009. The second stage will focus on identifying the best site for a satellite based on Mount Vernon Cancer Centre, probably Luton and Dunstable Hospital or the Lister Hospital in Stevenage.

Hillingdon Hospital ’s current showpiece is Bevan Ward, its all single-bedrooms ward, which took its first patients earlier this year. It was officially opened yesterday, 11^th June, by Ann Keen MP, Parliamentary Under Secretary for Health, with the unveiling of a plaque to mark the occasion.

The invited audience – which included several Ruislip Residents Association members who had supported the project in various ways – heard that the Minister started her career as a junior hospital receptionist and went on to become a nurse, so she has genuine roots in the NHS as well as current high level responsibilities. She went on to praise both Nye Bevan, for his vision of the NHS, and those who had promoted the ward named in his honour. She wished it well for the future.

Afterward there was afternoon tea, with a wide range of goodies and a splendid cake iced with the Bevan Ward logo. Much to my astonishment, I was invited to assist the Minister in the ceremonial cutting of the cake!

Good News from Mount Vernon Cancer Centre! June 2009
Barbara Gill was our June speaker. She is the Director of the Mount Vernon Cancer Services Development Project, which was set up by the two Hertfordshire PCTs last year, to consider future plans for the Cancer Centre.

Then she reminded us that her project’s interim report, published in March, reversed previous decisions and confirmed that the Cancer Centre will stay at Mount Vernon for many years ahead. That very welcome decision brought two immediate developments. Firstly plans to rebuild the dilapidated cancer wards are now underway, which is excellent news. Secondly the Cancer Centre is able to look for an academic partner.

Until the Cancer Centre was threatened with being moved to Hatfield it had a very fruiful academic partnership on site, with the Gray Cancer Institute. However, faced with that threat the Gray Cancer Institute was moved from Mount Vernon to Oxford , leaving an academic void, which damaged the ability of the Cancer Centre to take part in research trials or to attract research funding.

Now, with its future secure, the Cancer Centre has invited partnership bids from academic institutions and it has received three very prestigious offers. Its preferred bidder is the Institute of Cancer Research / Royal Marsden Foundation Trust, with University College London and Imperial College London equal in second place. The final agreement will not be made until the autumn, when negotiations are complete.

The next stage of the project will consider whether to expand cancer services at Mount Vernon or to use Mount Vernon as the hub of a system with one or more satellites further north, possibly in Luton or Stevenage .

All these exciting developments give the Cancer Centre a higher profile, contributing to the fact that the Cancer Centre has been selected as the first NHS site in the country to have cyberknife technology, which allows very advanced and precise radiotherapy treatment for some types of tumour.

Altogether this was a meeting to remember, with an excellent speaker and excellent news.

A whirlwind of change in Hillingdon community health services, May 2009
Maria O’Brien was guest speaker at the Community Voice May meeting. She covered so much ground that we felt a whirlwind had hit us! Her enthusiasm and dedication to patient services was transparent and exciting. Summarising is an impossible task.

Traditionally PCTs have commissioned services – which means planning and purchasing – and they have also provided community health services. NHS national policy now obliges PCTs to separate theses two roles. The former PCT provider services are now called Hillingdon Community Health which, from 1^st April 2009 , has been designated as an autonomous provider by NHS London. Maria O’Brien is its Managing Director.

However, Hillingdon Community Health is still responsible to the PCT Board although it is now an independent organisation with its own £30.5 million budget from Hillingdon PCT. It employs 550 staff to provide 32 different health services in patients’ homes and 19 clinics.

Its Adult Services include district and specialist nursing, podiatry, specialist dentistry, community matrons, various therapies, infection control, wheelchairs, rapid response teams, safeguarding adults service. It is responsible for two GP practices in the south of Hillingdon and also for the 22 bed in-patient facility at Mount Vernon in the Northwood and Pinner Community Unit.

Its Children’s & Young People Services include health visiting, child development, community paediatricians and nursing, various therapies, school nursing, safeguarding children, looking after children and also family planning and sexual health.

Various options are open to this new organisation. It could remain as it is or become a Community Foundation Trust. It could integrate with an acute NHS Trust or a Foundation Trust, or the Local Authority. It could become a Social Enterprise, outside the NHS, or merge with another PCT Provider. It could even become a private enterprise.

In 2009-10 it aims to focus on expanding and improving clinical services for local users, but it will also consult with staff, patients and the public, the local authority, hospital, and GPs before making recommendations about its future framework in Autumn 2009.

Within the next two months it hopes to achieve a wait of no more than two weeks for physiotherapy. It also plans to develop a “home” intravenous antibiotic service, expansion of the Rapid Response Service, a new wound care service, more community matrons to support patients with long term conditions and expansion of other services including diabetes, rehabilitation, immunisation and children’s services.

Hillingdon PCT has been very supportive, more so than many PCTs, with investment in community services and an extra 110 front-line posts in Hillingdon.

Questions came thick and fast. All were answered. It was a highly informative and interesting experience for the audience. Many thanks to Maria O’Brien!

The first step towards London Primary Care Trusts paying off the last £19m of Hillingdon PCT’s historic debt was for Hillingdon PCT to break even financially, for the second year running, for the year ending on 31^st March 2009. That was achieved, despite paying back nearly £9m of its debt during that year.

Next step was for the PCT’s Chairman, Chief Executive and Finance Officer to be grilled recently on why the debt arose, to make sure that it won’t happen again,

Having passed that hurdle, the PCT must break even again this year and next year, whilst still pay off nearly £8m of the debt each year.

That will be tough, but the other London PCTs are offering help so that Hillingdon PCT now has money specifically available to provide Hillingdon people with the same improvements as other Londoners under the Healthcare for London programme. So Hillingdon PCT will have a total of £5.6m for service improvements this year, for maternity services, the GP-led Health Centre, chlamydia screening, vascular checks and community equipment, particularly specialised wheelchairs, which have been a campaigning issue for several years. £3.6m of this is a loan, to be paid back when the historic debt has been cleared.

Hillingdon PCT is also getting financial help as part of the Department of Health strategy to get rid of mixed sex wards. £30,000 had been awarded to improve WC and ablution facilities in the Northwood & Pinner Unit at Mount Vernon and Hillingdon Hospital has been awarded £2m for similar purposes.

The new NHS Constitution came into force on 1^st April. It sets out what patients have a right to expect from the NHS, who is accountable if mistakes are made, how patients can complain and patients responsibilities.

Under the new complaints procedure, the Health Service Ombudsman acts as the second and final point of contact for complaints and health and social care complaints share the same complaints system. The emphasis of the system is local resolution.

Hillingdon PCT has agreed that in future it will breakdown complaints so that the relevant GP practice.is identified.

It also plans to publish a ranged of details about the services local pharmacies provide, to enable patients to make meaningful comparisons between them.

Delay in obtaining physiotherapy services is known to vary in different parts of the Borough, but this is being addressed and soon no patient should have to wait more than two weeks for physiotherapy treatment.

Bevan Ward
The May Board Meeting learned that the new Bevan Ward in Hillingdon Hospital will be opened officially by Ann Keen MP, Parliamentary Under-Secretary for Health, on Thursday 11^th June. This exciting new ward, with all patients in single rooms with en suite facilities, is a national pilot project, so it is to have a ministerial blessing at its opening.

Flu Pandemic
There are no identified swine fever patients in Hillingdon Borough. However, the Hospital and Hillingdon PCT are working well together to update their flu pandemic plans. So far the effects of the H1N1 virus have been generally mild, but it is good to be prepared in case it has a sting in its tail, which could happen.

Foundation Trust Governors
Candidates have now come forward as Governors to represent the South of Hillingdon, so an election is underway. Governors have already been elected for other parts of the Borough.

Infections
No MRSA cases in April or up to 27th May, the day of the Board Meeting, which was encouraging. However, not so the clostridium difficile report, which noted 13 cases in April, the first month of the accounting year. The annual target is a maximum of 127 cases, which is very challenging.

Accident and Emergency target breached
Attendances at A&E rose dramatically in April and only 96.3% of patients were admitted or discharged within four hours of arrival, against a target of 98%. More doctors are being rostered for evening shifts, when the breaches occurred.

Charging dispute with Hillingdon Primary Care Trust
Hillingdon PCT disputed the Hospital Trust’s charges for 2008-2009 on technical grounds and this dispute went to arbitration by NHS London. The PCT claim was upheld. The impact on Hillingdon Hospital in the year 2009-2010 will be an income loss of about £1m.

Swine ‘flu
The PCT is working with Heathrow Health Control Centre, the Urgent Care Centre at Hillingdon Hospital, and GPs and pharmacists across the Borough. Let’s hope swine ’flu does not touch our area, but it is reassuring that preparations are in place – just in case.

Public Health Report
This year’s Annual Public Health Report has a new twist. It is presented as a dialogue between a disadvantaged resident and the Director of Public Health. It is easy to read and refreshing. It admits that many factors in poor health are outside the PCT’s control - low income, unemployment, poor housing and limited education, which are the main causes in the gap in life expectancy in different parts of Hillingdon. However providing enhanced health services where they are most needed could help to address this gap. So, the report calls for more money to be spent in the south of the Borough – which may not be popular further north.

Andy Beckingham, Interim Public Health Director, who wrote the report, is leaving the PCT to take up an appointment nearer to his home, so he will not be around to carry forward his fight for more services in the south of Hillingdon.

PCT’s Provider Services
NHS London has awarded these services the status of Autonomous Provider Organisation, to be known as “Hillingdon Community Health”. So, these services will now operate independently, although they will still be answerable to the PTC’s main Board.

Hillingdon PCT’s historic debt
A Challenged Trust Board has been set up to oversee recovery of Hillingdon PCT and other trusts with historic debts. Hillingdon PCT stands to benefit by a write-off of £19m debt by the end of 2010/11, but it has to prove it can then stay out of debt in future. Meetings are being set up to look at the PCT’s affairs in great detail.

Comparison of GPs in Hillingdon
The PCT uses what it calls “A balanced scorecard for primary care” to measure GPs’ effectiveness. This provides comparisons for some chronic diseases, availability of services, cost effectiveness of prescribing and quality clinical outcomes. It aims to ensure: