Health

Finance
NHS London has given Hillingdon PCT a rating of 4 for its financial management over six consecutive quarters - only one PCT scored the maximum 5. However, this year the future looks grim. £12m is expected from the PCT in efficiency savings with £1m cut from management costs (even though Hillingdon has the lowest management costs in the NW London sector) and £4m to help other struggling trusts in the sector, plus other savings. 2011-12 looks even worse. Hard times indeed, despite the Coalition Government’s claim that the NHS is “protected” from cuts.

Performance
Although the PCT has achieved a “Good” rating from NHS London for the last quarter of 2009-10 it will be challenged even to get a rating of “Adequate” in 2010-11 because the budget has had to be reduced in a number of areas to meet the savings required by NHS London.

Local NHS changes
The Government has put a moratorium on all reconfiguration of NHS services unless they meet strict criteria and on development of polyclinics in London, but PCT provider services must be separated from the PCT by 31^st March 2010. So, we hear no more about polyclinics but still have plans for polysystems and the amalgamation of Hillingdon Community Health with Central & North West London Foundation Trust is still underway. There is also uncertainty about the future of the PCT, which could close in 2012 with its functions transferring to NHS North West London.

A Government White Paper is expected in July which will propose many NHS changes in addition to those already announced e.g. hospitals will no longer be paid for emergency re-admission of patients within 30 days of discharge; NHS London will be abolished in April 2012.

The Trust is doing well, achieving the highest possible rating from NHS London for its financial management along with a rating of “Green” for its governance.

The low number of working days in April and May led to a deficit of £658k, but this was £88k better than expected, despite inpatient activity rising by 10% and outpatient activity by 28%, whilst income rose by only 1.6% as a result of the new prices cap - last year this activity would have led to 7.6% more income.

Stroke Unit
Hillingdon Hospital’s Stroke Service has achieved Gold Standard for its TIA (trans ischaemic attack) service – the first Trust to achieve a Gold. The Stroke Network was so impressed with the Hillingdon service that it intends to use Hillingdon as an example in its Stroke Improvement Programme. However, the Stroke Unit’s expansion has achieved only half the expected income increase.

Care Quality Commission’s Inpatient Survey 2009
Overall the 2009 results showed an improving picture but it still has a long way to go. The care and treatment section showed four shifts from the lowest 20% in the country last year to the intermediate (60% zone) in 2009. The Trust is working hard to improve again next year.

Emergency Care
The Trust is in the upper quartile of all England Trusts, giving the A&E Dept. an enormous boost.

Fractured neck of femur
A project group is being set up to achieve the new criteria - patients to theatre within 36 hours from time of arrival in an emergency department, with patients under the joint care of a consultant geriatrician and a consultant orthopaedic surgeon with, later, a multi-professional rehabilitation team.

Deaths in the Trust
Although the standard mortality rate rose in January (SMR 82.4 versus England average 100) the level of deaths and SMR were not as high as last year and they fell again in February and March. The number of deaths in April 2010 was the lowest since The Trust first recorded this data.

Money …
Having, at long last, got rid if its historic debt, this PCT might be forgiven for expecting easy times ahead. However, it has a big disappointment. Financial features this year include:

These are still tough times. The PCT will have to reconsider what it can realistically hope to do this year.

NW London Commissioning Partnership
This Partnership now purchases hospital services for eight London PCTs. As this spending accounts for over 50% of Hillingdon’ s total budget, it will lead to many changes but it is expected to bring some savings. However it has also brought one loss already - Hillingdon’s Ann Johnson, has recently been appointed Sector Finance Director. She will be missed.

Hillingdon Community Health
Hillingdon has a number of new community services:

Out of Hours Services
All General Practitioners in Hillingdon are responsible for providing out of hours services for their patients. Every local Practice has a contract with Harmoni, which runs the local service for the GPs. The PCT is not party to the contracts but it monitors Harmoni’s performance against the National Quality Requirements. In Quarter 4 2009-10 Harmoni met criteria for urgent calls (20 minutes), routine calls (60 minutes) and percentage of calls within two hours. The front end of out of hours services is contracted with NHS Direct, by Hillingdon PCT. In Quarter 4 2009 NHS Direct met its target for answering calls within 60 seconds.

Finance
In April the Trust was £82k behind plan for the month and £185k behind its efficiency savings target. Births returned to a level close to last year’s average, but no higher, which was disappointing. 2009/10 national pay awards were reflected in staff costs with an overall impact of a 1.7% increase. Year-on-year inpatient activity rose by 4% and outpatient activity by 23%, yet NHS Clinical Income only rose by 0.8% as a consequence of the caps on what the Trust can charge for its services. On a like-for-like basis comparable to 2009/10 the Trust’s NHS Clinical Revenue would have risen by 2.7%.

The Trust is clearly facing a daunting financial challenge, reflected in prolonged discussion at its recent Board Meeting, without significant progress. A year end deficit of up to £5.3m could be risked if current trends continue.

Infections
The MRSA standard has changed. This year the Trust is only held responsible for bacteraemias diagnosed 48 hours after admission, but its target is a maximum of four cases in the year. One case was reported in April, so this will be a challenging target. The spread of Norovirus infection was recently controlled by early isolation of patients and strict infection control measures; the four cases in Drayton Ward / ITU spread no further.

Cancelled Operations
The Trust partly failed the cancellation target in 2009/10 due to bed availability, the number of over-run and complicated surgery cases, problems with instrument availability and theatre infrastructure and consultants’ sick or compassionate leave.

These problems are all being addressed, but in April 2010 twenty of 1,650 patients had operations cancelled on their day of admission, a performance of 1.2% against the target of <=0.8%. Each consultant’s list is being analysed to see if there are recurring themes to rectify. The availability of instruments has been addressed by capital investment.

Winter Planning Review 2009/10
Staff co-operation and achievement during harsh winter pressures were acknowledged at the May Board Meeting and praised. Rotas were adjusted, shifts extended, new ward rounds introduced at 5pm to allow discharge of suitable patients and transport was provided to enable staff to work during heavy snowfall. Some staff stayed in hospital overnight in order to be in place next day. Up to 50 extra beds were opened during peak demands and extra trauma lists were run in the evenings and at weekends. An emergency multi-agency taskforce assisted with discharge of patients. However, there were still heavy pressures, particularly in A&E and the Emergency Admissions Unit.

Based on the above experience, a written Winter Pressure Plan is being prepared in advance for next winter, which will be synchronised with all relevant agencies.

Winner in national MS Care Award
Alderbourne Ward staff deserves all the congratulations it has received on winning this prestigious award.

Joint working:
NHS London has five sectors. Following on from the appointment of sector chief executives, the proposal is for sectors to recruit full time executives for the areas of strategy, finance, performance and contracting, clinical, communications and public health.

A joint Committee of PCTs will continue to be the formal mechanism through which PCTs collaborate at sector level. The current establishment agreement for JCPCTs will be revised to clarify the decision-making powers that PCT Boards need to delegate to JCPCTs. Sector JCPCTs are expected to reduce membership to a maximum of 14 people. The new establishment agreement will be finalised by the end of April in order that it can be presented to PCT Boards for endorsement no later than end of June 2010

Polysystems:
The eight PCTs in the NW London sector are required to draft plans for polysystems development, to be discussed at a sector-level meeting of communications leads on 4^th May 2010. Board papers note that NW London should learn lessons from elsewhere, in particular North East London Sector, which is among the early implementers of polysystems in the capital – where the public, local community leaders and elected representatives are now actively engaged in high profile local protests against planned or proposed acute sector reconfigurations – and the BM A has joined in with its “London on the Brink” campaign.

Hillingdon PCT hopes to engage with local communities on its own proposals through the local authority, LINk, GP participation groups, the local Youth Forum and Brunel University. Other London PCTs will be undertaking similar discussions.

Finance: Hillingdon Hospital Trust squeaked home with an end of year surplus of £100,000 for 2009-2010, £2.4m behind plan, but far better than having a deficit.

Activity levels: New GP referrals remain very high, but births were lower than previously. A&E and elective surgery continued to flatten but the non-elective activity trend is high, which causes concern, particularly as Trusts now only receive 30% of the tariff for non-elective admissions above the 2008/2009 levels.

Hillingdon Hospital’s Annual Plan for 2010/2011: The Trust submitted its final revised Annual Plan for 2010/11 to NHS London in April. This includes a number of aspirations including its plans to increase stroke beds from 16 to 24 and to incorporate additional maternity deliveries, in line with its hopes to be a NW London maternity services provider. Its activity level of over 4,000 births per year with a supporting level 2 neonatal unit is expected to expand to manage more than 4,600 births per year by 2014/15.

The Trust has been asked to provide a Paediatric Oncology Shared Care Unit for West London, but the size and configuration are to be determined.

There are plans to improve and/or expand a range of other services including Plastics, Ear-Nose-and-Throat, Endoscopy, Bowel Screening, Genito-Urinary Medicine and Trauma.

The Trust continues to work closely with NHS Hillingdon and examples of collaborative work include plans for the Urgent Care Centre and the Referral Management Centre.

New Interim Chairman: Martin Roberts is the new Interim Chairman. Mike Whitlam, who has been acting in that role, remains Vice Chairman.

Finance: For the third year in a row our PCT has achieved end of year break-even – with a small surplus of £3,000 for 2009-2010. Its historic debt has been wiped out by other London PCTs, so it is no longer designated a challenged PCT.

Care Quality Commission’s Annual Health Check: The PCT has achieved “Fully met” on existing commitments and is on the threshold of “Good” for national priorities, which would achieve an overall rating of “Good” for quality of service – an improvement for both categories in comparison with last year. Targets that went from red to green during the year were immunisation, chlamydia screening and dentistry

Hillingdon Community Health Integration with CNWL: The provider arm of Hillingdon PCT, called Hillingdon Community Health, has had a very successful year. It is now proposing integration with Central North West London Foundation Trust, which already provides mental health services in Hillingdon and many other London Boroughs. Separating commissioning and provision functions was forced upon all PCTs by Department of Health requirements and subsequent merger of some kind was unavoidable. Hillingdon Hospital Trust had indicated interest in taking that role, but CNWL has been the preferred option. NHS London has given its approval in principle and formal approval is expected when final negotiations are completed.

Air pollution: At the April Board Meeting members heard that during the volcanic ash flight restrictions carbon emissions were recorded locally as almost zero - which suggests that flights, rather than road traffic, are responsible for the usual poor air quality near Heathrow.

Finance
At last! The Challenged Trust Board has wiped out NHS Hillingdon PCT’s £19m historic debt! However, £8m will be taken from the PCT’s 2010-2011 income, as the last tranche of its debt repayments, so it will be another year before it is finally free from the impact of debts dating back to 2003 - 2007. However, the PCT expects to break-even for 2009-2010. In contrast, The Hillingdon Hospital NHS Trust was on a knife edge and if all “worst risks” materialise it may be deficit for the year to 31^st March.

Quality Accounts
The Hillingdon Hospital Trust has been unconditionally registered by the Care Quality Commission. First Quality Accounts must be submitted in June.

Hillingdon Community Health
The provider arm of NHS Hillingdon has agreed to integrate with North West & Central London NHS Foundation Trust. A paper outlining the reasons for that decision is available on request.

Proposals for polysystems in Hillingdon
NHS Hillingdon proposes a three stage development of polysystems, open 7 days a week 8am to 8pm, offering diagnostic / outpatient services, management of long-term conditions, co-located with primary mental health services, some secondary health services and social care. The first polysystem hub will be in the Hesa Centre, Hayes Town, which may open in July 2011; the second hub, in the grounds of Hillingdon Hospital, may open in April 2012; the third hub, on the Mount Vernon Hospital site, possibly opening in April 2013. All plans will involve public consultation, the first about the Hayes proposals in January 2011. A sheet with more details is available on request

Reports on various Hillingdon meetings
Report from all local NHS Board meetings are available on request, also reports on the March meeting of Hillingdon’s External Scrutiny Committee and the Inequality Conference held in the Civic Centre on 31^st March.

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.

If you have any views on the above or want to help please contact Joan Davis see Feedback

Ruislip Residents Association

Health