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Update on Hillingdon Hospital, June 2009

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.

Mount Vernon Cancer Services Project June 2009

1.  Mount Vernon Cancer Centre’s search for an academic partner.

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.

2. Radiotherapy satellite systems across the world

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.

Official opening of Bevan Ward, Hillingdon Hospital, June 2009

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.

First she summarised the Cancer Centre’s troubled history. 

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!

Hillingdon PCT gets help from other London PCTs, May 2009

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.

Other snippets of news from the PCT’s May Board meeting were that:

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.

News from Hillingdon Hospital, May 2009

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.

What’s new in Hillingdon PCT? May 2009

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:

It looks at many services, such as cervical screening, influenza vaccinations for elderly patients, childhood immunisation.  To indicate whether services are satisfactory, it uses a traffic light code of red, amber and green.  In April eleven GP practices were in the red category on overall assessment.  These GP practices are named in the report – they are scattered across the Borough.  Deprivation scores are shown for each GP practice, but there appears to be no correlation between deprivation and red rating.

What's new at Hillingdon Hospital? April 2009

Resignation of the Chairman
The Chairman, Tony Valentine, has announced his resignation, effective on the 1^st July.

Accident and Emergency Department activity
Demand has recently escalated with an extra 35 to 40 patients per day in A&E, mostly between 8pm and midnight.  So Hillingdon Hospital failed to meet the national target of treating all A&E patients within four hours of arrival.  In April its rate dropped to 96.4%, bottom for London and in the lowest quartile nationally.  So, the Trust has been summoned to discuss its action plan with NHS London.  Additional staff are being introduced on evening shifts. 

Finance
2008-09 was very challenging, with the combined pressures of achieving the 18 week target, very high energy and utility price rises, and a large increase in agency staff use.  Never-the-less, the Trust delivered its best performance on national and local targets and ended the year with efficiency savings of £4.7m.  The highest earning departments were Obstetrics and Trauma / Orthopaedics, followed by Accident & Emergency.

Flu Pandemic
In a recent audit of preparations for a possible ‘flu pandemic the hospital scored an assessment of 98%.  This was a national audit, in which the London average was a score of 82%, so The Hillingdon Hospital was considered well prepared. 

MRSA Screening
It is    hoped that all elective patients will be screened for MRSA by the end of April or early May.  All inpatients after two weeks are now re-screened every 14 days to assist in the identification of high-risk patients.

Pressure ulcers
A successful pressure ulcer awareness week was launched in March to raise awareness among both staff and the public.

David McVittie's Address to Community Voice, April 2009

David McVittie is always a popular guest speaker.  He has charm and is frank.  As Hillingdon Hospital’s Chief Executive, his news is up to date and correct.  So, he enchants his audience – and our April meeting was a great success.

In a nutshell, what did he say? 

Firstly, his Board intends to rebuild  Hillingdon Hospital on its present site.  It looked at all options and this was the best.  In an ideal world the RAF site at Uxbridge might be first choice, but in practice it is not a front runner.

No London acute hospital has been successful so far in achieving foundation trust status, so his Trust is not alone in its disappointment that its application is on hold.  It remains confident of ultimate success.  It already has over 5,500 Foundation Trust members and has recently held elections for Governors.

He spoke about the current trauma and stroke public consultation.  His hospital receives less than one major trauma case per week, so it cannot not match the criteria for a major trauma centre, but the proposals will allow it to continue, as now, to deal with the majority of local trauma cases.

However, his hospital already provides a hyper-acute-stroke service for most of the day, so it is disappointed by the consultation proposals, which would send all local stroke patients to Northwick Park Hospital for the first 72 hours of a stroke attack.  His hospital would then become a local stroke unit, dealing only with transient ischaemic attacks and rehabilitation. 

His Trust’s vision for Mount Vernon is unchanged.  The new car park outside the Mount Vernon Treatment Centre will open in June.  Various old buildings must be demolished.  New cancer wards are needed, also new staff accommodation and new wards for elderly care.  A joint venture with the private Bishopswood Hospital could lead to shared accommodation for endoscopy services. 

The Trust is proud of its two new facilities.  Bevan Ward in Hillingon Hospital provides en-suite single rooms.  The Mount Vernon Treatment Centre provides top class elective care.

It has also done well in meeting national targets, in achieving a small financial surplus, in the outcome of staff surveys, in its thriving Patients in Partnership programme and in introducing its consultant led Emergency Admissions Unit which is open 24 hours a day, seven days a week.

The speaker stayed late to answer questions and to hear audience comments.  As always our meeting provided an opportunity for members to relate directly to the speaker -  interchanging views and information, to mutual advantage we hope.

Mount Vernon Cancer Centre is Safe, March 2009
At long last, the Mount Vernon Cancer Centre is safe.  The 2002 Varley Review recommendations have been overturned – so, no more talk about moving the Cancer Centre away from Mount Vernon! 

Instead all efforts will be directed towards making Mount Vernon the hub of a system with satellite services further north, in Hertfordshire or Bedfordshire, to provide routine radiotherapy for those who currently have very long journeys. 

The current Review’s Interim Report is being launched on Monday 30^th March, at a stakeholders’ conference, but the document is already in the public domain.  The main issue now is to ensure that services remain first rate in both Mount Vernon and any satellites.  No one wants second-class services, even if they are close to home.

This success is a triumph for local people.  Members of Ruislip Residents spear-headed the two Community Voice petitions – each with over 70,000 signatures.  Collecting those signatures involved a lot of hard work, but the outcome is very sweet.  When ordinary people pull together, they can make things happen!

Good and bad news from Hillingdon Hospital, March 2009

Firstly the good news
Both Mount Vernon Treatment centre and Bevan Ward are open and much appreciated by both staff and patients. 
It is encouraging that there have been no cases of infection in Bevan Ward – single rooms and isolation remain the most powerful tools against infection.
The Treatment Centre is receiving out-patients as well as elective surgery patients, but the operating theatres are not yet being used to full capacity. 

Now for the bad news
There were three cases of MRSA in January and two more in February making a total in year of 16 cases, four above target.  Everyone was clearly devastated. 
27 pages of the Board papers and most of the Board Meeting discussion were devoted to MRSA.  Every case is documented and analysed in detail.  All elective surgery patients are now pre-tested for this infection.  Hand hygiene is closely monitored.  Pressure sores are vigorously avoided.  It is difficult to know what more could be done. 

And no news on the Foundation Trust application
At the time of the Board meeting hopes were high that there would be an announcement within hours – but these hopes were dashed by silence.  Until such an announcement is made no one can be sure of the outcome.

Hillingdon Primary Care Trust News, March 09

This was a jam-packed meeting, full of facts, so here are a few items of particular interest to patients:

The Hillingdon Referral Medical Centre  The RMC currently processes over 80% of GP referrals to hospital consultant services.  Patient satisfaction surveys for dermatology patients are currently underway – so these patients can say what they think of the service.

Physiotherapy Services  Additional investment is being provided to reduce waiting times.  No one in Hillingdon should then wait more than two weeks to see a physiotherapist.  Weekend services are to be developed and the “physio-direct” telephone service.

Early intervention for psychosis  The PCT has failed its target of treating 38 new patients in the year.  However the new consultant started in post on 1^st January 2009 so the PCT hopes to do better in future.

GP surgeries extended hours  Good news for patients - over 55% of surgeries now offer extended hours – so fewer patients now need to go to A&E in hospitals.

Patient Choice  From 1^st April 2009 patients will have right to choose where they have treatment when referred for their first outpatient appointment, but this choice is at Hospital Trust level, not site level – so, if you choose The Hillingdon Hospital, you could find your treatment is provided only at Mount Vernon Hospital, since both these hospitals are part of the same Hospital Trust.  Patients can choose any hospital in England that provides the required service and meets the NHS standards, including independent and private hospitals that appear on the Choose and Book list.

Podiatry Service  This service is supporting the Hillingdon Age Concern’s Toenail Cutting Service by providing training and support when problems arise – good news, particularly for older people.

The Rapid Response Service This service, started in September 2006, to look after patients for a short time in their own homes, has now extended its hours to 8.30am to midnight, for 365 days per year.

Health Visitors  The national shortage is being tackled locally by supporting staff to undergo part-time training – so the PCT is trying to grow its own Health Visitors!

Parkinson Disease Specialist Nurses  A bid  for funding two part-time specialist nurses is underway and  appointments are expected early in 2009.

Cancer Waiting Times Targets - January 2009

The following targets were introduced between 2002 and 2005:

 Targets from January 2009 are:

There are also new rules about how 31 days and 62 days are counted.  The clock cannot now be stopped for patients to consider options or go on holiday, so reported compliance is expected to fall.

Winter takes its toll at Hillingdon Hospital - January 2009

A very cold December combined with outbreaks of flu put The Hillingdon Hospital Trust under intense pressure.  In January the Trust continues to have 30 additional beds open, to meet demand, as well as keeping more beds empty than is usual.

Winter vomiting virus is now imposing additional pressures.  Some wards are already infected and are closed to new patients.  The virus is more easily caught than the common cold and to curtail the risk of it being brought into the hospital, friends and relatives of patients are asked to make only essential visits. 

Infections
The Trust had two MRSA cases in January making a total of 13 so far in year, breaching the whole year target of 12 cases maximum.  The Board learned that three of the patients identified with MRSA had no symptoms, so it is possible that contamination of samples could have occurred.  It was also noted that in January last year that there were 28 cases of MRSA in year, so there has been dramatic improvement despite failing the target.  (Note too that every Trust has a target based on its own past performance, and that Hillingdon Hospital’s target is lower than many similar hospitals.

Finances
December’s financial performance was better than the same month last year and so the Trust’s financial position is as planned for this point in the year.

Hillingdon PCT can see light at the end of the tunnel!, Jan 2009

Last month it was proposed that London’s 31 PCTs should all pull together to resolve London’s historic debts.  The Department of Health offered a sweetener of £100m, so the deal has now been agreed, throwing a life-line to Hillingdon PCT which is still burdened with huge debts. 

Providing Hillingdon PCT breaks even financially up to March 2011, including debt repayments of over £8m in each of those years, then its remaining £19m debt will be met by the other London PCTs.  In the meantime Hillingdon PCT can borrow from the other PCTs to enable it to provide essential local investment.  This is all fantastic news.

Less good news is that Hillingdon PCT and The Hillingdon Hospital are facing some difficulties in resolving coding problems that govern how much the PCT pays for the hospital’s services.  Pending resolution, Hillingdon PCT is withholding payment above the level of its commissioning agreement.  It is hoped that mutual understanding will be reached, but the hospital could seek resolution via arbitration.

The Urgent Care Centre at Hillingdon Hospital is breaking even for the PCT, but the hospital’s A&E Department is losing income in consequence.  In contrast, the PCT’s Audit Committee found that the Referral Management Centre (designed to keep people out of hospital and provide services closer to home) shows no evidence of value for money, nor of improving the patient experience and it has had a negative impact on the relationships with The Hillingdon Hospital and GPs - but it has been successful in providing services more locally for 70-80% of GP referrals.  This sounds like win some, lose some.

Targets and ratings continue to absorb much time and energy.  Sub zero temperatures in December plus a local flu outbreak caused The Hillingdon Hospital to breach its A&E target to treat all patients within four hours of arrival.  It also had two MRSA cases that month, one above target, but this target demands reduction of previous performance, which started from a low number.  So, despite breaching its target for this time of year, this hospital continues to have relatively good MRSA infection control compared with similar hospitals.

The PCT’s Healthcare for London event in the Chimes, Uxbridge, last November, showed that the public has little awareness of what the PCT actually does.  The PCT’s new strategy aims to improve public awareness and participation in its affairs and it is inviting both Hillingdon Local Involvement Network, LINk, and other lay representatives to join a number of its committees.   

West Herts Hospitals under winter pressures, Jan 2009

The Board of the NHS Trust heard good and less good news at its first meeting in public in 2009.

Good news is that it is keeping MRSA numbers low with only 11 cases so far this year.  It is also meeting national targets to treat patients within 18 weeks of referral by their GP.  Its £1m surplus so far this year is further good news, although this is a smaller surplus than forecast, so it was greeted with muted approval.

However there were some bad things too, including seasonal pressures on beds impacting on A&E performance in December, which therefore failed to treat 98% of patients within four hours of arrival.

Worse from the patients perspective, was an admission that for some aspects of mandatory staff training there is currently a compliance of only 40% - this appeared to shock some members of the Board and certainly shocked the public who heard the report.

Also there was an admission that some words are operating with less that their agreed complement of staff, because recruitment of additional staff has not been sufficiently successful.  Bank and agency staff have been used, but they are costly, and that expense has undermined the Trust’s financial planning.

After a number of Board meetings with only good news, this meeting was less self-congratulatory than other recent meetings.  However this Trust’s remarkable recovery from dismal failure must not be forgotten.  It has accomplished near miracles and it is that success which makes this Trust well on its way towards achieving foundation trust status, which at one time was unthinkable.

Hillingdon Hospital’s progress - December 2008
Progress has been steady, but without dramatic news.

Foundation Trust progress
Having gained Department of Health approval to advance toward foundation trust status, the Trust is now under scrutiny by Monitor.  The process for election of public and staff Governors is underway with the election for the Council of Governors in February in readiness for authorisation as a Foundation Trust, hopefully in March 2009. 

Routine surveys of equipment and estate
Matrons have audited the Trust’s mattresses, with 180 being replaced in early December.

The Trust’s property has been comprehensively surveyed, with a report of over 1500 pages.  The buildings survey was undertaken by an external company, which reports a backlog of high/significant maintenance of over £22m, with a total backlog approaching £50m - excluding C Block at Mount Vernon, which was already awaiting demolition.

Maintenance designated high/significant risk means something that can have an effect on the delivery of core healthcare services e.g. the out-patients department roof at Hillingdon Hospital needs major repair work, for which tenders have been prepared.  £30m has been allocated over the next four years to reduce this high/significant risk to £2.8m and the total backlog to £17.6m.

Safeguarding children
Following the court verdict on the Baby P case, all local authorities including Hillingdon Borough, together with their partners such as the Trust, have been taking stock of the effectiveness of local practices to safeguard children.  Everyone hopes that nothing similar could fall through the safety net here.

Patients’ experiences
The Trust takes seriously the views of patients.  154 in-patient survey responses in October were, as usual, carefully analysed and league tables compiled, by ward, for each survey question.  Survey results are used to improve performance and to encourage increased response levels from patients.  Similar surveys are being piloted for out-patients and maternity patients.  A Patient Experience Steering Group is being set up to receive and monitor survey results.

Infections
The Trust was disappointed to have two MRSA cases in November but it hopes to stay within its full year target of 12 cases maximum.  However, a new Department of Health target to include screening of all day cases - approximately an additional 1000 patients per month - will be very challenging, as the Trust currently screens only 22% of these cases.

Finances
Revenue was lower than expected in November and operating expenses relatively high, but the year-end forecast surplus remains unchanged.  Agency and locum use exerted cost pressures, also energy and utility costs.

West Herts Hospitals Trust – on track for foundation trust status!, December 2008
It seems that miracles can happen in the NHS. 

In 2006-07, for the second year running, this Trust had Healthcare Commission ratings of “Weak” for both quality of services and use of resources, one of only four trusts in the country with such an abysmal record.  Last year it achieved “Fair” for both ratings  - and now it is well on the way to two “Good” ratings for the current year.  Astonishing!

Two years ago it was a non-starter for financial trust status and faced being taken over or broken up – now it is on track to meet the Department of Health Applications Committee in May 2009, followed by Board to Board monitoring by Monitor in the summer. 

It has responded to public consultation about its proposed foundation trust membership, and has both extended its consultation to February 2009 and replaced its “Out of Area Patient (& their Carers)” category with a new public constituency “Out of West Hertfordshire Area”, which will be welcomed by residents of Harrow and Hillingdon.  Its membership is at 1800 and this is expected to grow when a Membership Manager takes up post in the New Year. 

What has the Trust done to achieve such progress? 

The Trust’s positive approach extends to an unannounced Healthcare Commission inspection in October.  First hand feedback was encouraging, but with the report still awaited, the Trust has already put into place an action plan to meet criticisms the report might contain - boxes to be stored off the floors / regular cleaning of store rooms / cleaning schedules to be standardised / sellotape not to be used on posters / English tests to be undertaken by all Medirest staff prior to recruitment.  The last of these points will be music to the ears of many patients and staff – although many will ask why this fundamental requirement was not standard practice anyway!

Hillingdon PCT at Christmas 2008

1.  Finance
Good news is that the PCT has been granted an additional £1.31m capital allocation, to be spent by the end of March 2009 on its backlog of estate needs and critical IT needs!  The Trust still predicts breakeven at year end – its top priority – but it will be hard-pushed to achieve this as it is currently £5.1m overspent against budget.

2.  Medium Term Financial Strategy for London (MTFS)
This strategy aims to clear legacy debts of London’s PCTs and hospital trusts and to ensure implementation of Healthcare for London across the capital.  A new Challenged Trust Board will ensure stringent controls and governance arrangements are in place for those trusts that are enabled to clear historic debts.  If Hillingdon PCT maintains breakeven for the next two years, its outstanding debt at the end of 2010/11 will be paid off with funds provided by other London PCTs.  (More details are given in the report from Harrow PCT’s December meeting). In the meantime Hillingdon PCT may be able to borrow from nearby PCTs to invest in Healthcare for London initiatives.  From the perspective of Hillingdon residents, this is a major step forward, which - if the PCT can continue to balance its books - will eventually wipe out £19m of historic debt!

3.  Operating framework 2009-10 / financial allocations
Hillingdon PCT is a loser under a new weighted capitation formula, which favours areas with a higher proportion of older people.  Hillingdon is deemed 6.4% over-capitation, so the PCT will have reduced increases each year until it reaches its new target allocation.  In the next two years it will receive the minimum growth of 10.6%, in contrast to the average of 11%, with some PCTs having considerably larger increases.

4.  London Clinical and Business Support Agency (LCBSA)
This new agency, known as the “Hub”, brings together pan-London services, supports PCT commissioners and shares risks across the capital.  It is expected to improve the health of Londoners and minimise costs.  It will be responsible for delivery of Healthcare for London planning and The Thames Cancer Registry.  Hillingdon PCT is a net gainer in the system and it is handing over its BUPA contract to the HUB.

5.  London Specialised Commissioning Group (SCG)
This Group, based in Croydon PCT, will operate as a single team, with five Divisional Directors.  It will cover many specialised services eg Burns, HIV, AIDS, cystic fibrosis, cleft lip and palate.

6.      Consultation on acute stroke and major trauma services
All 31 London PCTs are working together on these services and both East & North Herts PCT and West Herts PCT have shown interest in joining them too.

Three London trusts can meet the criteria for designation as major trauma centres by 2010 – Barts and The London / Kings College Hospital / St Georges Healthcare.  Provision for some areas of north and west London are still being explored.

Twelve bids met the requirements for a hyperacute stroke unit, including Northwick Park Hospital.  Hillingdon Hospital only met the criteria for being a stroke unit, but both these hospitals met the criteria for Transient Ischaemic Attack (TIA) services.

It had been intended that public consultation would start in January, but this may be delayed.

Exciting times at Hillingdon Hospital, November 2008
How often do hospitals trusts have two things to boast about together?  That is the happy position of Hillingdon Hospital.  Bevan Ward, its pilot ward with 24 beds in single rooms with en-suite facilities is due to open early in January – and a few weeks later it will be opening its new Treatment Centre at Mount Vernon Hospital.  Here are a few facts:

The Treatment Centre handover is due on 19^th January 2009.  First patients will come on 3^rd February.  There will be a formal opening later, probably in March, possibly with a royal personage to open it. 

The main entrance will contain two specially commissioned stained-glass art panels. 

Completion of the nearby car park is not expected until several weeks after the opening, but some disabled spaces will be ready.

At first the Treatment Centre will have two operating theatre sessions daily, but extension of services is already being considered.  It will have four operating theatres, 24 in-patient beds, and 14 day-case beds. 

90% of elective care and orthopaedic care will transfer from Hillingdon Hospital to Mount Vernon – but patients who particularly want to be treated at Hillingdon will still have that option.

Around 500 staff have been consulted about the changes involved.  Agreement has been reached with nurses, clinicians, theatre and therapy staff; and a pharmacist is being seconded to the Treatment Centre.  Consultant timetables have also been agreed.

There will be changes at Hillingdon Hospital too.  Day case beds there will be reduced from 19 to 14 and Jersey Ward will be closed.  This will free-up 20 theatre sessions, the equivalent of closing two operating theatres.  One ward from the annex corridor will be moved into the tower block.

Altogether an exciting time!

Hillingdon PCT’s battle with debt, November 2008
Hillingdon Primary Care Trust continues to battle with financial problems.  Its November Board papers show that at month 7 in the year it has an overspend of £4.5m.  This is mainly due to unexpectedly high cost of hospital services.  But an underlying cause is its £42 million historic debt.  The PCT is still expected to break even in the year, despite repaying £7.7 million of the debt, plus £0.9 million for interest.

The Community Voice (of which Ruislip Residents association is a member) has made clear to NHS London that this burden is crippling local health services.  It contends that the debt should be wiped out – the NHS is not democratic, local people had no control over the debt arising, so why should they suffer for years while it is repaid? 

All the top staff in post when the debt arose have gone.  The new NHS staff did a wonderful job last year in breaking even.  Why should they be stressed by a debt they did not cause?

As an example of how this hurts local people, the Yiewsley Health Centre is one of the most neglected in the country, but there is no money to replace it.  Latest news is that NHS London has set up a PCTs’ Group to resolve legacy debts.  Let us hope that Hillingdon’s desperate need for help receives a positive response.

Audience spell-bound by speaker! November 08
At its meeting on 6^th November Jan Filochowski, Chief Executive of West Herts Hospitals Trust, held full sway over members of The Community Voice, including delegates from Ruislip Residents.  He spoke for over an hour, answered questions as they arose, and his audience would have kept him there till midnight if the Chairman had not intervened.

Such a basket of good news is rare in NHS circles.  A year ago his Trust was failing, with high rates of infections, long waiting lists, targets not met, heavily in debt with plans for rebuild of its hospital on hold and no hope of achieving financial trust status.  Today all that is changed.  Now it is amongst the best in the country for several targets and there is a surplus in the bank.  Plans for rebuilding the hospital are moving positively ahead and consultation on becoming a foundation trust is already under way.  Wow!

All this was backed from the audience with a recommendation that Watford General A&E is now wonderful – quick, efficient and kind.  What a turn-around!

To apply for membership of the foundation trust telephone 08444 776321

Hillingdon Hospital’s pilot ward is on show! October 2008

Hillingdon Hospital’s Board heard several items of good news at its meeting on 29^th October. 

Firstly good news about recently published Healthcare Commission Ratings – it maintained its Good” rating for use of resources and improved its quality of service rating from “Fair” to “Good”, which was very pleasing.

Secondly it heard that it already has 4214 public members for its foundation trust – but it wants more, so it will continue recruiting.  With only one MRSA case in September, it is currently on target for control of that infection and it is ahead of target for finances, which of course is all good news too. 

However, the really exciting news was about Bevan Ward, now on show to staff and with invitations in the local press for members of the public to see it too.  This 24 hour pilot ward has 24 beds, in three wings each with eight rooms of different designs.  The purpose of this pilot is to research the benefits for patients of having single bedrooms with en-suite facilities.  Research will compare current and pilot ward facilities, to find out what effects the new facilities have on patient outcomes, including:

Research will also test and compare room designs for:

Staff are very excited about the ward and they praise the high quality of the facilities, which had not been expected in a prefabricated temporary building.  They are confident that patients will be enthusiastic too.  First patients will be using the ward before Christmas, after staff training is completed.

Hillingdon Primary Care Trust is in the news! October 2008

Hillingdon PCT’s October Board Meeting brought a lot of interesting news.

1. Healthcare Commission Annual Health Check
The PCT improved from “weak” to “fair” on use of resources and stayed “fair” for quality of services – a step in the right direction!

2. Finance
The PCT still expects to breakeven in March, despite overspending £2.9m in the first six months of the year. This will take all its contingency funds plus additional savings – repaying its historic debt is a big burden and is still keeping it poor.

3. GP led health centres
All London PCTs have to open a new health centre this year. Hillingdon’s plans to replace Yiewsley Health Centre with extended services did not meet NHS London requirements, because the services could not be provided competitively. So the PCT had to think again. Instead, tenders are now being considered to provide new services in Hayes, mainly for patients of the Elers Road practice. This project will strain the PCT’s finances in 2009-10, but replacing the Yiewsley Health Centre remains the PCT’s priority.

4. Strategy for GP health services
All London PCT also have to plan how to implement Lord Darzi’s proposals for GP services to be provided in polyclinics – services can be provided within one building or from a number of locations through co-operation between a group of GP practices. Public consultation on Hillingdon’s plans will take place from November 2008 to January 2009.

Hillingdon’s strategy is to organise GP practices into eight groups, within three polyclinic areas based in:
i) Hayes Town Centre - to serve Hayes and Harlington, with some services at The Warren practice
ii) Uxbridge Town Centre - to serve Uxbridge and West Drayton, with some services in Yiewsley.
iii) Ruislip Manor - to serve Ruislip and Northwood, with some services in Northwood.

5. Engaging with patients, the public and service providers.
The PCT will be in the Chimes, Uxbridge, on November 3rd to gather views about health services from the public. It is also holding a conference on 14th November to explore how it can work with all its partners in social care, primary and secondary health care and the voluntary sector.

6. Current services
The PCT is meeting some national targets, including currently no MRSA cases, but it is below target on:

1. Choose and book

2. Early psychosis intervention

3. Chlamydia screening

4. Immunisations and vaccinations

5. Number of patients seen by dentists

6. Workforce sickness

7. Workforce appraisals

News on pressure ulcers is good - no cases in this quarter or last in Northwood and Pinner Community Unit at Mount Vernon, and with cases in nursing homes down from ten cases to six.

There were early problems with referrals lost between the new Referral Medical Centre and Hillingdon Hospital, but these problems are being overcome. Many patients are now being treated swiftly in the community instead of waiting for hospital appointments.

A blue plaque for Alexander Fleming at Harefield Hospital, October 2008
A Hillingdon Council initiative has honoured Alexander Fleming with the erection of a blue plaque at the entrance to Harefield Hospital, where he worked for many years from 1939. 

The plaque was unveiled by the Mayor of Hillingdon, Councillor Brian Crowe, on Monday 29^th September, in the presence of dignitaries from both Hillingdon Borough Council and the Royal Brompton & Harefield Trust.  The Mayor paid tribute to Alexander Fleming’s pioneering work in the development of penicillin, which brought such profound and lasting impact to the fight against infections.

Donald Edwards, Publicity Office of The Community Voice, was well prepared with both video and still cameras to capture the event.  He also seized the opportunity to record interviews with some of the people who were present, adding another dimension to this very special occasion.  We were most grateful to all those who allowed him to  do this.

Two very different AGMs on consecutive days, September 2008

Hillingdon PCT’s AGM 23^rd September 2008
This was in the afternoon, low key and all over in 15 minutes, before the routine Board Meeting.  Just a few members of the public were present.  It launched the Annual Report 2007-2008 highlighting the PCT’s main activities, accomplishments and areas for improvement.  Copies are available by telephone:  01895 452047

However the Board had much cause for rejoicing.  The PCT had achieved financial break-even for the first time in many years, had met all its financial duties and all national performance targets except for MRSA, where it was only marginally below its very challenging target.  This was true success and very sweet.

The Hillingdon Hospital’s AGM
This AGM on the following day reported an equally successful year.  However, in contrast to the PCT’s AGM, this was an evening event in the comparative splendour of Hillingdon Council Chamber.  There were displays and refreshments before the meeting, followed by reports and presentations to a packed audience, which filled the Chamber.  The Chairman, Tony Valentine, was clearly delighted with the large audience, mainly members of the proposed foundation trust.  He noted the strong local support for the Trust indicated by that evening’s attendance and also by the large number of volunteers who work in the two hospitals and by the success of the Patients in Partnership initiative, which is thriving.

After highlights of the year from the Chief Executive Officer, David McVittie, including progress towards the Mount Vernon Treatment Centre which will open in January, the very successful Annual Accounts were present by the Finance Director, Paul Wratton.  Then there were presentations on infection control, with senior nursing staff resplendent in their new dress uniforms.  This was followed by news about Bevan Ward, the pilot ward for testing three types of single-bed rooms, which will open next month – this project is a step towards final plans for rebuilding The Hillingdon Hospital.  Lastly there was a detailed update on progress towards foundation trust status, which may be achieved as early as next February.

The Trust’s Annual Report was launched too.  Obtain a copy of the report, or apply for foundation trust membership, or find out more about becoming a Governor by telephoning 01895 238282.

Mount Vernon Cancer Centre – good news confirmed! September 2008
A month ago we saw that the tide was turning for the Mount Vernon Cancer Centre and this splendid news was confirmed on September 4^th.  However, the BBC’s mid-day television news was ambivalent, leading some listeners to think the Cancer Centre was under threat, when exactly the opposite was true! 

The Review’s Publicity Officer was onto the BBC double-quick, and the next TV report made clear that the current proposal is to reject the Varley 2002 recommendation to move the Cancer Centre out of Mount Vernon.  Major changes since 2002 suggest that instead of closing the Cancer Centre its services should be expanded, possibly by making Mount Vernon the hub of a system with satellite services in other hospitals.

However, in order to reject the Varley recommendations, all stakeholders must first be consulted, so public consultation is underway until 4^th November.  The discussion document is available on-line at www.enherts-pct.nhs.uk/mvcc - or telephone 01707 369701.  We hope many members will respond to this consultation, so that the public voice is loud and clear.  We want the Cancer Centre to stay at Mount Vernon!

Still no Ambulance Station in Ruislip, July 2008
What a saga!  Back in 1994 the ambulances were homeless, sited in the road in Midcroft, off Ruislip High Street, waiting for calls with no facilities at all for the crews.  There were petitions and counter petitions about building an ambulance station in the Pavilion in Kings College Road.  That Battle was won by the opposition.

For a time ambulances were based at Winston Churchill Hall Ruislip, in unsatisfactory upstairs accommodation.  Then on to a temporary home at Mount Vernon Hospital.  Now, still temporarily, they use the old Northwood & Pinner Community Hospital in Northwood Hills – it is warm and dry there, with basic facilities for the crews, but too far north to be ideal.

By 2006 an ambulance station site was identified behind shops in Pembroke Road, near the Ruislip Manor traffic lights but now, two years later, there is still no sign of building activity. 

Enquiries by The Community Voice, of which Ruislip Residents is a member, indicate that Transport for London, head leaseholder of the site, is blocking progress, despite planning permission for an ambulance station being agreed with Hillingdon Council.  So a letter has been sent to the Deputy Mayor of London, Richard Barnes, to ask for his help to resolve this long-standing problem.

The only good news is that current ambulance response times are satisfactory, despite the lack of a purpose-built ambulances station.  This is a credit to the crews of course, but they deserve a permanent, purpose-built home.  We shall continue to press for this.  Their fourteen years wait is already far too long!

Hillingdon – out of the wood!  Or is it? June 2008
Last year Hillingdon PCT broke even for the first time in five years – a fantastic achievement!  However its backlog of debt is over £42 million – which the NHS says it must pay back.  £7.7 million is the amount it is supposed to find in the current year – a crippling burden.  Is that fair? 

The NHS is not democratic, so there was no way Hillingdon people could have stopped the debt arising.  Punishing the PCT is pointless – all the old Board have long since gone.  Punishing patients, children, old people who simply happen to live in the Borough is equally unjust. 

At the NHS London Board meeting this week, The Community Voice, of which Ruislip Residents is a member, made an impassioned plea for special help for Hillingdon.  If that plea falls on deaf ears Hillingdon will continue to have some of the worst accommodation in the NHS, since without money there can be no building of a new health centre in Yiewsley, nor replacement of The Hillingdon Hospital.  The 1940s temporary wards in that hospital are at last being pulled down – but that is only a first step.  A great deal needs to be done and with a huge NHS surplus in 2007-08 there is money in the bank to do it – it just needs a little creative accounting to set the money free.  We are watching and waiting!

Basic facts from NHS London June 2008

Board meetings last two or more hours.  Our report here must shrink to about two minutes.  Here goes!

Priorities for the year:  The SHA has six priorities for 2008-09.

1.  Consultation on delivering Healthcare for London
a.      PCTs or groups of PCTs will develop proposals for local services e.g. polyclinics.  PCTs will be asked to plan delivery of the total HfL programme by producing a five year Commissioning Strategy Plan.
b.      There will be pan-London consultation on major trauma and stroke pathways.
c.      Maternity pathways could require local or sector consultation.

2.  Commissioning
a.      The Department of Health has developed a programme called World Class Commissioning which outlines a set of competencies for PCTs.
b.      Pan London skills are being developed / also sector co-operation.
c.      All London PCTs will be expected to submit commissioning plans to NHS London by November.  They will then be assessed against performance on health outcomes

3.  Performance
Key targets are:
a.      A&E:  London achieved 97.3% of the four hour wait standard for 2007-08, just below 98% target.
b.      18 week waits from GP referral to treatment:  True now for 82% of inpatients - target 85% next December / and true now for 93% of outpatients - above 90% target for December
c.      Healthcare acquired infections – MRSA has dropped by 52% over three years and clostridium difficile rates fell 15% last year
d.      Modern matrons: target was to double the number by May 2008 - London rose from 436 to 906

4.  Trust transformation
To stabilise Acute and Mental Health Trust performance across London

5.      Public health initiatives
Priority is to combat smoking and obesity, the main causes of strokes and heart attacks

 6.      Improving internal effectiveness
To deliver future programme of work

All this will take money, so it is important that the London surplus for 2007-08 was £280million – 2% of its total resources.  Compare this with its 2005-06 deficit of £174 million.  Astonishing!

Herts Review of Mount Vernon Cancer Centre, June 2008

For people who love the Mount Vernon Cancer Centre, the new Herts PCTs Commissioning Review appears as yet another hurdle to face.  However it is heartening that Hillingdon PCT, at its June meeting, reaffirmed its support for cancer services at Mount Vernon. 

Its Chief Executive, Yi Mien Koh, recalled that in June 2006, when facing the possibility of services being moved from Mount Vernon to Hatfield (a threat now abandoned), the PCT Board had agreed. 
a) Proposed increase (to alternative cancer centres) in journey times and additional cost to individuals are unacceptable.
b) The preferred option is for safe and affordable supported ambulatory cancer services to be available at an accessible local site to Hillingdon
c) On the assumption that cancer services are to be withdrawn from the Mount Vernon site when Hatfield opens, the PCT will request that The Hillingdon Hospital considers the inclusion of ambulatory cancer services in its redevelopment plans”.   

She went on to state:
“I would like to take this opportunity to reaffirm Hillingdon PCT’s position taken previously, which I have conveyed to the two North West London PCT Chief Executives on the review steering group.”

And then she added:
“I have also expressed to David McVittie HPCT support for The Hillingdon Hospital to bid to take over Mount Vernon Cancer Centre from East & North Herts NHS Trust.” 

There was no dissent around the table – Hillingdon PCT Board shares our views!

Hillingdon Hospital rebuilding plans, May 2008

Hillingdon Hospital’s chief Executive, David McVittie, addressed Hillingdon PCT at its April Board Meeting. 

He stated that the condition of the Hillingdon Hospital estate is a threat to the Trust’s future, so it would like to start rebuilding the hospital immediately.  However, it is deterred by Monitor’s opposition to it doing this before it becomes a foundation trust. 

The Trust proposes a phased programme starting with demolition of the buildings around the annexe corridor in 2008-09 and over the next two years, followed by replacement of the Tower Block and podium.

The number of beds is still under debate.  The minimum plan would be to keep the best of its old buildings, with 150 old style beds, plus 200 new single bed rooms, at a cost of £150m.

The Trust will provide elective surgery, particularly orthopaedics at the Mount Vernon Treatment Centre, which is due to open in January 2009.  It plans to develop bi-lateral knee replacement, spinal and sports injury services and to bid for providing primary care musculo-skeletal services for the PCT . 

It is also committed to maternity services and it expects the number of deliveries to exceed 4,500 by 2011-12.

Andrew Lansley MP, Shadow Minister for Health, visited Mount Vernon Cancer Centre on 29^th April 2008

Andrew Lansley MP, accompanied by Nick Hurd MP, had a top brass reception at the Mount Vernon Cancer Centre.  E&N Herts Trust manages the Cancer Centre so its Chairman, Richard Breazley, was there, together with his Chief Executive, Nick Carver, plus Peter Ostler, the Cancer Centre Director, and Susan D’Arcy, Radiotherapy Manager – and me.  Having explained that Nick Hurd had invited me, everyone was very gracious about me being there.

When the two MPs arrived, introductions were made, and we all set off on a full tour of the Cancer Centre.  In walking from section to section a number of informal exchanges ensued, which were informative and interesting.

In addition I was accorded the privilege of a few minutes with Andrew Lansley ahead of his private meeting with the Chairman and Chief Executive.  I thanked him for coming, expressed the concerns and commitment of local people to retention of cancer services on the site, and made clear that The Community Voice and its members, including Ruislip Residents Association, welcome support from all political directions, even though many of them are non-party-political organisations.  As Shadow Minister for Health, Andrew Lansley could be a very powerful ally.

Official opening of the new Radiotherapy Centre at Mount Vernon, April 2008

Monday 7^th April 2008 was a very special day in the history of Mount Vernon, the day when the National Cancer Director, Professor Mike Richards, came to perform the opening ceremony in the presence of a largely NHS audience, but our own member, Donald Edwards, was there too, busy taking pictures including a video. 

All the top brass from East & North Herts Hospitals NHS Trust were there, taking pride that they currently run the Mount Vernon Cancer Centre.  Their Chairman, Richard Beazley, expressed much regret at the collapse of the proposal to move the Cancer Centre to Hatfield – in contrast of course to our own delight at that collapse!  However we rejoice with him in the excellent new facilities at Mount Vernon.  Later this year we hope that the Herts. Cancer Review will confirm that those facilities are secure on their present site, at least for the next few years.

Peter Ostler, the Cancer Centre Director, spoke about the amazing new technology which makes the radiotherapy bunkers removable, originally to allow them to be moved to Hatfield.  This installation comprised five bunkers, complete with linear accelerators already in place - a world first achievement.

Professor Mike Richards, the Cancer Czar, noted that this important radiotherapy centre is one of the largest in the country, with many clinicians, radiotherapists, physicists and 140 nurses on its staff.  The recent face-lift cost £22 million.  When pressed on future plans, he indicated that satellite working might be set up from the Cancer Centre, to make local services available to more people.

He noted that in cancer survival rates the UK lags behind its European neighbours, which he attributed mainly to late diagnosis.  Earlier identification is the key factor, needing more patient awareness, more primary care and more radiotherapy services.  Staff shortages were a bottle-neck a few years ago, but rapid progress since 2000 has produced around 40% more radiotherapists and clinical oncologists.  Better data collection is also vital, so that comparisons between hospitals can become possible.  Also, we spend more on in-patient cancer care than other countries, so in future we will be exploring how to treat more patients through ambulatory care.

It was a very happy occasions and smiles were abundant,  I was very sorry that I could not be there myself.

All the Board Meetings come together! April 2008

This week has seen a bevy of Board Meetings in public, seven in two days!  I have attended four of them – West Herts PCT, Hillingdon PCT, NHS London and Hillingdon Hospital.   

Some themes are common to them all.  They are all challenged by national targets particularly the target to treat in-patients within 18 weeks of referral by GPs and the target for A&E departments to treat 98% of patients within four hours – hospitals are challenged as service providers, but PCTs are also held responsible as purchasers of services, and strategic health authorities are responsible for their whole patch. 

They are all concerned with money.  However, none of the NHS bodies in our catchment area are causing major concern this year.  Hillingdon PCT has made a mammoth effort and has achieved break even, but still carries forward £42m of historic debt.  NHS London expects to carry forward a combined total of £300m surplus from its patch this year, but it has plans to make good use of it all in the months ahead.

Infections are another common concern.  Huge input of both money and effort has been made to combat these threats.  The MRS bacteraemia plan for London is 70 cases or less per month, achieved in 6 of the last 10 months reported.  Clostridium difficile cases are now 14% lower than last year in London - and West Herts PCT reports that it now has one of the lowest rates of this infection in the country.

Every PCT in the country has to make plans for a new health centre or polyclinic in the year ahead, offering an 8am to 8pm walk-in service seven days a week.  West Herts PCT has already announced that it expects its new health centre to be in Hemel Hempstead.  Hillingdon PCT is considering Yiewsley as its most likely site.

Another common theme for PCT’s is the current requirement that they split off their “provider” services from their “commissioning” services, operating clinics and district nurses, health visitors etc at “arms length”.  They are all busy setting up their new arrangements.  Separating the purchasing of services from provision of services is intended to avoid conflicts of interest, promote better services, and eventually to allow new providers to tender for service contracts.

Lastly, how and when hospitals will achieve foundation trust status is a common concern.  Central and North West London Foundation Trust achieved success in 2007 (it provides mental health services to most of NW London area).  Royal Brompton and Harefield’s application ground to an unexpected halt because of uncertainties over new ways of funding research.  The Hillingdon Hospital is expected to get FT status next February, Royal National Orthopaedic Hospital in May 2009 and North West London Hospitals in December 2009, when possibly West Herts Hospitals will too.

In all directions NHS staff are busy with end of year summaries, whole year targets and milestones.  March 31^st is the dead-line for this year’s statistics.  April brings a clean sheet, to start a new financial year.

What’s new in Hillingdon PCT? - March 2008
Hillingdon PCT’s use of BUPA to check its hospital bills is being watched throughout the NHS.  The three-year contract, first of its kind in the country, was signed on 31st January.  Hospitals code each episode of care they provide.  High coding leads to high bills.  BUPA’s first task is to check and challenge invoices received by the PCT where coding could be too high - a task the private sector no doubt perfected long ago.  Maybe the NHS will learn a few new tricks!

Our local hospitals are all in a frenzy to meet their “18 week” target by end of year, on 31^st March.  This target covers time from GP referral until treatment actually starts.  Treating enough patients before that dead-line is speeding up hospital activity and of course causing lots of bills.  Net result is that Hillingdon PCT – and no doubt other PCTs too – suddenly find their careful financial predictions start to look silly.  Hillingdon PCT still hopes to break even at year-end – but is no longer as confident as once it was.

Hillingdon’s new Referral and Management Centre is up and running, with 461 referrals in its first two weeks.  The aim is to treat patients near home rather than sending them to hospital.  The PCT thinks this is great - cheaper than hospital care.  What do patients think?  I hope they are being asked!

Breast-feeding is in the news.  It is said to promote long-term health benefits, including preventing obesity.  However, Hillingdon’s breast-feeding rate is the worst in London.  So, local young mums can expect to be pressured to feed their babies as nature intended.  Problem is that some of them can’t and some don’t want to do this.  How far should they be pressured?  Should Hillingdon Hospital and PCT be penalised?  It is noteworthy that these questions were not asked in the PCT Board meeting!

Star studded panel of speakers on: “Lord Ara Darzi’s proposals for Healthcare for London” - February 2008

The main item of the Community Voice meeting on 7^th February was a forum on Lord Ara Darzi's proposals, which are currently the subject of public consultation.

The panel of guest speakers was truly exceptional:

Don Neam, Communications Director, Healthcare for London, from NHS London

Professor Yi Mien Koh, Chief Executive of Hillingdon Primary Care Trust

Dr Sarah Crowther, Chief Executive of Harrow Primary Care Trust

Gareth Jones, Director of Strategic Planning, West Herts Primary Care Trust

Don Neame introduced the proposals and noted that copies of the consultation document, and a short summary version, are available from FREEPHONE 0808 238 5430.  Responses must be received by 7th March 2008.

The main proposals are:

1.      Very specialised services concentrated in only a few hospitals across London e.g. major stroke services, trauma services, major children's services, 24 hour A&E services.

2.      More services in the community, closer to home, some in polyclinics.

3.      More services at home e.g. end of life care, more home births

4.      Polyclinics serving up to 50,000 people, either in central buildings or as networks of smaller health centres and surgeries, staffed by GPs, providing a wide range of shared diagnostic and other services, open extended hours.

5. Local general hospitals providing hospital services for the majority of conditions, with emergency surgery provided separately from elective surgery.

After the introduction, Gareth Jones gave a brief update on the outcome of the recent Herts public consultation on health services, noting that Herts is in some ways already implementing the Ara Darzi proposals – concentrating major hospital services at Watford General and Lister hospitals, with elective surgery only at St Albans and Lister hospitals, and eight Urgent Care Centres spread across the County. 

All the guest speakers contributed to the subsequent discussion and answered audience questions. These ranged widely, from concern about the future of the Northwood & Pinner Community Hospital site, concern about the much needed health centre in Yiewsley, and the impact of the various Ara Darzi proposals on local residents.  Several questioners emphasised the importance of maximising the advantage of the adjacencey of Harefield Hospital and the Mount Vernon Cancer Centre Centre, both of which serve a wide population.

Time ran out too fast. The flow of questions and comments could have gone on for ever!

After the speakers had left, other local issues were raised.  The excellent progress of Hillingdon Primary Care Trust towards financial stability was noted – it expects to break even this year, which is a huge accomplishment, although it will still carry forward over £42m of historic debt. 

The £1m Mount Vernon Cancer Centre Appeal was noted too.  This appeal is to aid research and to redesign the Chemotherapy Suite.  Donation can be made on-line at:

www.cancertreatment.org.uk

There was also an appeal for members of the public to support Hillingdon Hospitals bid for Foundation Trust status, by applying to be a member – this carries no obligations, but would provide occasional updates, by post, on hospital news.  Tel:  0800 8766 953 to apply.

Hillingdon PCT News January 2008

Some people think NHS Board meetings are very dull – but this one certainly was not! 

Two new facilities are being launched, the Referral and Management Centre (RMC) and the Clinical Assessment and Treatment Service (CATS).  These will keep people out of hospital and provide services nearer to home.  Both are good news for patients.

Good news too about finances.  At last the PCT predicts breaking even at end of year in March, which brings in train permission from NHS London for more money to be spent on patient care - £1.5m to meet the national target for hospital treatment to start within 18 weeks of GP referral; £500k to support patients discharged from hospital; also money for clamydia screening and extension of GP opening hours.  All these will benefit patients.

Most importantly we learned that the former policy of selling off PCT land and buildings to raise cash is now dead.  Current policy is to retain and use all properties for health or social care purposes.  This reversal is partly due to public outcry about the earlier threats to sell PCT clinics – proving that public outrage can have impact!

Public concern about bed sores at Northwood & Pinner Community Unit, in Mount Vernon Hospital, also had impact, leading to a review published this week.  This shows that only one of the 16 pressure sores arose within the Unit - all the rest went in with the patient.  However the review uncovered the deplorable fact that in twelve months to April 2007, Hillingdon residents suffered a total of 50 pressure sores arising from stays in various hospitals!  The PCT is now pressing the hospitals to take better care.  

Also the Board showed it has a heart.  It refused to extend the two year moratorium on provision of electrically powered indoor/outdoor wheelchairs.  These are needed only by very incapacitated people who cannot leave their homes without a special wheelchair.  There is no legal obligation, so Brent, Ealing, Harrow and Herts PCTs have already withdrawn from provision.  Much to its credit Hillingdon PCT is exploring further how it might be able to help – no promises, but at least it is trying.

Policy on “Healthcare for London” is currently under public consultation.  All 31 London PCTs are holding roadshows.  Harrow’s was held last Saturday and was very interesting - Hillingdon’s is on Saturday 2^nd February, 1pm – 7pm, in the Middlesex Suite, Civic Centre Uxbridge.  Go along to learn more about polyclinics, specialist centres and possible changes in other hospitals.

Lastly, Hillingdon PCT has several staff changes - Hilary Pickles is retiring, Barbara Wood and Terry Kelly have new jobs.  All these will be missed.  A new post is to be created from 1^st April - Director of Patient and Public Involvement.

As a footnote, Hillingdon PCT ’s response to the Third Runway proposal at Heathrow is to oppose further expansion of the airport specifically on health grounds.  An interesting background paper was presented to the Board giving details.

Who could call that a dull meeting??

Hillingdon Hospital News – January 2008

Presentation to the Board on “Healthcare for London” proposals – Hillingdon PCT Chief Executive, Yi Mien Koh, aided by her Chairman, Mike Robinson, told members of the hospital Board about the Ara Darzi proposals to centralise major trauma, major stroke and major children’s services  into just a few hospitals, and to transfer many hospital services into the community.  Unsurprisingly, some of her audience felt threatened by these proposals and were very critical.  This item took a big chunk out of the meeting, so other items were cut short.

Heathrow’s January Crash - the near-disaster at Heathrow earlier in the month led to 18 minor casualties, a mercifully light outcome, but it showed that the hospital is ready for anything, so congratulations are due for all the forward planning and staff preparedness.

Infection Control –  targets for the year for cases of MRS and clostridium difficile were breached long ago.  The best to hope for now is improvement month on month, which happened in December, so progress is being made.  Also, external agencies have been complimentary about the measures the Trust has introduced.  A new start in April will be very welcome.

Hillingdon Hospital rebuild - demolition of Tudor and Willows buildings is starting now, to be followed by construction of the exciting “Pilot Ward”, due for completion by August 2008.  This will be used by the Department of Health and the Trust to test out the use of single bedroom wards.  If patients and staff like the pilot, this research will influence the design of the new Hillingdon Hospital and other hospitals across the NHS.

The new Mount Vernon Treatment Centre – building is on schedule and due for completion in December 2008.  The existing Princess Christian building is being redesigned internally.  Some staff are being moved out temporarily during this work.  When everything is finished, everyone will rejoice! 

Money – despite an unexpectedly high seasonal deficit in December the Trust remains, much to its credit, on target to end the year in surplus. 

Foundation Trust bid - the Trust is still a lot short of the number of members it needs to show that the public backs its application for Foundation Trust status.  Get application forms from Tel: 0800 8766 953 – or from Joan, (see top of web page for details), who has several thousands!!  Give them to family, friends, neighbours and other contacts – try taking them to the work place, the golf club, or wherever you can.

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

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