This Trust provides most of Hillingdon’s NHS hospital services, in one of its two hospitals.· Hillingdon Hospital’s Accident and Emergency Department provides all emergency care, as Mount Vernon does not have an A & E Department, but most of the Trust’s elective surgery is performed at the Mount Vernon Treatment Centre.·
This page will focus on news from Hillingdon Hospital and the Trust’s Board Meetings held in public. News of the Treatment Centre will appear on the Mount Vernon Hospital page.
The notes below are a selection from the papers for the meeting.
- 1. NHS missing many key targets: NHS England’s figures for November 2015 showed that:
- Ambulances missed their targets to answer 75% of the most serious 999 calls in 8 minutes – the sixth month in a row that this has not been achieved.
- A&E Units missed their target to see, treat, or discharge patients within four hours. For the 14th time in 15 months performance dropped below 95%.
- At the end of the month 1.6% of patients had been waiting more than six weeks for diagnostic tests – above the 1% target.
- One of the key cancer targets – the 62 –day target for treatment to start – was missed with 83.5% of patients seen in that timeframe, below the 85% target.
- The NHS 111 phone service missed its target to answer 95% of calls within 60 seconds. One in ten patients waited longer.
- Significant problems were also experienced in discharge of some patients from hospitals with over 153,000 days of delay, the second highest on record.
- 2. Junior Doctors’ Strike: The strike planned for Tuesday 26th January was postponed by the British Medical association. A February strike is still planned if talks fail.
- 1. Sustainability and Transformation Plan ( STP): Every health and care system must produce its own STP for October 2016 to March 2021 to meet the NHS planning guidance “Delivering the Forward View”, with first steps in place by 29 January 2016. The framework identifies 37 local health and care economies for this purpose with an average population of 1.5 million within NHS England’s 12 clinical senates. With a population of 2 million people, North West London will be one of the largest health and care economies – the defined area is co-terminus with the “Saving a Healthier Future” community.
- 1. Healthwatch Hillingdon Operational Priorities 2016-17: There are four priorities (i) Unsafe Discharge from hospitals (ii) Maternity, following the closure of services at Ealing Hospital (iii) Hillingdon Care Homes (iv) Child and Adolescent Mental Health and wellbeing.
- 2. Integrated Quality and Performance report:
- Clostridium difficile: To end of December the Trust had ten cases against a whole year target of eight, and a further case in January is being investigated.
- Hospital acquired pressure ulcers: The Trust is on target year to date.
- 3. Staffing: Vacancy numbers rose by 0.28% in December compared to 2014. The current vacancy rate is 10.26%. In December 2015 the Trust made 152 offers of employment with 50 new starters during the month. There was a 9% increase in staff for all professions compared with December 2014.
- 4. Finance: Year end revenue forecast is now a deficit of £1.5m. Year-end forecast capital expenditure has been reduced by £900k, which reflects the slippage on the paediatric scheme, moving expenditure from this financial year into the first half of 2016/17.
- A high number of frontline vacancies
- Low staff levels, exacerbated by inappropriate staff training
- Demoralised and stressed staff, bullying, and harassment
- Lack of senior staff supervision
- Failure to meet response target times
The Talent for Care proposals cover primary, community, mental health and secondary care settings. All ten trusts in NW London participate with a growing number of GP surgeries and other stakeholders, including CCGs and social care. Led by this Trust, it supports a number of strategic objectives including more NHS apprenticeships, vocational education and training, and piloting of the Higher Certificate for care staff.
8. Medical sickness: There are no reliable sickness records for medical staff across all divisions. This is being addressed.
9. Finances: November ended with a deficit to date of £1,279k of which £542k was due to depreciation.. There were 273 more staff to pay than in November last year.
1. NHS missed targets in September 2015:
Data from NHS England showed that the NHS missed it’s 4 hour A&E target as well as targets on cancer care, diagnostic tests and ambulance response times.
From 31st October healthcare professionals must alert the police if they treat a girl under 18 who has had female genital mutilation.
3. The Hillingdon Care Record:
The Trust’s electronic patient record has been successfully piloted and it will be rolled out across the Trust from mid-November, starting with mobile devices and then desktop computers.
4. Safer staffing:
Average fill rates for both Registered Nurses and Health Care assistants in October over all improved compared with previous months.
The Trust ended October with a year-to-date deficit of £1,258k, which was £1,606k behind plan. Its Financial Sustainability Risk Rating was 2. Financial performance was primarily driven by a £2.5m adverse variation on pay expenditure. Compared to October last year there was a net increase of 198 whole time equivalent staff and an additional 32 beds, plus a sharp increase in the use of additional 1:1 nurses for higher risk patients, as well as CQC and Shaping a Healthier Future related quality investments. Also, depreciation accounted for £501k of adverse variance.
There were 429 births in October, 34 more births than last year, but Ealing births increased by 50.
7. Emergency inpatient spells:
These increased by 196 (7.3%) compared to October last year with a year-to-date increase of 3.9%.
8. National Physician Associate Expansion Programme:
The recruitment programme began in both UK and the USA in August 2015. By 13th November, 184 applications had been received. The confirmed demand is for 200 posts. The extended deadline for applications is 7th January 2016.
9. Charitable Funds:
Total income for year ending 31st March 2015 was £358k, including investment income and revaluation of investments as well as new donations. Total expenditure was £285k. A Charity Director is being appointed and is expected to be in post early in 2016. The balance of funds was £684k, a net increase in year of £98k. £300k is considered an appropriate reserve. The intention is to reduce the overall balance in a gradual planned manner until it is at £300k. £26k is held in restricted funds which have been specified by the donors.
1. Simon Stevens speech to Kings Fund: Replacing the old focus on foundation trusts, mergers and acquisitions, the new focus is on transforming care. NHS England will top slice the total NHS budget for 2016/7 to provide funding for integration projects and local transformation plans. Neighbouring organisations must work together and bid for funding above base allocations to finance projects.
2. NHS Finances: In the three months to end of June 2015 the total NHS overspend was £ 930m, on course for an annual deficit of at least £2bn, due largely to a growing demand for patient care and higher than expected staff costs. Of acute medium sized Trusts such as Hillingdon FT, 97% were in deficit. (THH reported a £1m deficit at 30th June 2015).
3. Nursing temporarily on list of shortage occupations: Following pressure from NHS providers, nursing is now listed, with its long-term inclusion under review. Non-EU nurses are no longer at risk of having visas rejected and those earning less than £35,000 per year will not have to leave UK after six years.
4. Capping Agency Staff Pay Rates: From 1st April 2016 the cap will be 55% above the relevant national pay rates. The 55% accounts for national insurance, holiday pay, pension contributions plus a small administration fee. This cap will be introduced in stages from November 2015.
5. Care Quality Commission Report “State of Care”: Three quarters of the 79 hospitals visited under the new CQC inspection regime had safety problems. Over 40% of care and nursing homes and one in three GP services had safety problems. Lack of staff, in term of skills and numbers, was identified as a major issue. Other issues included medicine management and the ability to learn from mistakes.
6. NHS 111 and General Practice Out of Hours Services: These services are to be brought closer together to provide better access to 24/7 urgent clinical assessment.
7. The Trust’s Licence from Monitor: The Trust is at risk of not complying with three Monitor requirements – financial performance, CQC standards, and A&E targets. For finance, a Continuity of Service Risk Rating of 3 is required, but its rating is currently only 2; the CQC action plan following inspection still has one item outstanding, about infection control; and the Trust has not met the A&E standard in Quarter 2, due to staffing problems and higher than expected activity levels.
8. Finance: To end of September, end of Quarter 2, the Trust had a year to date deficit of £1,111k (£1,562k behind plan and it would have been £211k but for £250k unplanned income received for lease rental for prior years). Key deficit drivers were additional beds, high agency expenditure and shortfall on Quality, Innovation, Productivity and Prevention delivery (QIPP). Efficiency savings of £3,228k, were £857k behind target. The revenue forecast remains a deficit of £2.7m.
In keeping with other FTs currently off-plan, Monitor requires a financial recovery plan from the Trust. The Trust is asking Hillingdon CCG whether additional in-year financial support is available.
9. Staffing: Thirty midwives are in the process of transferring to the Trust, which will assist in managing the additional demands from Ealing patients.
In September average staffing rates for both Registered Nurses and Health Care Assistants improved and staffing for night shifts was compliant at both Hillingdon and Mount Vernon hospitals.
There is a recruitment drive to fill consultant and medical junior doctor posts with permanent appointments to reduce locums and agency doctors. Medicine now has only two vacant consultant posts.
10. Car parking at Hillingdon Hospital: If the current proposals are implemented there will be 15% more spaces than in the Deck option and the additional spaces should be open by March 2016. Expansion of Maternity and Paediatrics will add to pressures on car parking.
11. Phlebotomy at Mount Vernon Hospital: Facilities have improved with an average waiting time of 15 minutes in a recent audit. An expansion of the waiting area is also being progressed.
12. Closure of two wards: Lister and Pinewood Wards at Hillingdon Hospital were closed between May and July of this year. Pinewood Ward could be opened up as a contingency for winter surges.
13. Length of Stay Schemes: A discharge lounge operating from Lister Ward from November will increase the number of patients discharged earlier in the day. New ambulatory pathways for Surgery and Paediatrics will start in November. An additional 10 step down beds at Harlington Hospice have been commissioned by Hillingdon CCG.
1. Junior Doctors’ Contracts: On 13th August the British Medical Association (BMA) decided not to re-enter contract negotiations for junior doctors. In September the Dept. of Health announced it will impose a new contract on junior doctors working in England from August 2016. The current proposals are for basic hours with standard pay to run from 7am to 10pm Mondays to Saturdays, 30 hours per week more than at present.
2. Consultants’ Contracts: the BMA has agreed to start these negotiations. The government wants more senior doctors to work on weekends as part of its seven-day plans in England. Any deal will be put to a vote by consultants early next year.
3. Agency Nursing Staff Rules: An annual ceiling for total nursing agency spending is being set for each trust for the period October 2015 to March 2016 and for the following three years as well as mandatory frameworks for procuring agency staff.
4. Patient Records: The Health Secretary, Jeremy Hunt, has made clear that by 2016 all patients should be able to access their own GP electronic record online including their allergies, medication, blood test results, appointment records and medical histories. By 2018 this record will cover all their health and care interactions.
5. Mount Vernon Site Update: Progress has been made towards a Memorandum of Understanding between The Hillingdon Hospitals NHS FT and East & North Herts. Hospital NHS Trust about the future redevelopment of this site and the two organisations are working together on this issue.
6. Hillingdon Hospital Car Parking: Following the collapse of the deck car park business case on economic grounds, potential capacity for an additional 40-50 spaces has been identified as relatively straightforward on the Hillingdon Hospital site. Designs are being finalised for submission to the planning authority and implementation should be possible within 6 -7 months. There has already been a net gain of 101 parking spaces through additional on-site and off-site initiatives since December 2014.
7. Safe staffing: Staffing for night shifts is compliant across both sites, but day staffing by registered nursing, midwifery and care staff continues to be challenging. When staffing is below plan the senior nursing team assess the potential impact on patient care and take mitigating action.
8. Infections: The Trusts has had seven cases of clostridium difficile this year against a whole year target of maximum eight cases – but in six of the seven cases there have been no identified lapses in care.
9. Finance: The Trust ended August with a deficit of £1,150k, which was £1,402k behind plan. Efficiency savings were £2,585k, 2.8% of operating expenses, but this was £801k behind the annual plan target. The overall adverse financial performance was primarily influenced by additional beds, high agency expenditure and shortfall in planned savings. Also, in August, activity was lower than expected, resulting in lower income.
The Secretary of State’s July vision for the NHS included:
- The need for 7day NHS services, to ensure that patients are as safe at weekends as they are during the week.
- The establishment of NHS Improvement - the new name for the jointly led Trust Development Authority and Monitor. Ed Smith will oversee the integration of these two bodies and is Chair Designate of NHS Improvement.
Kings fund report on options for integrated commissioning:
- There are around 400 separate local organisations responsible for commissioning different health and social care services, which is considered unsustainable.
- A single ring-fenced budget and a single local commissioner, as recommended by the independent Commission on the Future of Health and Social Care in England, is seen as the way forward, with the organisational model developed and agreed locally from 2017 and arrangements in place by 2020 at the latest..
Capital Investment Task and Finish Group:
- This group was established in recognition that the Trust’s estate presents a major challenge on both the Hillingdon and the Mount Vernon sites, but that, due to the longstanding financial challenges in the local health economy, the Trust does not have the cash reserves to fund the necessary estate investments and the funding needed in ICT and medical equipment.
- The group has moved from its original objective of examining resources, recognising that a strategic outline case must be a first step towards progress. It has started with Hillingdon, but will also need to oversee the potential reconfiguration of Mount Vernon.
- The Chairman reported that negotiations about the Mount Vernon Cancer Centre with East & North Herts NHS Trust were further advanced, but were not yet complete.
- The two chairmen will meet again in August.
- Meetings are also underway with the local planning authority.
Meeting with John McDonnell MP:
This meeting too went well, with a focus on general practice, social services and the poverty of the population in the south of Hillingdon.
The Chairman called for future reports to be more informative about what had been achieved in the recent period and the priorities for the next period.
The Trust is under increased financial stress.
Quality, Innovation, Productivity and Prevention (QIPP):
In Month 3, June 2015, the Trust delivered £472k savings, £247k short of its planned £718k. Reduction in patient length of stay and workforce savings make up a considerable part of the current QIPP programme.
In Quarter 1 income was £28k and expenditure £41k, with £677k held in June 2015. A fund raiser is to be appointed. This will be a senior post, with interviews in September, and an expected start date before Christmas 2015.
Single Chief Executive for Monitor and the Trust Development Authority: These organisations will share the same CEO by the end of summer 2015 when David Bennett of Monitor will step down, but the two organisations will not completely merge.
Lord Carter’s review of operational productivity: Lord Carter has worked with 22 leading NHS hospitals to spread best practice and save money by doing things more efficiently, e.g. better management of staff rotas, annual leave, sickness absence, optimising medicines, purchasing.
Very Senior Managers Pay: The Department of Health is asking for a review of executive pay to justify the amounts paid. Salaries above £142,500 must be cleared with Monitor and NHS England. The opportunity to “retire and return” is to end.
Care Quality Commission to have extended role: The CQC has a new duty to examine cost effectiveness and sustainability of use of resources. The enhanced approach will go out to public consultation as part of the CQC’s future strategy in December 2015.
Ealing Hospital’s Maternity, Neonatal and Gynaecology will close on 1st July 2015: Paediatrics will follow one year later. Hillingdon Hospital is preparing to take some ot the transferred patients. An ultrasound scanner funded by the Shaping a Healthier future programme has been ordered. Additional midwives, neonatal nurses and medical registrars are being recruited.
Recruitment: In year to June 2014 there has been an increase of 95 Health Care Assistants, 31 Nurses and Midwives and a decrease of 18 Administrative and Clerical staff. Approval to recruit from outside the UK was agreed in December 2014 – nurses from Italy, Spain, Greece and the Philippines have been recruited.
Staffing: Achieving planned staffing levels remained a challenge in May 2015, due to additional beds being open – 16 more beds in the new Acute Medical Unit than in the old Emergency Admissions Unit, Marina Ward moving to Fleming Ward with a gain of 15 beds, two extra capacity wards open to deal with volume of demand - also vacancy levels and the acuity and dependency of patients, requiring additional supervision. High fill rates at night continues to be prioritised.
Pilot site for the Care Certificate: The Trust has been shortlisted for an award for the implementation of the Care Certificate, which 114 new and existing staff have now completed.
Lack of bedside lights in Fleming Ward: This is being addressed by the Estates Department.
Finances: At end of May 2015, month 2 of the year, the Trust had a year to date deficit of £949k, £733k behind plan. This was primarily due to additional beds, high agency expenditure and a shortfall on delivery of the Quality, Innovation, Productiviy and Prevention programme (QIPP). £164k was due to revised depreciation assessment.
Continuity of Services Risk Rating: This remained at 2 (1.5)
Signing of 2015-16 contracts: All the main Commissioning Contracts have now been signed.
Births: In May there were 319 births, 36 less than at the same time last year, but there appeared to be an increase in births in early June.
Emergency Department attendances: There was an increase of 5.3% compared with last year.
- Readiness for the transfer of maternity facilities from Ealing Hospital: It was reported that plans for the transfer are well under way and the Board was asked to confirm the Trust’s readiness to proceed with the transfer. Funding has been agreed and recruitment of extra nursing and midwifery staff is proceeding well. The actual date of the transfer has been deferred from the original date as Ealing had deferred the closure of its maternity services to ensure a safe transfer. It was noted that the closure of the Ealing Unit had caused considerable local controversy. It was therefore important to ensure that the new facility in Hillingdon had the confidence the community.
- National Survey of Adult Inpatients: The results are based on a 38% response rate among 312 patients who were surveyed in 2014; this was part of an annual national survey. The Trust recorded rather a disappointing response with its results being worse than those for 2013 and compared unfavourably with other Trusts. Amongst the factors on which the Trust scored badly were: - length of time on the waiting list, admission dates changed by the hospital, shared sleeping arrangements with the opposite sex and cleanliness of toilets and bathrooms. The Trust has already put in hand a programme to ensure that cleaning meets National Standards. Improving Communication and involvement with patients is a priority in the 2015/6 Quality Report.
- Staffing problems: It was noted that the very high use of agency staff in April 2015 showed that the situation was not improving. Since the Trust’s vacancy rate is actually not as high as many other Trusts, it is not clear why the use of agency staff is rising. The chairman commented that the Board was faced with a great deal of data and that there needs to be more data analysis. It is hoped that success in recruiting full time staff will ultimately impact on the agency staff bill. It is also hoped that some “ad hoc” redeployment of staff from areas where there are less pressures to areas of difficulty may be possible on a daily basis. Clearly the safety of patients must be the prime consideration.
- Care Quality Commission Inspection Action Plan - Progress Update: The Trusts detailed improvement plan was submitted. It was noted that many of the areas which the CQC had criticised were now self- rated as good or better. There were only one or two areas still coded red. It was felt that the Trust had made great strides in responding to the CQC’s criticisms.
Items of particular interest from the Board's papers:
Finances: The April 2015 deficit was £358k, £250k worse than plan. Pay, particularly agency pay, was £208k overspent. The Trust’s Continuity of Services Risk Rating dropped to 2. At the time of producing its financial report, the Trust had not signed any of its commissioning contracts for 2015/16, but key terms had been agreed. Births in April were 350, 48 more than in April last year
- Shortlisted in the Health Service Journal Awards: This Trust is proud to be listed in the top 100 places to work in healthcare. The list includes mental health and community trusts, acute trusts and clinical commissioning groups. An awards lunch is being held on 7th July in Birmingham.
- Confirmation of election pledge: The Prime Minister’s 18th May speech confirmed his pledge to increase NHS budgets by at least £8bn a year by 2020, plus creation of a ‘seven day’ health service.
- Wifi: 2014/15 investment in a wireless network has enabled provision of WiFi services for use by patients, the public and staff on the Hillingdon site from April and at Mount Vernon from May 2015.
- Identification of staff: Each ward now displays a poster showing the various staff uniforms and the roles that they imply. Staff should also introduce themselves to patients by their name and role.
10. Specialist nurses: Dementia training is now mandatory and a Dementia Nurse Specialist provides ward based dementia advice and expertise. However the Trust has no Continence Nurse Specialist.
11. Recruitment: 11 Italian nurses arrived in May and are undergoing in-depth induction.
12. Infections: The Trust had one case of MRSA in each of the last two years, which was less than the national and London average rates. The Trust’s rate for clostridium difficile was also below the national and London averages, although its 18 cases last year failed its target of maximum 16.
13. Complaints: At 31st March 2015, 22 complaints were with the Parliamentary and Health Ombudsman, 15 from last year and seven from earlier years - not necessarily a reflection on the Trust’s response to the complaints, but more often a disagreement with it findings. Of these, four have been rejected and six upheld, in part or in full. The rest are still under investigation.
14. Female Genital Mutilation: There were 57 new cases in four months, the tenth highest in London.