Ruislip Residents' Association

Hillingdon Hospital FT

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 items of particular interest, not a summary of the meeting.

Hillingdon Hospital is to develop an Excellence Centre: The National Skills Academy for Health is working with four organisations to set up regional hubs to develop collaborations between education and training providers and healthcare providers from the public, independent and voluntary sectors, including care homes, dentist, pharmacies and GP surgeries.  Each Excellence Centre will deliver new learning resources for healthcare support staff, including courses on community care, dementia, signs of abuse, and various clinical skills.  This Trust will develop the North West London Excellence Centre

Care Quality Commission Inspection: The Trust has complied with the CQC warning notices and is awaiting unannounced inspection visits.

Shaping a Healthier Future (SaHF): Ealing Clinical Commissioning Group has delayed decision to late May on the date for maternity, paediatrics and gynaecology services to move from Ealing Hospital to other hospitals, but receiving Trusts still expect maternity services to transfer during the summer.  In preparation, this Trust is moving its early pregnancy assessment unit (EPAU) / emergency and gynaecology services from the maternity building into the tower block, and transitional funding is under negotiation for an additional ultrasound scanner.  Staff recruitment is already underway.

Quality and Operational Performance: In 2014-15 there was a 9% growth rate in emergency attendances and a 6% growth in emergency admissions.  The Accident & Emergency target to treat and discharge patients within four hours was narrowly missed, achieving 94.1% for the whole year against a target of 95%.

Theatres: Improvement of ventilation in Hillingdon Hospital theatres started in February and will continue until at least July.  This is causing the Trust to operate with 20 less theatre sessions a week, despite relocating lists to Mount Vernon and extensive weekend working.  However, the Trust is still achieving its Referral to Treatment targets and is ensuring that all urgent surgery (for emergencies, trauma and cancer) is not delayed.

Finances: The Trust ended 2014-15 with a deficit due largely to the continued need to employ agency staff in order to meet safe staffing levels, and the need to comply with Care Quality Commission requirements following the CQC inspection.  However the Trust achieved its Quality, Innovation, Productivity and Prevention (QIPP) target of £7.5m in full and retained its Continuity of Services Risk Rating (CoSRR) of 3.  Its financial plan for the year ahead, to be submitted to Monitor in May, includes a deficit of £6m and a drop in CoSRR to 2, due largely to the significant revenue and capital costs required to comply with the CQC inspection report.  .

Births: At 336, March births were 21 more than last year and for the full year there were 60 more births.

Nurse Staffing: Staffing during March remained challenging due to continuation of previous factors e.g.:

  • An additional 16 beds in the new Acute Medical Unit (AMU)
  • Marina Ward moving to Fleming Ward, with 15 more beds
  • Three extra capacity wards open
  • Acuity and dependency of patients, requiring additional care and supervision

Nurse Recruitment: Recruitment continues both in UK and abroad.  13 Italian nurses are due to join the Trust on 18th May and 12 offers have been made to Spanish nurses.  The Trust has filled all midwifery and Health Care Assistant vacancies and is now focusing on recruiting and retaining Registered Nurses.

The Trust needs about 133 more nursing staff for its full complement – it recruits about 15 per month but generally loses about ten, so there is a large shortfall, which must be covered by bank or agency staff.

Medical staffing: There is no national standardised tool for safe levels of medical staff at either senior or junior level, but there are some proxy measures for junior medical staff through the educational assurance framework, which has shown recently that Hillingdon has pressures in paediatrics, obstetrics, gastroenterology and geriatrics.  The “Five Year Forward View” emphasis on care in the community envisages a drop of 5% -10% in training posts in secondary care in 2015 / 2016.

Charitable Funds: A recent report by Kingston Smith recommends that the Board has a more proactive approach to fundraising, noting the success of other NHS charities.  However, it stresses there must be a clear distinction between the charity and the NHS Trust supported by the charity, so that donors know they are contributing to a charitable endeavour, not propping up or replacing a tax-funded organisation

Published on 09 May 2015

The notes below are items of particular interest, not a summary of the meeting.

1. National tariff: Following objections to the original tariff proposals by provider trusts, Monitor and NHS England proposed a new voluntary option, the “Enhanced Tariff Option”, for 2015-16 which was agreed by this trust and 210 other trusts, equating to 88% of all NHS providers   This increases payment for emergency admissions beyond the threshold from 30% to 70% and the marginal rate for specialised services from 50% to 70% as well as lowering efficiency requirements by 0.3%  However, despite this new tariff, the Trust still has significant contract gaps with NHS England and Hillingdon CCG and if these are not closed it will be extremely difficult for the Trust to submit a balanced financial plan for 2015/16.  Discussions are ongoing.

2. Monitor review of the Foundation Trust sector: The overall sector performance against key operational targets continued to worsen during Quarter 3, failing to meet Accident & Emergency targets and cancer waiting times, and failure for the third quarter in a row to meet the referral to treatment target for admitted patients.

The number of patients attending FT A&Es rose by 8% compared with last year.  Bed occupancy rates were 94% in November and December, up 2% on last year.  The aggregate net deficit of FTs has grown to £321m, five times higher than planned.  Smaller acute FTs remain the most financially challenged with 78% of small and medium acute FTs in deficit.  There continues to be a significant overspend on contract and agency staff.

The Foundation Trust Network is now known as NHS Providers

3. Commissioning of GP services: Hillingdon CCG and 86 other CCGs have been approved to jointly commission GP services with NHS England.  Final details will not be apparent until after 31st March.

4. London Health Programme Standards (LHP): This has 153 quality standards for acute hospital care.  LHP has been adopted by Shaping a Healthier Future. The NW London Seven Day Services Programme prioritises 10 of these standards for implementation over the next two years.  For this Trust the cost is over £6.6m.  Over the last year there has been investment in consultants in Emergency Medicine 16 hours per day / seven days per week, also Paediatric Consultants and progress towards the radiology diagnostic standards.

5. Shaping a Healthier Future: Ealing CCG has still not agreed a date for transfer of maternity, paediatrics and gynaecology services from Ealing Hospital to Hillingdon Hospital, Northwick Park Hospital and other local hospitals, but Ealing’s Maternity Unit is expected to close this summer.

6. New wireless Network: The Trust’s new system assists various users.  The Acute Medical Unit uses it to monitor electrocardiogram devices.  Laptops connected to the Unit reduce the need to print paper copies.  Community midwives can connect to the network both on and off site.  Many other uses are being developed.

7. Accident and Emergency Department issues: There was a marked decrease in total attendances in February, although still 3% higher than in February last year, but patient flows were compromised by an outbreak of norovirus which closed four wards for 8 days.  The majority of target breaches were due to lack of bed availability, partially due to an unexplained increase in patients’ length of stay.  In February 94.1% of patients spent less than four hours in A&E, narrowly missing the target of 95%.

During February 89.3% of patient were transferred to a cubicle within 30 minutes of arrival by ambulance.  A new rapid “see and treat” service for ambulant patients is being developed to improve access to cubicles and to reduce ambulance service handover times.

The new Acute Medical Unit was designed to have a maximum 48 hour length of stay.  In January and February 54% of its patients were discharged home and 46% were admitted to a specialty ward.

8. Ambulatory Emergency Care: During January and February this service saw 270 new patients, with approximately 400 patients per month including follow ups.  For the second consecutive month this has had an impact on reduction of non-elective admissions.

9. Rehabilitation services at Mount Vernon Hospital: For many years the Trust provided specialist rehabilitation through the 20 bedded Alderbourne Rehabilitation Unit at Hillingdon Hospital, with 115 patients per year and a bed occupancy of 97%.  The Daniel’s Rehabilitation Unit at Mount Vernon opened last July  and expects to reach full capacity of 16 beds by the end of March 2015 – inability to recruit sufficient nursing staff has limited the number of beds that could be opened safely.  The service continues to be oversubscribed.

10. Finances: The financial position remained on course for a deficit of £1m at year end, but the Continuity of Services Risk Rating remained at 3..

11. Car parking: Charges from 1st April at both Hillingdon and Mount Vernon sites will be £1.50 per hour.  It is intended that all car parking sites will become “pay on exit”, but this will take some time to implement.

12. Staffing issues: A new recruitment manager has joined the Trust.  This Trust’s staff turnover at 11% is lower than any of the surrounding hospitals.  Recruitment continues in both UK and abroad.

Published on 28 March 2015

The notes below are highlights from the Board papers, not a summary of the meeting.

  1. 1. Care Quality Commission (CQC) inspection report: The outcome of the October 2014 inspection of the Trust was announced on 10th February 21015.  The Trust received two Warning Notices and five Compliance Notices together with a list of MUST and SHOULD actions required.   The CQC planned to make an unannounced visit in the 14 days after Tuesday 24th February to check progress towards those goals.  The Trust’s overall rating was “Requires Improvement”  but Caring was rated as “Good” and Safety was rated as “Inadequate”.  The Trust is responding very positively and expects to remedy its shortcomings in the near future where possible.  However some factors are outside the Trust’s control unless it receives external support – old buildings for which it has no money, recruitment of permanent staff instead of using agency staff - which it has been attempting to do for many months.

Although these ratings are a disappointment  it should be recognised that many other trust’s have  received similar ratings, reflecting the very real pressures under which all NHS trusts are currently working.

  1. 2. Chief Executive’s report:
    1. a. National Tariff 2015-16: The statutory consultation on the proposed National Tariff received objections from over 51% of relevant providers.   Monitor and NHS England are considering whether to revise the proposals or to refer the issue to the Competition and Marketing Authority.
    2. b. Shaping a Healthier future: Closure of the maternity, paediatric and gynaecological services at Ealing Hospital will impact on nearby hospitals.   A business case to provide additional A&E and inpatient capacity at Hillingdon Hospital has been submitted and funding agreed.
    3. c. New Chief Operating Officer: Karl Munslow–Ong  has moved to the same post in the Chelsea & Westminster Hospital NHS FT.  The new Chief Operating Officer is Joe Smyth, previously the Trust’s Director of Operational Performance.

  1. 3. Friends and Family Test: In January 2611 patients completed a FFT survey, with eleven in patient wards and nine outpatient areas achieving 100% responses.  Three areas received no negative responses – paediatrics, neonatal and the Minor Injuries Unit.  All areas achieved at least 93% of positive responses ,

  1. 4. Infections: The Trust had four cases of clostridium difficile in December and six cases in January and another case early in February, a total of 17 cases in year, breeching its target of maximum 16 cases.  The contractual sanction for each case in excess of the objective is £10,000.

  1. 5. Integrated Care: A new approach to integrated assessment within the Trust is being developed with Social Care.  Social workers will be on site seven days a week and a social worker will be based in the new acute medical unit (AMU) working alongside Trust discharge coordinators and therapists to identify on admission the anticipated patient’s discharge needs.  Implementation is expected in April or May.

  1. 6. Workforce Development: There are a number of initiatives:
  • Shadowing for students from Uxbridge College undertaking a Health and Social Care Course
  • Care Certificate for Health Care Assistants – to be introduced nationwide from March 2015
  • Support for newly qualified nurses and those returning to nursing.
  • Leadership development

  1. 7. Staffing: Vacancy levels and extra capacity beds continue to be the biggest challenges.  Planned and actual staffing levels are agreed at daily memtings in conjunction with the Director of Patient Experience and Nursing..

  1. 8. Summary Hospital-level Mortality Indicator (SHMI): This bands 137 NHS Trusts for all deaths in hospital and for 30 days post discharge.  15 had lower than expected death rates, including this Trust, and 9 had higher than expected  deaths.

  1. 4. Finance: In January The Continuity of Services Risk Rating remained at 3.  The year to date financial position  was a deficit of  £1.53m, which was £1.55m behind plan
Published on 14 March 2015

The notes below are highlights, not a summary of the meeting.

1.  Last Board Meeting for Dr James Reid: Tributes were expressed for the seven years of service of this effective Non-Executive Member, who latterly acted as Interim Chairman.

2.  Risk ratings: Continuity of services risk rating is 3 and the Governance risk rating is Green

3.  Chief Executive’s report: This was wide ranging and included

    a.  Foundation Trust Sector’s target failures: These included:

  • For the third quarter in a row, the sector failed to admit or discharge 95% of patients from A&Es within four hours; major A&E departments breached the target for 23 consecutive weeks.
  • The FT sector again failed to meet the 90% Referral to Treatment target for admitted patients in Quarter 2, and the 85% target for 62 day wait from GP referrals for the second quarter in a row – during this quarter this Trust met both targets.
  • At Quarter 2 the sector’s overall deficit was £254m - close to 80% of acute FTs were in deficit.

b.  National Tariff 2015 -16: The emergency care marginal rate rules continue to apply, but with the rate uplifted to 50% from 30%.  Commissioners should adjust the baseline from 2008-09 where providers have seen a material change in the volume and value of emergency admissions – and the retained funds must be invested in managing the demand for admitted emergency care, with investment decisions evidence based and communicated to all relevant stakeholders.

c.  Chancellor George Osborne’s Autumn Statement: An additional £2.2bn in 2015-16 will help to deliver the first year of the NHS Five Year Forward View.  To access such funding hospitals must have assured plans for greater efficiency and sustainability in the year ahead and be paperless by 2018.

d.  The Dalton Review: The CEO noted three recommendations particularly impacting on Trust Boards:

  • Delivery of safe, reliable, high quality and economically viable services for their populations
  • Development of an enterprise strategy which could  be transferred to a wider system
  • New organisational and strategic leadership roles to support new organisational models.

e.  Launch of MyNHS website: This is on the NHS Choices website.  It seeks to enable people to compare their local hospital, their care services and their local authority – data includes food quality, staffing, patient safety, efficiency  and outcomes for individual consultants in some categories.

f.  Care Quality Commission inspection: The meeting to convey the inspection findings with the Trust and major stakeholders will now be held on 6th January 2015.

4.  The National Physician Associate Expansion Programme: Physician Associates are healthcare professionals working under medical supervision and performing junior doctors’ tasks e.g. medical histories, physical examinations, patient management schemes.  They have been an integral part of USA healthcare for over 50 years.  There are currently 200 working in UK.  The programme to expand their number is hosted at Hillingdon Hospital.   200 experienced PAs from the USA are being recruited.

5.  Staffing levels: In November staffing was challenged by the volume of extra capacity beds, ranging from 50 – 70 beds, as well as the staff vacancy levels, and the acuity and dependency of patients, but steps were taken to ensure safe and effective nursing care.  Details for each ward were provided in the papers.

6.  Emergency Department and the Urgent Care Centre: The volume of patients regularly overwhelms the physical capacity of both these units with insufficient cubicles making it impossible to treat all patients within four hours, despite the UCC allowing the Trust to use two cubicles within its domain.  The increased activity led to emergency admissions increasing by 10% in November, at times exhausting the beds available, which impacted on flows out of A&E and had an adverse effect on performance.

7.  New Acute Medical Unit: This opened on 15th December with 40 beds in bays, plus 6 single rooms (one with low pressure for infectious patients).  Patients can be admitted by local GPs as well as from the Emergency Department and the Urgent Care Centre – they are expected to stay less than 48 hours.

8.  Winter Funding: The Trust requested over £2m to prepare for winter by increasing A&E and other staffing, supporting weekend working and increasing escalation beds available.  £1,292,800 has been received for staffing support and weekend working up to March 2015, but currently nothing for more beds.

9.  Finance: The end of November position was in line with the forecast of £2.8m deficit at year end.

10.  Out of Hours Moves: Non-clinical reasons for moves after 11pm must now be approved by the On Call Senior Manager eg to provide single sex accommodation. It is difficult to make accurate predictions with average bed occupancy at 97%.  Elderly patients who live alone are not discharged after 9pm.

Published on 23 December 2014

The notes below are highlights from the Board Papers only.

Emergency activity: During October there was a 16% increase in the number of patients attending the Emergency  Department, creating great pressure on both performance and finances.

In October the Trust was unable to meet the A&E target to admit or discharge 95% of patients within four hours of arrival and it is unlikely to recover sufficiently to achieve that target for the quarter overall.  Ernst & Young reported that if more than 20 patients are waiting, all later attendances are likely to breach the target.

A 14% increase in emergency admissions required additional beds and agency staffing:  the agency staff spend is now forecast to be more than double that of the previous financial year.

To create additional facilities, the Emergency Department and Urgent Care Centre have agreed to share a small additional space, which will be staffed by an extra doctor, two nurses and a phlebotomist.

The Winter Fund will provide additional medical staff at weekends and extra surgical  and orthopaedic registrar cover out of hours.

The CCG is committed to trying to reduce demand from 10 GP Practices with high rates of referrals to A&E and it is purchasing 13 step down beds in the community, to assist patient discharge, to free hospital beds.

Financial problems: The Trust ended October with a deficit of £0.7m leading to a reduction to 2 in its Continuity of Services Risk Rating.  Monitor has been updated about the Trust’s financial pressures and the likelihood that it will be in deficit by £2.8m at the year-end unless significant additional funding is secured.  The deficit could be as high as £4.3m if winter pressures cause increase demands.

The six months to October 2014 showed an increase of 11.1% bed-days versus last year, two whole wards, but funding for over-performance above the guaranteed minimum is capped at 45%, producing only £0.8m.

The Trust employed  an additional 299 whole time equivalent staff versus October 2013, with agency costs £1038k higher than in October last year.  However it expects to achieve its planned savings in full at year-end.

Theatres: Urgent unplanned maintenance of equipment caused downtime and changes to operating lists.

London Ambulance Service: Only 89.2% of October handovers took under 30 minutes. Total arrivals were down for the month but there were spikes  - on one day 80 arrivals compared to an average of 58.

Paediatric beds: In view of expected additional demands following closure of facilities at Ealing Hospital, this Trust has submitted a business case for expansion of Peter Pan Ward by provision of four single ensuite rooms in a modular bay at a cost of £1.6m.  A decision on this is expected in December.

Transition arrangements for the closure of Ealing Hospital’s Maternity Unit: Transition decisions, to be confirmed by Ealing CCG at its meeting on 26th November, are expected to include closure on 27th March 2015.  The Hillingdon Hospital Trust expects to gain some Ealing staff  from the closure but it is also seeking recruitment of additional staff.

Feedback from the Care Quality Commission Inspection: The date of the Quality Summit to present the CQC’s findings has been set for December 18th.  This will be attended by representatives of the CQC, the Trust and key partners including Monitor, Hillingdon CCG, Hillingdon Healthwatch and the Overview and Scrutiny Committee of Hillingdon Council.  The purpose of the meeting will be to agree a plan of action to respond to the inspection’s findings, including any input  needed from stakeholders, such as commissioners .

Beaconsfield East Ward wins a national award for its design  and environment: This rehabilitation ward was refurbished to make it  friendly for dementia  patients.  It has won “Best Internal Environment” at the annual Building a Better Healthcare Awards.  It was also “Highly Commended” in the category of “Best External Environment”  and shortlisted in the award for “Best Collaborative Arts Project”.

New IT advances: The Informatics, Communications and Technology department (ICT) made several advances in the first half of 2014, mostly on time and within budget, including:

  • Electronic transfer of letters etc to GPs – By the end of Quarter 2 over 2,000 letters per week were being sent to local GPs.
  • A new Picture Archive and Communication system (PACS) – used mainly for storage and retrieval of radiology images

The main development for the second half of the year is the creation of the core digital care record, the Hillingdon Care Record (HCR) which will include clinical correspondence, pathology  and radiology results  and the ability for this record to be viewed from any desktop or mobile device.                                  

Published on 03 December 2014

 The notes below are highlights, not a summary.

1.  System Pressures: The Chief Executive, Shane DeGaris noted that 80% of acute Foundation Trusts are in deficit with 86 FTs recording a combined deficit of £227m.  The activity pressures on the NHS had a clear impact on operational performance with the sector overall breaching the target to treat 90% of admitted patients within 18 weeks of referral, as well as the four hour A&E and 62 day cancer targets.

London Chief Executives and CCG Chief Officers met on 6th October to discuss London challenges. This Trust met the Quarter 2 A&E target, but London as a whole failed to meet this for the first time since before 2007-08.

2.  Finance: Year to date the Trust has a deficit of £397k, £539k worse than plan.  At the end of Quarter 2 the Continuity of Services Risk Rating remained at 3 but there is effectively no further headroom before the overall rating drops to 2.  The main underlying pressures remain pay expenditure and agency staff to meet unprecedented high levels of emergency activity.  Occupied bed–days increased by 11.6% in September.

3. Care Quality Commission Inspection: Initial feedback on this month’s inspection was positive and encouraging but some concerns were raised – the poor condition of some buildings, reliance on agency staff, some areas of cleanliness and other issues.  The draft report is expected in around six to eight weeks’ time.

4.  Industrial action: The Government’s 2014/15 pay award led to industrial action on both 13th and 20th October, but the Trust and staff co-operated to minimise disruption to patients.

5.  Acute Medical Unit: The new AMU and Endoscopy building, to be handed over to the Trust on 14th November, will be called the Nightingale Centre.  This project is on time and within budget.  The 46 bed AMU is expected to open to patients on 12th December 2014 – it will have a negative pressure side room for nursing tuberculosis infected patients and five other single rooms.  Endoscopy is due to open on 3rd February 2015.

6.  Bed Occupancy / staffing: During September between 50 – 70 extra capacity beds remained open. Staff shortages were tackled by use of bank and agency staff and by matrons working clinically. The number of beds can be flexed to meet this level of activity, but it is more difficult to increase support services such as radiology, pharmacy and therapies, which leads to an increase in the average length of patient stay.  The Trust is attending Jobs Fairs in Glasgow, Ireland, Wales and Leeds, as well as recruiting widely overseas.

7.  Lack of capacity for winter pressures: Until the AMU opens, the Trust has no spare capacity to meet the usual October – December increase in activity. However, it has increased staff in A&E, enhanced out of hours and weekend cover to facilitate patient discharge and is exploring the possibility of an enhanced discharge lounge to accommodate patients on beds and to dispense take home drugs. It has already received £100k resilience funding to support key emergency department interventions and it has submitted several bids for funding from a new national winter pressure fund, as well as a bid to NHS England for £2m for further admission avoidance strategies. The Trust has also been working with the CCG to commission additional beds in the community for medically fit patients that are not ready to return home, and to obtain enhanced support from intermediate care and social services, including Rapid Response and Home Safe to assist discharge.

8.  Accident & Emergency / Urgent Care Centre quarterly activity: The number of people attending these services significantly increased during the second quarter, compared to the same period last year.  September saw an increase of 17% in attendances and a 16% rise in emergency admissions.

9.  Edmunds Ward: To date 159 Northwick Park patients have been admitted to Edmunds Ward, 112 for rehabilitation services and 47 awaiting arrangements for complex placements.

10.  Ealing Hospital’s Maternity, neonatal and paediatric services: On 26th November 2014 Ealing Clinical Commissioning Group will consider transition plans for these services, prior to decisions in January 2015.  The Maternity services are expected to close in March 2015 and the Paediatric services in July 2015.  Each of the five units receiving maternity services expects around 500 additional births per year from March 2015.

11.  Mount Vernon staff accommodation: Two accommodation blocks are in use. Freddie Watson House has 35 rooms and Block 2 has 54 rooms.  Before refurbishment 56 rooms were unoccupied.  The refurbishment of 37 of these rooms is close to completion, which will be an attractive factor in staff recruitment.

12.  Ebola Virus: Trust procedures are in line with national guidance.  The Trust is well prepared with training and personal protective equipment. However, any Heathrow Airport passenger suspected of having the virus would be taken directly to the infectious diseases unit at The Royal Free Hospital.   A praised training exercise in the Trust was filmed, to be used for training purposes for other health professionals.
Published on 03 November 2014

1. Friends and Family Test: In August the overall scores for inpatients, A&E and maternity all improved, with “extremely likely to recommend” the most selected response in each of these sectors.

2.  Finances: At the end of August the Trust was behind plan with a deficit of £0.6m for the year to date. This was in line with the revised forecast for the year and the continuity of services rating remained at 3 but it risked reducing to 2.  The Trust has therefore been moved to monthly financial monitoring by the Regulator, Monitor.  The main underlying pressure remained the high cost of agency staff to meet the unplanned levels of emergency work, for which payment is at the marginal rate of 45%.  There has also been a reduction in overseas visitor income.

3. Shaping a Healthier Future: The Outline Business Case for the Trust’s capital development was submitted on 15th September, at a total cost of £93m.  This would provide for 6000 births per year, refurbishment of one theatre, an additional two recovery beds, A&E expansion with increased cubicle capacity, an additional four ITU beds, and £65m for backlog maintenance and master planning.

4.   Bed Occupancy: Year to date there have been 70 additional admissions per month in the age band 70 – 100 years, which has contributed to the continued occupation of all available escalation capacity.

5.  Safer staffing: Vacancy levels and extra capacity beds continued to be the biggest challenges to safer staffing in August, which was the peak holiday season too.  Between 50 and 70 extra beds were open.  The acuity and dependency of patients was high. These beds are still open.  Planned and actual staffing levels are reviewed for each shift by the ward sister and matron and they are also discussed at daily bed meetings, with a range of actions to address issues.

6.  Nurse recruitment: The Trust’s stand at the Royal College of Nursing in early September led to 79 expressions of interest, with 36 interviews resulting in September. Since June 2014 36 nursing and midwifery staff have actually started working for the Trust  and 34 nurses will be starting soon.  The Trust is also recruiting in Glasgow, Swansea and Ireland.  An overseas recruitment agency is being consulted to assist in overseas recruitment.  The Mount Vernon staff accommodation will be available soon - a new attraction.

7.  Edmunds Ward: To date 150 patients have been admitted to this ward – 104 required rehabilitation services  and 46 were admitted while complex placements were made.  89 have been discharged either to home or to a nursing home, and 31 have been transferred back to Northwick Park Hospital for medical reasons.  The Ward sister now participates in a weekly telephone conference call that is chaired by the Heads of Unscheduled Care  for Harrow and Brent CCGs, which aims to escalate outstanding issues.  The Ward is also working closely with Northwick Park Outpatients Department, where a number of Edmunds Ward patients have orthopaedic appointments.

8.  Winter planning for emergency activity: Contingency plans have been approved by Hillingdon CCG with an award to the Trust of  a further £100k. This will pay for additional emergency staffing.

9.  Secondary glazing of Kennedy and Jersey Wards: These wards are at the top of the tower block.  It was planned to reglaze their windows in September but the Trust felt unable to close 30 beds at this time due to the current bed-pressures.  The reglazing has now been delayed until the New Year, when the additional 46 Acute Medical Unit beds become available.

10.  Healthcare Acquired Infections: The Trust had no clostridium difficile cases in August and has had four cases for the year to date.  The Trust is ranked 8th out of 26 in London and 40th against 160 NHS England Trusts.  For MRSA the Trust is 7th in London and 72nd in England.                         .

11.   Research: In 2013-14 the Trust entered 843 patients into 40 wide ranging studies, which benefitted patients, staff and the Trust.

12.  New Chairman and a new Non-Executive Director: The newly appointed Chairman, Richard Sumray, has wide experience in the NHS, sport, policing, education, the voluntary sector, and as a magistrate; he takes up his post on 1st November.  Richard Whittington, a KPMG partner, joins the Board as a NED on 1st October, replacing Craig Rowland, also an accountant, who is retiring after many years service

Published on 25 September 2014

1.  Finances: At end of July the year to date position was a deficit of £433k, £614k worse than plan, due mainly to very high emergency activity levels and agency costs, which had been expected to reduce at end of winter. Also, over performance is contractually agreed with the host commissioner at the marginal rate of 45%

2.  Bed Occupancy: Except for one week in July the number of emergency admission were higher than in previous years.  Emergency medical lengths of stay have also started to increase, resulting in higher than expected occupied bed days.

3.  Preparations for winter: The Trust was awarded £503k to reduce planned activity waiting times by September 2014, to improve elective pathways for winter 2014//15.  Additional lists over weekends and maximising theatre utilisation during normal working hours are expected to benefit 367 patients.  The Trust has also been awarded £1.2m to support its winter emergency services, including 7-day working.

4.  Ebola: There are concerns world-wide about the current outbreak of ebola in Africa.  Due to the proximity of Heathrow Airport there are heightened concerns about potential carriers of ebola being brought to Hillingdon Hospital’s A&E.  Any clinical suspected cases brought from the airport will be transferred immediately to the specifically identified Infectious Diseases Unit.  The London Ambulance Service is fully informed.

5.  Shaping a Healthier Future – impact on the Trust’s Maternity Services: NW London’s proposals for downgrading Ealing Hospital’s maternity services impact on Hillingdon Hospital, leading to plans for 500-800 births at Hillingdon, to support a safe transition from Ealing Hospital services.  A large two-storey extension at the front of the existing Hillingdon building has been identified as the preferred option for delivery of this enlarged service.  Staffing with 1:30 midwives to patients is expected.  The Outline Business Case is expected to be put to the Trust Board on 29th October 2014, having previously been put to other relevant NHS Boards.

6.  Nurse recruitment: Recruitment days are held monthly - 49 nurses are due to join the Trust over the next two months. The Trust will have a stand at the Royal College of Nursing Fair in September and it is reviewing overseas recruitment. A press advert in Watford targets nurses interested in working at Mount Vernon. All third year student nurses are invited to apply for posts. Work with Bucks New University is simplifying student recruitment. 37 accommodation units at Mount Vernon are being refurbished, to attract  recruits.

7.  Hillingdon Whole System Integration: The Clinical Commissioning Group, Local Authority, providers of Acute, Community, and Primary Care, and the voluntary sector are working together on integrated models of care for Hillingdon. The Better Care Fund, which totals almost £18m - £15,642k from Hillingdon CCG and £2,349k from Hillingdon Council - is to improve health and social care services, avoid acute admissions, support Seven Day services, and earlier hospital discharge. A proportion of the BCF will be linked to achieving a locally set target for reduced emergency hospital admissions, based on quarter 4 of 2014-15, with an expected minimum target of 3.5% less admissions.  The first corresponding payment will be in May 2015.

8.  Post implementation review of projects: Details of several projects were provided, including:

  • Beaconsfield East Dementia Care Project:  The Department of Health awarded £845.1k, resulting in significant improvements for patients, savings in revenue costs, and reduction in backlog maintenance.
  • Maternity Delivery Suite Upgrade Project: The DH provided £741k and the Trust £299k, plus £315k later, leading to a much better patient environment and quality of care, plus removal of infrastructure risks.
  • New MRI Scanner: The new scanner is faster then the old, allows full body scans, increases productivity by 10%, and saves £133k in a full year from the cost of 739 scans by the Paul Strickland Scanner Centre.
  • Endoscopy Capacity Expansion at Mount Vernon Hospital: The unit is now co-located with other Treatment Centre services, instead of being isolated, which is better for both patients and staff.  It is now compliant with decontamination regulations.  It has produced 37% growth in work from outside Hillingdon.
  • Clinical Records Relocation: The majority of the Trust’s clinical records, approx. 600,000 records, are now in one centralised offsite building, instead of risking water damage in the previous unsuitable storage. Staff now work in a safe, fit for purpose environment, which has improved staff morale.  During the move there were delays in providing records, but service provision is now returning to normal.

9.  “Sign up to Safety”: This new national campaign aims to strengthen patient safety, save 6000 lives over three years, and make the NHS the safest healthcare system in the world.  The Trust will focus on reducing medication errors, pressure ulcers, patient falls and acutely ill older people.

Published on 27 August 2014
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