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.
1. Finances / emergency activity: The Trust ended the quarter with a £0.4m deficit due to the high cost of agency staff caused by the surge in emergency activity, which was 25% above the quarterly plan agreed with commissioners. Emergency admissions in June increased by 350 compared to last year and the number of blue light ambulance arrivals increased by 137 in the quarter – so the Trust has been unable to close any if its winter escalation capacity. Despite these pressures, the Trust retained its continuity of services risk rating of 3, but this is in danger of dropping to 2. It is still possible that the Trust may break even at year end, but it could face a deficit of up to £2.3m.
However, THH is not alone. The Kings Fund quarterly Monitoring Report notes that 1 in 4 Trusts forecast ending the year in deficit and it also notes that the number of nurses, midwives and health visitors has increased by almost 9,000 in the last six months to nearly 315,000, the highest on record.
2. Nursing and midwifery staffing: Staffing during June was challenging, with 50 – 70 extra capacity beds open to meet demand. 25 new nursing staff started work in July. A series of recruitment days for nurses and health care workers are being held on Saturdays; applicants are interviewed and given offers on the same day. On 7th June 25 nurses and 26 health care assistants were recruited, but they had not yet taken up their posts. Estates are looking at refurbishing the Mount Vernon accommodation blocks to support recruitment,
3. Elective patients: £503k has been secured to improve the waiting times for at least 275 Hillingdon elective patients who have been waiting more than 16 weeks for treatment.
4. Neuro- rehabilitation capacity: There is a shortfall in capacity across the Region. Patients often have to wait considerable amounts of time to access the Rehab services on the Aldebourne Unit. Now a new 16 bedded unit is being refurbished in Daniels Ward at Mount Vernon, opening late July.
5. New MRI Scanner: The official opening was on 17th July. The scanner is already providing scans for 500 patients a month - a key factor in quick accurate diagnosis and maintenance of patient flow.
6. Emergency Care project: The newly completed Clinical Decision Unit has been operational since 17th July.It is designed to create a link between the A&E and the Acute Medical Unit – work on the link to the A&E in the tower block will start in August 2014 for expected completion in November 2014.
7. Hillingdon Hospital Masterplan: In recent years the hospital has suffered serious infrastructure under-investment arising from the failed PFI rebuild. “Shaping a Healthier Future” is providing an estimated £18m to make a material difference in the Trust’s estate, but the estimated investment needed is around £40m more than the £18m promised. The long-term strategy will be based around retention and refurbishment of the tower block and podium.
8. Mount Vernon Site: “Shaping a Healthier Future” plans are unlikely to affect this site. The potential commercial opportunities of the site are being considered and a marketing plan is being drafted.
9. Patient Led Assessment of the Care Environment: Four assessments were made on both sites
- Privacy dignity and wellbeing
- Condition appearance and maintenance
- Food and hydration
Despite Mount Vernon achieving slightly lower ratings on the first three criteria than on its last assessment, and Hillingdon improving on all counts, Mount Vernon scored better than Hillingdon on everything except privacy, dignity and well being, where their ratings were 84% and 89%.
10. CQC inspection: the Trust will be inspected in the week commencing 29th September 2014.
11. Charitable funds: Income in the first quarter was £65k, which exceeded expenditure. There are now plans to assess how best to ensure that funds are spent within an appropriate timescale.
12. Organ donations: In 2013/14 there were 3 deceased solid organ donors, resulting in 7 transplants.
Beaconsfield East Ward is primarily a rehabilitation ward, expecting predominantly older patients. It has been carefully designed to be dementia friendly, with clever use of colour – pale walls in day areas to reflect light, bright yellow doors to identify showers and toilets, and each bed bay with a different colour theme, to help patients find their own sleeping area.
The Ward now has beds for 16 patients, four less than before the refurbishment, with separate male and female bays, which are large and airy, opening onto the garden. There are also two side rooms for single patients. Each patient has a lockable wardrobe, a bedside cupboard and access to a personal communications centre.
It has a large adaptable day-room, also opening onto the garden. The day-room is comfortably furnished with groups of settees and armchairs in bold colours. This room gives access to a kitchen where patients can be assessed for competence to manage at home, which doubles for general use. Also off the day room, there is a small gym and a sensory room - with several interesting visual items to stimulate patients - which can double as a quiet room when that is needed.
The garden is a joy. It has an extensive terrace leading down to the main garden. There are numerous benches and two shaded areas. All flower beds are raised to waist height, making it easy for patients to see touch and smell the plants. The plantings have been chosen to cover all the seasons, to give interest throughout the year.
At the end of the launch, Donald secured an interview with the refurbishment’s architect, Georgia Burt, of GBS Architects, who was interviewed by Joan. Others of the GBS team were present too. Donald’s video of the launch and this interview will appear on our website.
This exemplary project is likely to promote wide interest within the NHS, so the unit is likely to have many visitors. It is particularly pleasing to hear that the architect is now embarking on the refurbishment of Hillingdon Hospital’s Paediatric A&E Department. We are confident that it will be a pleasure to monitor the progress of that project
Strengthening the Trust’s clinical leadership: A newly established forum of senior managers and clinicians, to be known as The Trust Management Executive (TME), has been formed to develop the Trust’s service strategy and its transformation agenda.
Monitor’s Review of the FT Sector for year ending March 2014: The Sector faced increasing challenges to meet financial and operational performance targets, particularly the four hour A&E target - due to lack of beds and discharge delays - the 18 week referral to treatment target for admitted patients and, in the last two quarters, performance against the target for cancer treatment to start within 62 days from GP referral, which fell to the lowest level for two years. There was a significant decline in financial performance, with 40 FTs reporting deficits in 2013/14.FTs are now required to submit weekly information about waiting time trends.
The Trust’s ratings for Q4 was: Governance – green. Continuity of Services – 3.
Finances: The May position was a year to date deficit of £696k, £512 worse than plan. The Continuity of Services Risk Rating remained at 3, rounded from 2.5, but the Trust is at danger of slipping to 2. The main underlying pressure was non-achievement of the planned expenditure on staff pay. Agency expenditure at £730k was £367k over plan.Occupied bed days were 16.8% higher this year.
Nursing and midwifery staffing: There has been much national concern about minimum staffing levels – the Francis Report, the Keogh Review, and the Berwick Report. Berwick suggested that operating a general medical-surgical hospital ward with less than one registered nurse per eight patients, plus the nurse in charge, may increase safety risks substantially – but it is widely accepted that this should not be seen as an acceptable minimum for all wards. The Royal College of Nursing suggests that for good quality care each RN oversees 5-7 patients. Three Trust wards have funded establishments higher than recommended, one is similar, the rest have lower levels. Full details for each ward, day and night, were available in the Board papers. Assessment of need is on an individual shift and ward basis, with additions from bank or agency staff if needed and available. The Trust has vigorous recruitment and retention programmes.
Local accommodation problems were noted as a recruitment difficulty. Graham Bartram, in the public question session, suggested applying for a grant for key worker housing to rejuvenate the empty staff accommodation at Mount Vernon. Joan Davis suggested asking Foundation Trust members for their help in identifying suitable accommodation. Both suggestions were welcomed.
Bed occupancy: There was a steep rise in emergency admissions in May, some of which can be attributed to the closure of the Observation Ward, but the majority of this increase is attributable to patients with higher acuity levels than expected at this time of year. A&E resuscitation activity increased by 24%. To manage the influx all winter escalation capacity was opened and on some occasions patients were accommodated on the male day care unit. Work is ongoing to understand this change in demand and to respond appropriately.
A new paediatric A&E: Plans are being developed this year, for work to be done in 2015-16.
Dementia strategy: The Trust’s Dementia Strategy, ratified in November 2013, has four domains:
- Raising awareness, changing attitudes
- Care and support for patients and their carers
- Environment of care – learning from Beaconsfield East Ward needs to be taken forward in other areas of the Trust
- Pathways for treatment and care
Care Quality Commission Inspection: All acute trusts will be CQC inspected by December 2015. This Trust will be inspected in the week starting 29th September 2014. Up to 30 inspectors are expected. At the end of the first day the CQC will hold public ”listening events” for members of the public to tell the CQC about experiences of care within the trust.
- Friends and Family Test: This test is implemented across all inpatient wards and the A&E and Maternity departments. In A&E it performs better than the London or national outcomes. For inpatients its positive responses total over 90% but are 1.5% lower than London and 2.5% lower then the national rate. However, it has a smaller proportion of negative responses than the averages for London and the whole country.
- Estates backlog maintenance: Arup have been commissioned to determine what work is needed to bring the Hillingdon Hospital Tower and Podium to a reasonable and sustainable condition and a meeting has been arranged with the “ Shaping a Healthier Future” team to discuss how the necessary work can be progressed.
- The 2013 Patient Led Assessment of the Care Environment (PLACE) Assessments:
Key assessments (a) Hillingdon Hospital (b) Mount Vernon Hospital (c) National average:
- Condition, Appearance, Maintenance: (a) 75.54%, (b) 90.12%, (c) Nat. av. 88.75%
- Privacy, Dignity and Wellbeing: (a) 74.22%, (b) 90.68%, (c) Nat. av. 88.87%
- Cleanliness: (a) 86.67%, (b) 98.48%, (c) Nat. av. 95.74%
- Patient Food: (a) 86.18%, (b) 92.04%, (c) Nat. av. 84.98%
Both hospitals are above average for food, but Hillingdon is below average on three counts.
- PLACE Improvement Plan: This plan has driven many improvements including investment in 250 new ward based patient chairs, 300 new reception and waiting room chairs, and 55 new wheelchairs in public areas. Another improvement is better signage.
- Bed Occupancy: The number of elective admissions is similar to same period last year, but there is a marked increase in the number of emergency admissions.
- Referral to Treatment Performance: For admitted performance, the Trust is currently the best result in London and 4th nationally. For non-admitted, it is 3rd in London.
- Hospital Standard Mortality Rate: For 2011/12 the Trust rate was worse than the national average for both weekday and weekends, but it has improved to the national average for weekends and below the national average for weekdays. The notes of all patients who die in the Trust are audited by another consultant within the same speciality, who gives an opinion on whether there were any issues in the quality of the patient’s care.
- Finances: The April position was a deficit of £367k, £126k worse than plan. Pay did not reduce sufficiently from the steep increases reported for the previous quarter. The Board was warned that its financial stability requires pay expenditure, particularly agency costs, to return to historic levels - April 2014 agency spend was £696k compared with £375k last April, and £291k average monthly spend for first nine months last year
- Hillingdon Hospital car parking: The Trust is exploring the possibility of a platform above the existing car park to provide additional car parking spaces.
- Paul Strickland Scanner Centre: The new Chief Executive is Claire Strickland, daughter of the founder, Dr. Paul Strickland. As a physiotherapist she specialised in complex cancer care. She has memories from childhood about the Scanner Centre.
The notes here concern only items of particular interest – they not a summary of this Board Meeting in public.
Finance and performance: The Trust has fully delivered its 2012/14 financial plan and has also delivered the quality and performance targets used by Monitor to evaluate Foundation Trust performance.
Better Care Fund: The Trust is committed to health and social care integration but fears that plans to move services into the community will remove a significant part of its income, which represents a serious risk.
Productivity, efficiency and Cost Improvement Programmes: The Trust’s Quality, Innovation, Productivity and Prevention plan (QIPP) requires £12m savings in 2014/15 and £8m in 2015/16 – the largest SaHF related plan relative to turnover of any NWL provider organisation, which equates to a loss of £36m revenue over the next four years. A ward was closed in 2013/14 and another ward is closing in July 2014, a total reduction of 49 beds. Opportunities for savings are now limited. Transformation priorities are focused around six themes:
- 7 day working
- Ambulatory Care
- Integrated Care
- Elective Pathway Redesign
- Operational Excellence
- Accessible and Responsive Services
Estate Issues: Hillingdon Hospital was built in the 1950/60s and now requires significant investment to bring it to current standards. Cost of backlog maintenance is estimated at £17.5m plus circa £40m required to repair the 1960s Tower and Podium main hospital building – there are no immediate safety concerns but the building has poor thermal efficiency, as well as poor aesthetic appearance.
Friends and Family Test: This test was implemented across all inpatient wards including Maternity and A&E. Overall the March score was 67, the highest Trust score to date. It was based on 1207 responses.
Collaborative working amongst NW London’s CCG Groups: The Chief Executive reported that the eight CCGs have agreed to put funding into a central budget worth £139m for 2014/15 and to continue this strategy for the next five years. This means, effectively, that CCGs with a surplus will be supporting those with a deficit and that resources will be shared across CCG boundaries to ensure more equity of funding. This will enable investment of £57m to deliver Shaping a Healthier Future, £35m to ensure a more level ‘financial playing field’ between CCGs and £47m to improve out of hospital services such as seven day opening and community and mental health services.
Expansion of acute care: The new Emergency Ambulatory Care unit (EAC) is to be transferred to the new building co-located with A&E and to become part of the Emergency Department. It will accept direct referrals from GPs and form the UCC. The expansion of the Acute Medical Unit and EAC is expected to reduce length of stay and to lead to a reduction of 20 general acute beds by the middle of 2015. To deliver this strategy the Trust must increase its number of acute consultants and the skill mix of nursing staff must change.
Expansion of Obstetrics: In May 2014 much of the Trust’s inpatient gynaecology service will transfer to the Mount Vernon site, which will free space at Hillingdon Hospital to absorb the expected transfer of around 800 births per annum from Ealing Hospital, which may happen as early as December 2014. An Outline Business Case for formal approval in May 2104 proposes to expand the maternity and neonatal unit to accommodate up to 6, 000 births per annum (circa 2,000 more than currently provided). A trainer has been appointed to work with the Nurse Education Lead to develop a competenc based programme for nursing and midwifery staff Band 1 to Band 4.
Mount Vernon site: Over the year ahead an increase in orthopaedics and other surgical specialties is expected, as well as gynaecology. A new Neuro Rehabilitation Unit is expected to open it August with 16 beds managed as an extension of the Hillingdon Hospital service.
Paediatric HDU: Winter schemes allow continued provision of this unit in April.
Mortality rates: Both the Trust’s Crude Mortality Rate and Hospital Standardised Mortality Rate are steadily improving.
NB Items of particular interest – not a summary of the Trust’s Board Meeting in public.
Farewell to Chairman, Mike Robinson: The Chairman retirds on the 31st March, so this was his last Board Meeting in public after five years service. He received much praise, thanks and good wishes from all sides.
Financial risk rating – 3; Continuity of services risk rating – 4; Governance risk rating – Green
Finance: The Trust is forecasting a better end of year result than its approved plan, a surplus 0.5% of turnover, achieved due to additional contracts to assist Northwick Park Hospital meet its over-winter demands.
The Trust’s contract with Hillingdon CCG for 2014 -15 has not yet been agreed. £5m more revenue funding needs to be identified in order for the Trust to set a balanced budget.
Emergency Care reconfiguration: The contractors, Kier, started work on the 6th January and expected to complete their work by the end of April. Wet and windy weather in January and February damaged the retained kitchen wall, so completion of the kitchen, by Jarvis, is expected in May 2014, about eight weeks late. The off-site construction of the new modules is in progress.
Shaping a Healthier Future: The business case for capital development is being prepared for presentation to the Board for approval in April.
Staff Survey 2013: The response rate from Trust staff was 45%, in contrast to the national rate of 49%. The Trust rates showed an improvement since last year on a number of measures and scored above national average for the percentage who would recommend the Trust to family and friends as a place to work or to receive treatment. It was in the top 20% of trusts for three measures, but worse than its own score last year and the national 2013 score for patients receiving enough information about their treatment. An action plan is in place to address poor responses.
A&E report: The four hour target was achieved each week in February and the Trust continues to be identified as a high performer by comparison across London. This was achieved despite a higher than average ambulance attendance with an additional five ambulances per day, totalling an additional 447 category A attendances in blue light ambulances in the year to date.
When ambulances arrive in batches cubicle capacity is inadequate to cope with demand and the ambulance off-loading area is an inadequate size. Long-term the rebuild will address these issues. In the meantime a review of patient flows is underway to assess whether improvements are possible.
In February the Urgent Care Centre saw 53% of patients, compared with 60% in the previous month.
Support for Northwick Park Hospital: Edmunds Ward was opened until March to provide additional bed capacity for Northwick Park Hospital. This service has been extended until the end of April 2014. To date the Trust has received 515 referrals from Northwick Park for elective procedures, with 359 patients agreeing to have procedures undertaken by the Trust - 170 patients have already had their operations at Mount Vernon.
Clostridium difficile: With one case in February the total for the year reached 12, which is still within the target of maximum 14. Under new rules the target for the year ahead is a maximum of 16 cases – the penalty above that number is £10,000 for each case.
Revalidation of medical staff: Each doctor has been allocated a revalidation date by the General Medical Council over the next five years. This is the process by which the GMC confirms continuation of a doctor’s licence to practice. The Trust provides an electronic system for annual appraisal which contributes to the process, currently for 239 doctors.
Charitable funds: In the first nine months of the year “patient welfare and amenities” was the highest category of expenditure. In that period £46k was spent against an income of £26k, leaving £595k in reserve, a reduction in the total balances held, in line with the current policy.
Looking ahead: Planned activities in the year ahead include the official launch of the new MRI scanner, the official opening of the Acute Medical Unit, the official opening of the Maternity Unit and the official opening of Beaconsfield East Ward. In answer to a question from Community Voice it was noted that the Trust has informed East & North Herts Hospital NHS Trust of the terms for transfer of land and buildings at the Mount Vernon Cancer Centre, to enable that trust to improve its cancer facilities, which it is hoped will be accepted.
NB Items of particular interest from the papers – not a summary of the Trust’s Board Meeting in public.
Finance: The Trust continues to expect to meet its financial plan at year end and to achieve a services risk rating of 3, but to the end of January savings were £1.2m behind plan (15.4%).
Shaping a Healthier Future: High and significant backlog maintenance has been included in the business case for the Trust’s capital development, but the SaHF team acknowledges that this does not fully support the investements needed on the Hillingdon site and further consideration is being given to this problem.
Friends and Family Test: FFT scores are proportion of responders who would strongly recommend minus proportion who would not recommend or are indifferent. For January 2104 the scores were:
- Combined A&E, inpatients and maternity score was 63, from 1362 responses
- A&E scored 61, from 500 patients, a response rate of 27%
- Inpatients scored 64, from 545 responses, a response rate of 36% - all wards exceeding the 15% target rate for responses, with scores ranging from 93 for the Coronary Care Unit to 45 for the Observation Ward (excluding one with few patients and one newly opened for extra capacity)
2013 Picker inpatient survey: The response rate was 41.7%, from 344 responses. This uses problem scores. This Trust had 16 questions with scores worse that the other trusts in the same survey but it had improved since last year on 13 questions, with a lower score in only two – on privacy in A&E, and consultant time to discuss treatment options.
The interface between Nursing and Estates Facilities: The Care Quality Commission’s October 2013 report noted that lack of maintenance meant the hospital did not always provide a safe and comfortable environment. It highlighted areas of flooring, radiators removed from walls and not made good, decoration, bell calls not working, dripping taps and duct tape on windows. Remedial action is in progress.
Bed occupancy: Despite the milder than normal winter, there has been a seasonal spike in admissions.However, despite those admissions, the continued reductions in lengths of stay have allowed the closure of Beaconsfield East Ward for refurbishment.
Cancer Report: The teams are working to reduce delays on complex pathways. When patients need extensive investigating before being transferred to a tertiary provider the Cancer Manager will proactively manage the pathway with the receiving site to ensure that patients receive treatment as soon as possible.
A&E: In December, resourced through Winter Funds, the Trust invested in additional clinical and management staff to support peak periods of attendance. During January the Trust exceeded expectations and became one of the top performing hospitals in London.
A&E attendances stayed stable after opening of the Urgent Care Centre, which sees about 60% of patients.
On average between 8% and 11% of ambulances arriving at the hospital are private plus up to 2.5% from the voluntary sector, with sometimes 25% being private sector vehicles. These ambulances provide no forewarning of their arrival and when a number arrive together this can cause operational problems.
Edmunds Ward: Of the 44 Northwick Park patients recently admitted to this ward 24 required rehabilitation services and 20 were awaiting complex placements. As this ward is open only until the end of March, additional transfers will not be accepted after the middle of February.
Northwick Park elective work: In support of Northwick Park’s backlog 342 referrals have been accepted and 114 operations have ensued. A further 67 patients have treatments planned with 161 patients awaiting decisions. Of these referrals 43% were for orthopaedics, 42% for general surgery and 15% for gynaecology.
Extension of Gynaecology: The new Ambulatory Gyanecolocy Clinic opened on 27th January. It accepts direct referrals from GPs, the Urgent Care Centre and A&E; this clinic is helping to prevent admissions as well as improving capacity in A&E by accepting direct referrals.
Mortality indicators: In the Summary Hospital-level Mortality Indicator (SHMI) for July 2012 to June 2013, published in January 2014, the Trust is in the lower than expected range at 0.8835.
Emergency re-admission within 30 days: The target is 6.5%, achieved by large acute trusts in NW London between September 2012 and August 2013 by only Chelsea and Westminster Hospital with the rest between 7.7% and 9.4%. This Trust then scored 8.1%, which for the current year to date is 7.7%.
Births: 348 births in January were 10 more than last year, but cumulatively 142 (4%) less for year to date.
NB Items of particular interest only – not a summary of the Trust’s January 2014 Board Meeting in public.
Finance: At the end of quarter 3 the Trust continues to forecast break–even at year end in March 2014, an improvement on its record of £1.9m deficit last year. It is also on course to achieve a financial risk rating of 3, or better in every quarter since becoming a foundation trust.
2014/15 National Tariff Payment System: There is an uplift on last year’s prices of 2.5% on average and a national efficiency requirement of 4%, so a net result of prices dropping 1.5% for this year. The marginal tariff of 30% for emergency admissions above a baseline is maintained, but the baseline must be adjusted locally where there is evidence that there have been significant changes in the pattern of emergency admissions faced by providers. Also, commissioners must demonstrate how the 70% retained is invested, and show that plans for its use are evidence based, transparent and effective.
Hillingdon CCG’s funding: The national allocation for Hillingdon CCG will increase by 4.36% in 2014/15 and 3.99% year-on-year in 2015/16, an increase of approximately £23.7m across the two years, but because the maximum increase in any year is limited Hillingdon CCG will then still be 7.73% below target.
Shaping a Healthier Future: The business cases for capital developments in the Trust are being developed. Backlog maintenance and infrastructure improvements are being prioritised, taking into consideration the number of construction teams able to work on site at any one time. The Maternity scheme is proving more expensive than expected, above the original £10.5m, with the Trust facing the possibility of a department that may make significant financial losses; compromises are being considered and the business case remains in outline. Emergency Care Reconfiguration is behind its original schedule and at this stage around £555k over budget. Operational use of the Acute Medical Unit is planned for December 2014 and for Endoscopy February 2015. 22 car parking spaces are being lost to provide relocation of the waste compound, which is offset by renting spaces from the nearby Garden Centre – a long term solution for Trust car parking is being prepared for consideration at the March Board meeting.
Mount Vernon Strategic priorities: Amongst the Trust’s top priorities, two are specific for Mount Vernon, to deliver the clinical strategy and, within the Estate and Facilities priorities, to deliver a Strategic Outline Case.
Francis Report Action Plan: The Trust is responding with an increased focus on fundamental standards and safer staffing, greater monitoring of standards, root cause analysis of pressure ulcers and falls with general emphasis on learning form patients and staff, and increased visibility and accessibility of Senior Trust Staff.
Quality Report: This report is required by Monitor. It will focus on continuing with the First Contact Project and the Inpatient Care Project, and other projects to improve patient safety in Emergency and Maternity Care, and to improve responsiveness to patient need. New patient care pathways are being introduced. Actual versus planned staffing will be published every month from April 2014. Skill mix by shift figures show that staffing levels at night in December 2013 were significantly outside the recommended level and that the Peter Pan Ward for children has substantial staffing problems.
Winter bids: The Trust bid successfully for £1.1m of winter pressure funds to develop projects to meet surges in activity, the first tranche for additional resources in A&E and supported seven day working schemes. Development of a 7 day work programme is part of the Borough’s integration planning.
There was extensive planning with health and social care partners – Social Services were commended for supplying packages of care over the Christmas period, which in previous years caused extensive delays to discharges.
Edmunds Ward, led by the Trust’s Care of the Elderly team provides 20 beds for Northwick Park Hospital patients and 9 for the Trust’s own patients.
Northwick Park elective work: By the end of December the Trust had received 360 referrals for surgical orthopaedics, most to be undertaken in the Mount Vernon Treatment Centre - lists are booked until the end of March 2014.