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.
Finance: November 2013 brought a deficit of £107k, £68k better than plan. Cumulative savings were £856lk behind plan (14.2%). Births were 39 lower than the previous November and cumulatively there was a 5% drop in births for year to date. Emergency in-patient admissions reduced by 1.4% but the admitted patients were more seriously ill.
Winter pressures: A&E continues to be an area of close focus having recently breached the A&E four hour target for two weeks. The Trust is being assisted by Monitor on this issue.
In August 2013 recruitment of two additional Emergency Care Consultants was approved. One consultant is now in post and a second starts in January. An extra middle grade has been rostered between 8pm and 6am seven days a week. Extra nursing staff have been allocated and the senior nurse is now supernumary to allow effective co-ordination of the whole department. The Trust has also appointed three additional phlebotomists to ensure blood samples are taken early in the patient’s journey. These actions are part of a comprehensive action plan, supported by funds from Hillingdon CCG and NHS England.
The Trust bid successfully for £491k to expand services at the weekend and is developing other bids, including one with Central & North West London FT for 15 intermediate care beds.
Monitor ratings: The Trust recently achieved the following ratings:
Financial risk rating – 3
“Shadow” continuity of services risk rating – 4
Governance risk rating – Green
Dr Foster Good Hospital Guide: This recently published Hospital Guide rates the Trust highly commended for its improved weekend emergency Standardised Mortality Ratio (SMR) from 2011/12 to 2012/13.
Emergency Care Reconfiguration: The discovery of asbestos has had a material impact on progress of this project with respect to both time and money. As a result the Acute medical Unit is now planned to be operational from December 2014 and the Endoscopy Unit in February 2015.
Mount Vernon 2015 project: Positive progress was made in a recent meeting which identified in principle an option that would enable East & North Herts Trust to develop cancer services on the site. Detailed work is now underway which will consider financial and legal implications. A further meeting is planned in January.
National Cancer Patient Experience Programme: The National Cancer Patient Experience survey is an annual survey commissioned by the Department of Health. Current findings refer to in-patients between September and November 2012. This Trust had a good set of results when benchmarked against other providers across south and west London and on two questions had the highest score in England.
The questions in the survey include the visit to the GP, diagnostic tests, reports on operations, research trials, and on-going support. The Trust’s survey results show that patient’s are reporting a real improvement in their experiences along this pathway.
Meeting the nutritional needs of patients: In 2006 NICE reported that one in four patients in NHS hospitals were either malnourished or at risk of malnutrition and that as much as 70% of malnutrition in acute hospital admissions was unrecognised and unmanaged. This Trust has four specific nursing interventions aimed at supporting good nutritional care:
- Nutritional assessment: Screening takes place within 24 hours of admission and then weekly
- The Red Tray: This identifies patients who need help at mealtimes
- Best Practice at Mealtimes: Patient Companion Volunteers assist on some wards.
- Protected Mealtimes: Stop non-essential clinical activity / prepare the patient / record intake
1. These are challenging times for the NHS. There are financial constraints, activity pressures which impact on Accident and Emergency Departments and emergency services, also national targets of many kinds, and new measures for patient satisfaction – all with adverse publicity for any shortcomings, which pressurises staff.
2. There are now more patients in the system, more of them elderly and frail, but resources are more expensive, and there is less money available. Despite these problems and the requirement to achieve substantial efficiency savings, new clinical pathways are being devised to improve patient services.
3. Public expectations remain high and national targets have become increasingly challenging, such as targets for avoidance of MRSA and other infections. Both these factors encourage higher standards of patient care. The Trust is meeting all key targets set by Monitor and is maintaining a financial risk rating of 3, as well as delivering a high level of savings. Between April and October 2013 it achieved £4.4m of efficiency savings, £1m more than for the same period last year, as well as a small financial surplus - and it expects to break even at year end in March 2014, in contrast to £1.9m deficit last year.
4. Compassion is at the heart of the Trust’s services for patients, their families, and for staff. Patients’ safety makes many demands - that events which should not happen are avoided, and that staff members have the skills to recognise patients’ needs. When mistakes occur, these should be acknowledged. Responses to failures or complaints should be open and transparent, with apologies given.
5. There has been an issue about a higher risk of death for patients admitted at weekends, when fewer members of NHS staff and Social Services staff were on duty. That is being addressed.
6. Discharge procedures and outpatient issues have also caused concerns. Both are being addressed.
7. Listening to patients is important. “Clinical Fridays” take the Trust’s senior nursing staff to patients’ bedsides, to hear their views and to initiate counter measures where needed. The CARES initiative applies to all staff, focussing attention on communication, attitude, responsibility, equity, and safety. Patient surveys provide information on patients concerns, leading to changes to improve the experience of patients, such as the project to reduce noise at night.
8. The Trust received encouraging responses to the new Friends and Families Test. 3,745 inpatients said they were extremely likely to recommend similar treatment in the hospital to their own loved ones, plus 1,495 who were likely to do so, with only small numbers choosing ambivalent or negative options.
9. The Care Quality Commission’s unannounced visit to Hillingdon Hospital in October 2013 found it compliant on four tested measures, but with less than full compliance on three other tests. Overall the visit was very successful, with placement for Hillingdon amongst the 37 trusts in the CQC’s band 6, its lowest risk category.
10. The North West London programme “Shaping a Healthier Future” will impact on Hillingdon and Mount Vernon Hospitals. Hillingdon is one of the five hospitals of the nine in the area that will provide seven days a week emergency care. It will expand its 24/7 emergency services, to match the expected increase in A&E workload. Significant investment is already underway to extend the department with building work and refurbishment scheduled for completion in 2014. The new 24 hour Hillingdon Urgent Care Centre opened in September, and is working well with A&E.
11. Beaconsfield East Ward, in competition with 15 other hospitals, has won an award of £845,000 to create a dementia friendly environment for its patients. Better use of colour, signage and light will improve the ward for these patients, as will a new patient day-room, a Sensory Room and a Sensory Garden for their use. The refurbished ward is expected to open in February 2014.
12. Work on refurbishment of the Maternity Unit began in September with the aim of completion in May 2014. There will be en-suite facilities in each of the ten delivery rooms, more comfortable furnishings, soft lighting, music and media systems which will make them more welcoming.
13. The Mount Vernon Cancer Centre wants to consolidate its facilities on the site and there is agreement in principle about this between its managing trust, East & North Herts. NHS Trust, and its landlord, The Hillingdon Hospitals NHS FT. Mount Vernon is a complex site, so various options are being explored.
14. All current Governors of the Trust reach the end of their term of office in March 2014. Volunteers willing to seek election as Governors must complete and return nomination forms by 28th January 2014. Voting will take place by secret postal ballot in February / March 2014.
The speaker then answered a wide range of questions, which raised many interesting points, including:
15. More patients now suffer from dementia, in addition to their other clinical needs. Dementia training is therefore being revised for all staff in contact with patients across the Trust.
16. Spartan day rooms could be improved by the use of charitable monies which are held by the Trust.
17. Lay people already serve the Trust in many ways and they are recognised as a valuable resource. The Care Quality Commission is proposing to include lay people in its inspectorate.
The speaker was thanked on behalf of the audience by the Vice Chairman, James Kincaid, which was endorsed by loud applause from all those present.
The audience had been warned that a video of the address was being made, When ready this will be placed on the Video page of the Community Voice website at www.communityvoicehealth.org.uk
Care Quality Commission’s Unannounced Visit:
The Trust met three standards fully, caused minor concern on two - cleanliness and infection control / safety and suitability of premises, and moderate concern on one – staffing. Some wards with one nurse to none or ten patients at night were not compliant with RCN recommendations.
At the end of October the Trust was £300k behind plan, but that is £1.3m better than at this time last year, so the Trust expects to break even at year end and to maintain its risk rating of 3.
The 2014/15 tariff guidance states that when a trust is reimbursed less than the full tariff, both commissioner and provider must agree how the shortfall is used, either to manage demand or to improve discharge facilities.
Allocations to CCGs for 14/15 and 15/16 are expected in week of 16 th December, together with broad assumptions regarding allocations for the following three years.
The UCC now treats relatively well patients, so A&E treats fewer patients, but their needs are more complex, making it more difficult to meet the target to admit or discharge 95% of patients within four hours. In October A&E achieved only 91.3% but the rate for the combined A&E, UCC and MIU achieved 96.6%.
The Trust’s above average performance on clinical effectiveness is not matched by its feedback in the National Patient Survey. “Trust responsiveness to patient need” and “overall experience of care” was slightly below the national average. The Trust is working to remedy these shortcomings.
The recent Patient Led Assessment of the Care Environment (PLACE) showed the Mount Vernon site as performing well; however, the Hillingdon site performed below the national average with a number of concerns, many related to the aging estate and poor maintenance. In the Friends and Family test responses, 93% of patients were satisfied with the responsiveness to their needs. Further progress is expected in response to the First Contact Project, to improve the experience of outpatients, and the Leaving Hospital Project, which is already improving both the medication and the documentation which patients take home.
“Shaping a Healthier Future” programme:
- Business Case Maternity Services:
- A maternity scheme was developed but was found to be significantly above the available budget. Further work is ongoing.
- CT Scanner: The projected increase in demand does not warrant an additional CT scanner, but there is a clinical risk in having only one scanner. The proposed mitigation is to acquire a Gamma Camera with a CT head in 2014/15.
- MRI Scanner: Demand is predicted to exceed capacity, but not enough to be cost effective. So other options will be pursued, such as working with another provider, using a mobile service, or outsourcing.
North West London Integrated Care:
NWL is one of the 14 sites awarded pioneer status, out of over 100 applications. NWL will receive support and advice from the Government and national partners. It is unclear how Hillingdon will access this support given the Local Authority’s decision not to back the application bid, but there is commitment from the NWL team that this will not exclude Hillingdon health care organisations from the process. The DH ambition is to make coordinated health care the norm by 2018.
NWL has set up six working groups:
- Embedding partnerships: This includes the Lay Partners Forum and Lay Partners Advisory Group.
- Populations and outcomes: This will identify current outcomes and build future goals.
- GP networks: This facilitates joint working and sharing of resources and risks.
- Provider networks: This will assist sharing of information and providers working together.
- Commissioning, governance and finance: Budgets etc for joint commissioning will be identified.
- Informatics: A NWL informatics strategy will be developed
Integrated Transformation Fund:
This fund, set up by the Government, has £3.8bn to increase integration between services. Early indications suggest that this will include £11m of existing health funding in Hillingdon. Hillingdon Health and Wellbeing Board Sub Committee is considering a new form of service delivery, but plans must be jointly agreed with key partners. A stakeholder group has been formed including Hillingdon CCG, CNWL and THH which meets two weekly. Access to the Integration Transformation Fund in 2015/16 will depend on the local two year plan for 2014/16 – plans must be agreed by March 2014.
Current Local Integration Programmes include: Scaling up of rapid response, community dementia pathways, falls services, intermediate care on hospital discharge, improved mental health services, and improved joint working by acute and community health services, social services and third sector agencies.
Edmunds Ward at Mount Vernon:
This will be open from 2nd December to end of March 2014, with 20 beds for use of Northwick Park Hospital and 9 beds providing additional winter capacity for THH.
London Cancer Alliance: A recent independent review found a minority of stakeholders felt progress on provision of care to patients had not yet been demonstrated and that LCA had done a considerable amount of mapping of services but it was unclear how that added value for stakeholders.
The following is a summary of the main points of the meeting.
Care Quality Commission’s Unannounced Visit: This took place over several days in October – a Friday evening visit to A&E, followed by an all day visit on Saturday in the wards, with maternity, paediatrics and a couple more wards on the Monday. Six particular factors were examined:
- Respecting and involving people who use services
- Care and welfare of people who use services
- Cleanliness and infection control
- Safety and suitability of premises
- Assessing and monitoring the quality of service provision
The inspectors spoke to many patients and members of staff. The formal report is still awaited.
Monitor’s review of the Foundation Trust sector for Quarter 1: The Trust’s Chief Executive, Shane DeGaris, reported some key points of the review:
- Just over half of the FT sector is rated ‘green’ for governance, but the acute sector has the poorest profile with 30% of all acute FTs and 35% of small acute FTs rated ‘red’. (This Trust is green)
- Monitor expressed concern about A&E performance: 31FTs failed the four hour target in Quarter 1, compared to 13 in the same period last year.
- Half of all acute FTs reported a deficit in Quarter 1, before exceptional items.
- The average financial risk rating for the acute sector was 3.1, with this reducing to 2.5 for the small acutes (This trust’s rating was 2.9)
- Monitor expressed concern that FTs are finding it increasingly difficult to deliver savings.
Consultation on 2014/15 tariff: The Chief Executive reported that Monitor and NHS England are consulting on the following proposals until the end of October:
- Providers are to be expected to make annual efficiency savings of 4%. Taking account of rising NHS costs of 2.1%, on average the prices paid to providers will therefore go down by 1.9%, releasing funds to commissioners to invest in other services.
- With respect to the current marginal rate for emergency admissions, the rule which stipulates that Trusts are paid only 30% of the tariff price fore each emergency admission over 2008/09 levels – the remaining 70% being retained by commissioners to invest in keeping patients out of hospital. There are two new proposals. Firstly, where an increase in admissions is outside the provider’s control, commissioners will be required to agree a baseline before the marginal rate applies. Secondly, NHS England will ensure that money retained by commissioners is spent as intended.
North West London’s NHS Services
National Institute for Health Research (NIHR): The NIHR Clinical Research Network is the clinical research arm of the NHS. It encourages patients to take part in clinical research, and ensures that studies are carried out efficiently. It provides funding to hospitals and surgeries to pay for research nurses, scans, x-rays and other costs of NHS clinical research. It operates across England through a national co-ordinating centre and15 local branches, with Imperial College Healthcare NHS Trust the host of its NW London branch from April 2014. The indicative funding for NW London is £15m per annum
Infrastructure improvements needed to support “Shaping a Healthier Future Programme”: These are under detailed consideration at Hillingdon Hospitals NHS Trust, including electrical distribution and medical gases, but all key services will be checked. Maternity Services will be increased to provide for 5,500 or more births per year. A new emergency theatre is planned and the case for additional MRI and CT scanners is being explored.
Ealing Council’s request for judicial review of the SaHF consultation: Having been denied permission for a judicial review, Ealing Council is to have an oral re-hearing on 9th and 10th October.
Hillingdon Health and Wellbeing Board
Integration of care by NHS and Social Services: The Leader of Hillingdon Council, who chairs the Health and Wellbeing Board, has set up an integration working group to take forward integration of health and social care in Hillingdon.
Hillingdon Hospital FT
Finance: At the end of month 5, the Trust’s performance is rated “green” and its financial risk rating remained at 3, despite ending the month with a £97k deficit. Achieving the Trust’s savings plans remains the biggest financial challenge for the year.
Monitor’s new ratings: Two new ratings take effect from 1st October 2013, which will not automatically indicate a breach of licence or trigger regulatory action, but may prompt more detailed investigation. A green rating will indicate no causes for concern. The average of these two new ratings will provide an overall rating.
One rating will assess continuity of services; this will incorporate measures of financial robustness, to indicate when there is a significant risk to the financial sustainability of the FT, which could endanger the continuity of its key services.
The other rating will assess governance; this will include performance against national access and outcomes requirements, CQC judgements and third party information – MRSA will no longer be a factor in assessing governance. Any FT failing to meet at least four performance indicators, or failing the same performance indicator for three or more quarters, will trigger governance concern, potentially leading to investigation and enforcement action.
NHS Winter pressures: Last month the Government announced £500m funding would be available over two years to relieve winter pressures in A&E. For the coming winter £55.5m has been allocated to ten London Trusts, with three in NW London accounting for £11.6m – but Hillingdon got nothing.
Both the hospital and Hillingdon CCG are protesting, particularly as last winter Hillingdon A&E just managed to achieve the 95% target in quarter four, due to the additional winter funds provided. Without such funding the hospital faces an additional challenge in the winter ahead.
As part of the same announcement the Secretary of State outlined three specific themes to improve care of older patients with complex health needs, which are currently being developed for roll-out next year. These are:
- Patients should have a named clinician, probably a GP, responsible for co-ordination of their care across the NHS, whether at home, in hospital, or in a care home .
- Older people’s care must be joined up between the NHS and social care services.
- Information and patient records must be shared across the NHS and social care services, with the aim that by the end of 2014 at least 1/3 of A&Es should be able to see the GP records of their patients and at least 1/3 of NHS 111 services should be able to see the GP records of their callers.
Note: These are notes on items of particular interest – they are not a summary of the proceedings.
Finances: The Trust’s financial risk rating remained at 3. In July there was a surplus of £189k, £2k better than plan. Efficiency savings to date was behind plan, but better than at the end of July last year.
Successful bid to secure funding for dementia friendly environments: £845,120 has been awarded by the Department of Health to improve Beaconsfield East Ward and the garden shared with The Stroke Unit, to be completed by March 2014. This is one of 116 national pilot schemes. It was felt that this offered a unique opportunity to get the press involved at each stage of this scheme being led by experts.
Estates and Facilities annual update: The five yearly six facet survey of physical condition, functional suitability, space utilisation, quality, compliance and environment management was completed in June 2013
Shaping a Healthier Future Programme: This programme has considerable impact on the Trust
- Backlog maintenance: Three main strands for work packages phased into future capital programmes :
- High and significant backlog maintenance: The 2013 Arup Condition Survey and the consequential risk appraisal by Capita will guide this work.
- Infrastructure capacity improvement programmes: To accommodate future developments.
- S106 obligations agreed by the Trust and Hillingdon Council
- Clinical services: Also three main strands
- Maternity services: This aims to provide for 6000 births per year, with improved facilities.
- Theatres and ITU: There are plans for an additional new build theatre and ITU bed. The current 7 theatres’ efficiency will be improved once the 46 beds on the new Acute Medical Unit open in autumn 2014, which will allow redesign of the recovery space following surgery. Resuscitation capacity will also be improved.
- Diagnostics: The case for additional MRI and CT scanners will be explored
Ealing Council’s application for judicial review of the whole programme: Permission for a judicial review was refused on 8th August. Ealing Council expects to have an oral hearing in early September.
Maternity Overview: Births continue to remain low but the market share from Hillingdon Borough has increased over the last year. Staffing ratios have improved, placing the Trust as middle to high in comparison with other Trusts. The unit is currently preparing for a redevelopment of all its delivery rooms, a large capital project costing £750k.
Pressures on A&E: The London Ambulance Service reported that during the height of this summer’s heat wave calls exceeded 6,000 per day. Hillingdon A&E attendances exceeded 300 compared to a daily average of 220. There were days in July when ambulance arrivals increased by 50%.
Reinvestment of funds withheld due to readmissions above target: Hillingdon CCG is planning to reinvest these funds in a number of schemes to prevent avoidable admissions, most of which are expected to be available by October 2013. The Trust is keen to attract work from CCG’s other than Hillingdon as this will help the financial position of the trust.
The Friends and Family Test: The Trust was in the top half in London for inpatient feedback and in the top quarter for A&E. Some patients add comments. Themes are analysed. Comments on meals have led to review of menu choices, plus provision of additional meal choices for long term patients who might suffer from menu fatigue. Noise and lights at night has also emerged as a concern, leading to remedial action. One patient’s experience as an inpatient was brought to the meeting in the form of a report to demonstrate what actions have been taken following this patient’s stay in hospital.
Liverpool Care Plan: This is to be replaced with an individual approach to end of life care for each patient, backed by condition-specific good practice guidance and a named senior clinician responsible for its implementation for each patient. A training programme on sensitive issues has been set up.
Note: These are notes on items of particular interest – they are not a summary of the proceedings.
NW London's bid to be a pioneer in health and social care integration: The 8 CCGs in NW London and all corresponding Councils except Hillingdon have agreed to support the bid, which promises Government support for up to five years to integrate health and social care services.
Finance: The first Quarter ended £73k behind plan but a financial risk rating of 3 was maintained, as required. The cost of agency and bank staff was £111k lower that the year to date plan. 299 births in June was the lowest number since February 2010. Total A&E attendances year-on-year were flat, but level of ambulance arrivals and acuity of patients has increased.
A&E attendances: The hot weather in July looks likely to impact on A&E with a record 10,000 attendances in the month expected.
Hillingdon Urgent Care Centre: The Trust was disappointed that it did not secure the contract for the UCC which was awarded to a private partnership led by Ealing Hospital NHS Trust.
Hillingdon Health and Wellbeing Board: Hillingdon Council has approved the Health and Wellbeing Board as a Committee of the Council. It will oversee the production of the Joint Health and Wellbeing Strategy and Joint Strategic Needs Assessment. It will be chaired by the Leader of the Council; its Statutory Members include officers of the Council, members of the Council’s Cabinet, and representatives from Hillingdon CCG and Hillingdon HealthWatch. Hillingdon Hospitals NHS FT and Central & North West London NHS FT have been offered non-voting co-opted positions on the Board.
Imperial College Health Partners: The Partners, of which this Trust is a member, have received an unconditional licence for five years as the Academic Health Science Network for North West London.
It will receive funding from NHS England, subject to achievement of agreed objectives.
Liverpool Care Pathway: The Review of this pathway published its findings on 15th July. It confirmed that the LCP principles are sound, but that poor use of the pathway has caused concerns. Consequently the pathway is to be phased out and replaced with individual care plans.
Variability in services in London: A review of London’s hospital based acute medicine and emergency general surgery found huge variability, particularly in consultant availability at night and at weekends. Ideal standards have been published for several departments. All the standards have been achieved somewhere in London, but no trust currently achieves them all. They are focusing attention on improving standards locally. Full details of how this Trust relates to the standards were published in the Board’s papers.
Review of 14 hospitals in England with higher than average death rates: The findings of the Review led to much Board discussion to learn from the findings. Key factors included learning from complaints, learning from junior staff who move both within and between trusts, senior staff supporting juniors, minimising use of agency staff. The Board reappraised its own stocktaking, noting areas for improvement.
Clinical Fridays: The new Director of Nursing, Prof. Theresa Murphy, has introduced “Clinical Fridays”, when senior nurses and midwives work on the wards with the clinical teams on direct patient care to enhance clinical leadership and improve standards for patients.
Infections: National tolerance for MRSA is zero, so all hospitals have zero targets. The Trust has been assigned responsibility for one case this year so has breached its target, but it remains within the Monitor Compliance Framework which accepts six cases in the year. For clostridium difficile the Trust had two cases in the first Quarter, within the Quarter’s target of four.
Paediatrics: There is a shortage of paediatric nurses in A&E, a national problem. Transfer of HDU children is high risk as transfer facilities are unsatisfactory and the child must be accompanied by senior Trust staff.
Infection control: Two MRSA bacteraemias were identified in May, both assigned by Hillingdon CCG as the responsibility of the Trust. Responsibility for one case was accepted, but the other was contested and referred to the Director of Public Health for arbitration, which led to it being re-assigned to the CCG.
The Trust had two cases of clostridium difficile in May, one antibiotic related, the other taken after bowel surgery, which root cause analysis deemed should not have been sent for analysis.
Quarterly summary of Serious Incidents: Serious incidents in this Trust are now reported to Hillingdon CCG, as the lead Commissioner, irrespective of the particular commissioner. Hillingdon CCG will be responsible for robust investigation, for implementation of actions to prevent recurrence, and for reporting outcomes to the Clinical Support Unit for shared learning.
Serious incidents are investigated by a panel. The investigation of one incident in 2012, where a child’s tumour was missed on a scan, was led by Great Ormond Street Hospital.
The suicide earlier this month of a man in the Emergency Assessment Unit is being investigated by a panel. Two “never events” have occurred in 2013, both relating to retained swabs; both are still under investigation,
Quality of care at ward level: Unannounced visits by senior managers are taking place to observe care, speak to all levels of staff about the care they provide, and to hear comments from patients and families.
Urgent Care Centre: Work on the old Fracture Clinic site has discovered pipework embedded in the concrete joists, which is not normal industry practice. This is causing about two weeks delay in completion of this stage of work. However, the eventual handover of the Urgent Care Centre should be unaffected.
Health Education England: This new organisation now has responsibility for all NHS education and training. The Government’s objectives for HEE until March 2015 contain 38 short-term objectives, including those for recruitment into NHS–funded training posts; students seeking funding for nursing degrees should first serve up to a year as a healthcare assistant. All NHS staff who look after patients should have dementia awareness training; 100,000 staff should have foundation level training by March 2014.
Integrated care pilot for elderly patients and for adult diabetic patients: This Trust, in collaboration with Central & North West London FT, led a successful bid to provide an assisted discharge pilot that commenced in May. This provides intensive therapy support in the home for up to five days, aiming to cut hospital stay by up to four days. A further bid by the Trust has also been accepted. This provides specialist diabetic training to staff in selected nursing homes, with the aim of reducing the number of diabetic patients needing hospital admission. A clinical nurse specialist was recruited to lead this programme, who is supervised and supported by a Consultant from the Trust.
Implementation of “Shaping a Healthier Future”: This Trust has been allocated £200,000 to support its business case for implementation of the programme. By accepting the funding the Trust agrees to follow the spirit of the programme’s principles and to deliver agreed time and quality standards.
North West London’s application to be a pioneer in integration of health and social care: On 14th May, Norman Lamb, Minister for Care and Support, invited local areas to submit by 28th June applications to be pioneers in integration of care. The eight CCGs and Local Authorities of NW London, together with those in Richmond, have agreed to apply and believe they have a strong case for being awarded this status because of the strong foundation provided by the work already underway in the “Shaping a Healthier Future” programme. Pioneers will benefit for five years from both outside funding and expertise. This will aim to support the breakdown of the barriers to integration and to aid development of effective innovations. All NW London NHS bodies are being asked to support the application, which this Board agreed.
Pressures on A&E: Various changes are underway. Medically expected patients are transferred directly to the Emergency Assessment Unit. Work on the discharge process and increased community provision should free up beds more quickly. Prompt booking of patients should reduce ambulance turnaround delays. Prompt senior clinical assessment within A&E should speed up flow within the department