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 December 2011 Board Meeting in public was shorter than usual, with no great surprises.
In hospital death rates
As in-hospital death rates have been falling, Dr Foster re-based its data in September. Hillingdon’s rating for the last 12 months, 102.2, was slightly above national average, but two areas, A&E and well babies, were significantly better than average and a number of departments have recently achieved a lower death rate.
At end of November the Trust ‘s financial risk rating fell to 2, but the score is expected to return to 3 (the requirement for foundation trusts) at the end of December. The current reduction is expected to have no adverse impact as the Trust is on quarterly appraisal by Monitor. The year-to-date financial performance was a deficit of £1,129k, £3,219k behind plan, with efficiency savings £2.855k behind plan
The Board was asked to note “local contract caps on what the Trust can charge commissioners this year has resulted in a significant amount of work being done but not expected to be paid for. At £1.9m so far, this is clearly a crucial business issue for the Trust, impacting on its ongoing financial viability”.
Grange Ward is to be re-opened in preparation for winter pressures.
Mandatory staff training
The Trust’s current compliance rate is 71.5%. There has been sustained improvement over the last two years but more needs to be done. A number of measures are in place to improve compliance,
A benchmarking was recently undertaken across London hospitals – but only a few responded. Of those that did, two had achieved over 80% compliance, three had around 70% (similar to THH), and three had compliance between 50-65%.
(Lay people find this difficult to understand as “mandatory” and “statutory” imply essential, but NHS spokespeople, in several trusts, suggest that the training requirements apply to broad categories of staff, for some of whom the relevance is obscure)
From 1st January 2012 Hillingdon and Mount Vernon visitors’ car parking charges will rise. The new prices are based on the average price across England in NHS hospitals. Hillingdon Hospital will provide 10 minutes free and Mount Vernon Hospital, (a bigger site with pay and display system), will have 30 minutes free.
Because the two sites have different payment systems their charging is slightly different, although broadly similar. The new Mount Vernon charges are shown on our Mount Vernon page.
Hillingdon Hospital Pay on Exit Charges from January 2012:
10 mins - 30 mins
30 mins - 60 mins
1 hour – 1.5 hours
1.5 hours – 2 hours
2 hours – 10 hours
10 hours – 24 hours
Each extra 24 hours
Disabled parking - free
Weekly visitor permits - £12
Monthly visitor permits - £25
Frequent cancer treatment £1
Refurbishment of Main Entrance at Hillingdon Hospital:
The main reception desk has been repositioned and the coffee shop extended
Survey of Doctors in Training 2011/12
Four Hillingdon Departments are in the top 12 in the country in a survey run by the General Medical Council – geriatrics, general surgery, diabetes, endocrinology – and others were in the top 25% too. This will help the Trust to be allocated medical trainees in future.
The Trust expects to invest around £11m in IT over the next five years. The Patient Administration System will be upgraded in January. Bed management will be rolled out early in 2012. All hardware devices will be replaced within five years. An electronic patient record system is expected in 2015.
Infections are within targets, with three cases of MRSA bacteraemia to date – MRSA screening has exceeded 90% since August - and 18 cases of clostridium difficile to the end of October. The caesarean rate has increased to 34% against a target below 27%. A new Surgical Geriatric post is expected to help patients who are unfit for surgery after breaking hips in falls.
The Trust is still financially risk rated at 3, required by its authorisation as a foundation trust, despite local contract caps leading to much work being done without payment. In October elective activity and A&E admissions were high and other services average but efficiency savings were less than planned. Achieving 4% saving this year is challenging. Many controls are in place. Clinical Divisions now have monthly financial reviews; booking agency staff must be authorised by an Executive Director; all one to one nursing is authorised by the Director or Deputy Director of Nursing. A car parking review expects staff parking to rise from £1 daily to £2.50 and patient parking to rise to probably £5 for over two hours at Hillingdon Hospital with a slightly different tariff at Mount Vernon because of its different payment system. No increase is expected for disabled or concessionary parking.
To meet seasonal surges due to influenza and bad weather, an additional 50 beds are planned. Other plans include the Urgent Care Centre extending its hours to 2am. There is a divert policy across North West London for hospitals to provide mutual support when needed.
Annual Charities Report
Funds have been used to purchase medical equipment, enhance patient and staff environment and to train personnel. The long-term policy is to reduce the balance to below £500,000. In the current year, expenditure was £382k, income was £405k and the balance increased from £588k to £620k.
The Trust has maintained its financial risk rating of 3, as required from a foundation trust. It is behind plan by over £2m but expects to regain financial balance by the end of the financial year - delivery of efficiency savings remains its key priority and risk. Its problems stem from financial caps for payment for work done, high levels of emergency work, theatre maintenance at the start of the month, and births in September down 19 compared to 2010 - but both discretionary and agency pay were lower than last year. Response to a question noted that In 2010/11 the Trust spent £8.32 per patient per day on food.
Three MRSA bacteraemia in-year and 5 clostridium difficile cases were reported, year-to-date, both within target.
A September analysis of frequent A&E attenders identified ten patients causing A&E pressures - one had attended 158 times since 1stApril 2011. The Trust is working with LAS and other partners to ensure alternative care is available to support these frequent attenders in the community.
The new Standard Hospital Mortality Index rates this trust 88, well below the 100 England average.
Care Quality Commission Report
The CQC planned and delivered a series of 100 unannounced inspections of acute NHS Trusts across England between March and June 2011, looking at standards of dignity and nutrition on wards caring for elderly people. In these visits they talked to patients and their families and interviewed staff. The Hillingdon Hospitals FT was not amongst those visited as it had been inspected by the CQC some months previously and been found to give good care. However, 20 of the hospitals visited by the CQC were found not to be meeting the legal standard for elderly care.
Accidents and security incidents to staff: The level of reporting of staff accidents is similar to last year with 47 reported accidents, mostly minor accidents such as hitting head on shelf. There were 136 reported security incidents, the highest category relating to disruptive patients or individuals under the influence of alcohol or other substances. 15 cases of verbal abuse contained the threat of assault to the individuals involved.
This was the first Annual Meeting as a foundation trust. It was held in the Education Centre at Hillingdon Hospital, on 20thSeptember . Publicity posters were displayed in the lounge where coffee was served. Numbers attending were small, with few unfamiliar faces, but Ruislip Residents' Association was well represented. This was all in contrast to last year’s meeting, in the Council Chamber at the Civic Centre, where the display was bigger, hospitality was lavish, and attendance was large. This year’s event was noted in The Pulse, emailed to members with that facility, and freely available in both the Trust’s hospitals - but was wider publicity perhaps curtailed?
The presentations were numerous, well organised and impressive. The opening by the Chairman, Mike Robinson, was followed by short items from various clinical specialties – colorectal surgery, orthopaedic surgery, the rapid recovery programme – and then the heavy-weights, the Finance Director Paul Wratton, the Medical Director Susan LaBrooy, Governor Roy Shipton, Director of Nursing and Patient Experience Marie Batey, and Chief Executive David McVittie.
The message throughout was upbeat and predictable, recounting the Trust’s successes, but warning that currently financial pressures are great and these are challenging times.
One contribution was outstanding and memorable, from Yasser Mohsen, the Egyptian colorectal surgeon, and Nurse Consultant Pat Black. They outlined their work on helping patients to face and respond to colorectal surgery. As a result of their efforts patients are enabled to recover more quickly and with better outcomes, despite spending less time in hospital.
Car parking charges:
Prices will rise on 1st January but the rates have not yet been confirmed.
Drop off parking near the Child Development Centre at Hillingdon Hospital:
Parents of disabled children have had difficulty in parking near the Child Development Centre. This problem is being addressed with the introduction of drop-off bays allowing 20 minutes free parking.
It was reported that although all NHS hospitals provide disabled parking bays, the majority require payment on the same terms as for other users. The Hillingdon Hospital Trust has until now provided disabled parking free of charge, but that policy is being reviewed and could be changed. Since the Trust manages its car parks directly, any profit from parking charges reverts directly to the Trust.
The Trust has been concerned about the distress caused when cars are clamped and it is therefore exploring fixed penalty charges as an alternative. A deterrent is needed to combat careless and inconsiderate parking and other car park abuses. Cases of road rage, tail-gating and dangerously fast driving were reported as having occurred within the hospital car parks.
Car park lighting
An audit is underway.
The Trust was in readiness during the recent London riots but mercifully services were not required. The hospital’s normal work carried on as usual.
Security staff attacked on duty:
Two incidents occurred in the last month. Body cameras are now being worn by Security Officers attending incidents. The Officers will issue verbal warnings that behaviour is unacceptable and that it will be recorded. It is hoped that this will act as a deterrent, which has been the experience in other London hospitals.
Fund raising for Ophthalmology:
Staff from the Ophthalmology Department have raised a significant sum by organising a fundraising Ball. The event was fully subscribed with 200 tickets sold and was a big success due to the generosity of staff, friends, patients and suppliers.
Efficiency savings were £910k, 41%, behind plan. All Clinical Divisions will be involved in monthly financial review meetings until satisfactory financial performance is restored. At end of Quarter 1, year-to date financial performance was £1012k worse than plan. Financial forecasts will be revised in September. Maintaining a rating of 3 is very challenging and this is causing concern.
Year-on-year inpatient activity remained stable but there has been a significant reduction in out-patient activity. Births remain 1% lower year-on-year despite 405 births in July being the highest ever.
Monitor Compliance Framework:
At month four the rating was amber-red with the following issues causing concern:
- Hospital Acquired Infections: There were ten cases of clostridium difficile in Quarter 1 and three more up to 17th August. A root cause analysis has been undertaken on every case. Three cases of MRSA bacteraemia have arisen in 2011-12.
- Cancer 62 Day screening to treatment: In June there were two breaches – so rated red, although late referral and patient choice were responsible for the delay.
- Third degree tears in childbirth: Rated red at 13.23% against target maximum 11.5%. It is the first time this year that the rate has been outside acceptable limits, so a detailed analysis is underway.
- A&E unplanned re-attendance rate: An increasing number of patients with diagnosed mental health needs are re-attending A&E when experiencing a crisis. The Trust is working with CNWL on this - CNWL is reviewing its duty desk opening hours.
- Early access for women to maternity services: The 12 week target has improved to 71% in July, still below 90% target. Work with PCT and Public Health is underway.
- Initial time for ambulance arrivals: Work with LAS on this is ongoing.
Walk to Work Week and Bike Fayre
The Trust ran a very successful “Walk to Work Week” to encourage car owners to leave the car at home and is holding a Bike Fayre on 28th July, aimed at encouraging use of bikes, with a number or incentives:
- Free bike maintenance
- Free bike maps
- Bikes and accessories available at discounted prices, both new and refurbished
- A physiotherapist on hand to offer advice on cycling to avoid injuries
Much work is underway to improve patient flow through A&E. One initiative trialled this month was the provision of senior clinical triage at the front door. This was very successful in terms of streaming patients and discussions are taking place with Harmoni regarding introducing this as soon as possible.