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.
National In-Patient Survey:
The Board was very disappointed in the recent results and spent a great deal of time trying to address the root cause of this. Visits are to be arranged to hospitals that have managed to improve their survey outcomes to learn form their experience.
- A number of improvements have already been introduced since the survey took place many months ago:
- A bedside guide has been developed and will be introduced in July.
- Nursing handover has been changed, with the greater portion of the handover at the bedside so that patients are more involved and can meet staff looking after them on the oncoming shift.
- Hillingdon Age UK has started a programme of unannounced visits to wards to scrutinise care at mealtimes and is keen to provide more volunteers to assist patients at mealtimes.
- Also a Carers’ Strategy is being developed with Hillingdon Carers and local carers, as well as cared-for patients, which will be launched in the autumn.
- Handheld computer “tablets” are being used to allow patients to respond to questions with yes/no answers, which is giving the Trust a reliable and fast path for obtaining information about patients’ views.
National Award for Alderbourne Ward:
This rehabilitation ward won the Multiple Sclerosis Professional of the Year Award 2010. The MS Society is the UK’s largest charity for people with multiple sclerosis, which affects 100,000 in the UK.
Keeping the hospital safe:
In March 2011 the Trust purchased three body mounted surveillance cameras for use by its security personnel at Hillingdon Hospital. These cameras will only be activated after a verbal warning if an incident of antisocial beheviour occurs. Other London hospitals have seen a dramatic reduction in the number of violent and aggressive incidents towards hospital staff following introduction of similar cameras.
There were 8 cases of Clostridium difficile in April and May which exceeded the current trajectory. A Root Cause Analysis has take place for each case. In the same two months the Trust also had cases of norovirus.
There was one case of MRSA bacteraemia in May. This too caused Board concern.
Re-attendance rates at A&E also caused concern. A target to reduce from 7.4% in May to less than 5% in Quarter Two will be led by the Consultants in A&E and will be facilitated by the newly appointed Manager of Emergency Care.
There have been 2.7% of elective admissions patients readmitted since April 2011 against a maximum tolerance of 2.5%. A number of steps are being implemented to reduce readmissions including piloting telephone calls to patients to check on their condition post-discharge and improved access for patients to consultants or nurse specialists via the provision of a dedicated telephone number.
- Points of particular interest only
Annual Quality Account
Legislation now requires all NHS Trusts to produce an Annual Quality Account as well as an Annual Finance Account. This will be published on the NHS Choices website by 30th June. Preparation of the Trust’s Quality Account is in progress, but still subject to amendment. It identifies seven priorities for 2011-12:
1. An enhanced recovery programme for orthopaedic patients and for some bowel and gynaecological operations.
2. Better clinical pathways for dementia and diabetes, jointly developed with primary care.
3. The Leaving Hospital Project – focused on improving patients’ experiences.
4. The first Contact Project – improving the outpatients’ experiences.
5. Better communication.
6. Improvement in the maternity services.
7. A set of quality targets agreed with the Trust’s commissioners, including more clinical pathways, reducing short stay admissions, improving discharge communication.
April 26th was an historic day. Hillingdon Hospital always said it would continue to meet in public if it gained foundation trust status – and, in contrast to some foundation trusts who stubbornly hold all Board Meetings behind closed doors, Hillingdon Hospitals has kept its word. Achieving this new status is a great credit to the hard work of the Trust, as the path to success is complex and demanding. Now it has the pleasure of heading the field , while for neighbouring NHS Trusts this status is still a far goal. In the process it has changed its name. Have you noticed that it is now The Hillingdon Hospitals FT? Only one letter different, but at last Mount Vernon is in on the act!
The first Board Meeting in public heard very good news. All last financial year’s targets were met. Earlier this month the Minor Injuries Unit at Mount Vernon celebrated 15 successful years in operation – it enjoys high public esteem, serves 24,000 patients and undertakes approximately 8,000 radiological scans per year. There was good news for patients too – the Board is surveying its hospitals for introduction of hearing loops to assist people who are hard of hearing and it hopes to complete the work in the year ahead.
Let’s hope this good beginning leads to further success ahead.
Good news all round – a year to date surplus in February of £8k, and ahead of its efficiency savings plan by 5%, partially explained by its massive 47% decrease in use of agency staff despite only a 4% increase in use of its own “bank” staff. Agency expenditure in February was the lowest since December 2006 and at £108k was £100k lower than the average for the first ten months of the year. The forecast year-end financial position remains a surplus of £295k.
Inpatient activity rose by 4.6% compared with last year and outpatient activity by 9.2% - but clinical income rose only 5.2%, as a consequence of the contractual caps on charging. Without the caps clinical income would have risen by 2% more.Births:
In February there were 323 births against 269 in the same month last year.Help ahead for deaf patients and visitors:
Over time, loop systems are to be introduced in around 50 sites in Hillingdon and Mount Vernon hospitals. Main reception areas will be the first to have this very useful facility.
RUMOUR OF A&E CLOSURE:
This rumour circulated locally at the end of February. The Gazette carried a refutation on Wednesday 23rd February and at the Board Meeting in the afternoon it was totally dismissed, which was reassuring. Where do such rumours come from?
PROGRESS TOWARDS FOUNDATION TRUST STATUS:
Other rumours had suggested that The Hillingdon Hospital Trust would not be able to become a foundation trust if the Hillingdon health economy were in financial difficulties. Since NHS London Board papers show that NHS Hillingdon is expected to end the financial year in deficit, there was cause for concern. However, at the February Board Meeting of the Hillingdon Hospital Trust, reassurance was given. David McVittie, Chief Executive, noted that NHS Hillingdon is now part of a cluster of PCTs – Ealing, Hillingdon and Hounslow – and finances are in such flux between them, that their difficulties are unlikely to impact on the hospital. The application for foundation trust status is progressing well and there is hope of success by 1st April 2011.
STRATEGIC PLAN 2011/12:
This is a comprehensive document, rolling forward the 5-year Plan agreed last year. Interesting components include: a) Expansion of the Acute Stroke Services to a 24-bedded unit with an integrated therapy suite at Hillingdon Hospital, to cater for stabilised stroke patients and “high risk” TIA patients. b) For Elective Orthopaedics the intention is to continue to develop a centre of excellence for trauma services at Hillingdon Hospital, transferring elective activity to Mount Vernon Hospital. c) Following a bidding process the Trust has been selected as one of the providers of a Paediatric Oncology Shared Care Unit, which is very welcome.
Year to date financial performance in February was a surplus of £46k, 20k better than plan, and efficiency savings progressed well too, also ending the month ahead of plan. The forecast year-end financial position remains a surplus of £295k.
BEVAN WARD RESEARCH
Research collaborations were formed with two academic teams, York Health Economic Consortium and Space Syntax (a consultancy that explores how design affects performance. The research was widely based considering patient and staff satisfaction, clinical outcomes, cost, impacts of ward layouts on travel patterns and walking distances, ease of observation by staff of patients and patients of staff, patient experience and staff preferences.
EXPECTED AND UNEXPECTED OUTCOMES
Some outcomes were unexpected. During the first ten months there were 33 patient falls, which was more than the 24 falls in the corresponding period a year before on Fleming Ward, which was transferred into Bevan Ward as a research study. On Bevan 30% of falls happened in the bathroom and a further 22% occurred whilst the patient was walking to the toilet in their own room. Reasons have been explored. Patients may be taking more risks because the bathroom is closer, but the design of the prototype door has been reviewed by the Department of Health so that this feature can be altered in other clinical environments.
Length of stay was expected to reduce owing to factors such as improved sleep quality in a more composed setting, but in Bevan Ward the length of stay did not alter significantly.
As expected the larger floor space and increase in number of bathrooms increased the cleaning costs in Bevan Ward. Cleaning hours were adjusted from 10 hours per day to 17.5 hours per day.
DO PATIENTS LIKE SINGLE ROOMS?
Perhaps the most revealing outcome concerned patients’ views on single rooms. 87% did not feel isolated and 92% would prefer a single room for a future admission to the hospital but there remained some patients who had concerns about being in a single room and lack of socialisation. There have been three pieces of work about socialisation factors and social areas are likely to be included in all new design proposals for this Hospital Trust.