This page will contain local overview information, such as reports on local NHS services from Hillingdon’s External Scrutiny Committee; this Committee is set up by Hillingdon Borough Council and all its members are Hillingdon Councillors.
The page will also contain information about neighbouring NHS services, including Northwick Park Hospital and Watford General Hospital, which are sometimes used by Hillingdon residents.
In December, LNWHT received £105 million from ITFF, consisting of £69 million to cover a revenue deficit, £21 million to improve liquidity and £8.8 million to boost its bed base. The trust, formed from the merger of Ealing Hospital Trust and LNWHT in October 2014, saw its financial performance deteriorate “significantly” in 2015, documents revealed.
The organisation had been predicting a £19.1 million deficit after “synergy savings” from the merger of £15 million. Instead the trust has a deficit of £75 million. The ITFF criticised trust governance and the NHS Trust Development Authority for allowing the situation to worsen.
The ITFF committee minutes from December said: “While steps are being taken now, the committee questioned why intervention is seemingly so delayed. At the time of the merger, the committee recommended that additional board strength would be required. It would appear that delays in rectifying this issue, as well as seemingly poor due diligence, have led to significant problems that have in turn been allowed to worsen for a significant period of time.”
A trust spokeswoman said: “The trust recruited a new chief executive and executive team that were in place by the second half of last year. In addition, an improvement director and team were appointed midway through the year.
“With the new team, the trust was successful in halting a further deterioration in financial performance and ended the year achieving the planned deficit. Pay costs were reduced by an average of £2 million a month in the second half of the year, compared to the first six months, and this improvement has continued.”
From the Evening Standard—21 June. More parents will be forced to rely on Northwick Park Hospital (NPH) when Ealing’s paediatric ward is closed from June 30. However, the recent Care Quality Commission (CQC) report for NPH reported “examples of poor infection control practice, leading to higher infection rates for C. difficile and MRSA than expected.” Stricter infection controls procedures have been ordered.
The report reveals inspectors were so concerned at some aspects of care that they served a warning notice on NWHNT after their visits last October and November, ordering significant improvements. This was because there was “sparse” medical cover on its high dependency unit at the weekend and “frequently no doctor”.
The trust, was rated as “requires improvement”, but received a “good” score for its services’ caring nature.
Professor Sir Mike Richards, the CQC’s chief inspector of hospitals, said: “We found all staff at the hospitals were dedicated, caring and supportive of each other within their ward and locality. However, we had significant concerns about the provision of expert support for consultant radiologists at weekends.”
- Crick Ward Assessment Unit 24 beds (incl. one bariatric)
- Darwin Ward Acute Short Stay Unit 24 beds (incl. one bariatric)
- Elgar Ward (infectious diseases) 15 beds
This £14m facility represents a state of art working experience for staff and patients and should improve patient flow by helping to speed up the patient pathway from A&E admission to ward bed and safe discharge.
Junior Doctors’ Industrial Action As a direct result, 18 elective and 688 outpatients appointments were cancelled. 50 members of staff took part in the action. New appointments will be given according to priorities and extra clinics to help will be run.
Breaking The Circle Despite the recent increase in demand for services, the changes include:Reducing the number of London Ambulance Service waits of over an hour, 30 minutes and over 15 minutes;
- Discharging patients earlier in the day helping to reduce the time patients wait in A&E for a bed and improving patients experience;
- Starting Older People Assessment & Liaison Service working within emergency pathway ensuring that frail elderly patients receive the best possible care as early as possible;
- Introducing new processes and systems in communication with Social Care and Community Services in the management of long stay patients.
Fighting Flu The national target of 75 % of staff vaccination has not been reached; by 15th January, only 35.5% of staff had agreed to be vaccinated.
Staff Excellence Awards The 2016 LNWH Pride in our Staff awards will recognise the excellence of individuals and teams working for the Trust. 211 nominations have been received up from 180 in 2015.
Ealing Emergency Department Receptionists have received a commendation for “Outstanding contribution to Community Safety in Ealing Borough” from the Metropolitan Police.
Relocation of Denham Unit Denham Unit was relocated from Harrow to CMH on 8th January. It is based on the former Roundwood 1 Ward.
ENT services At Ealing Hospital Since 18th January, ENT services from Ealing Hospital are now provided by clinicians from NPH and CMH rather than Imperial College Healthcare. Patients will continue to be seen at Ealing and listed for surgery at NPH or CMH at first, with expansion into Ealing over the next couple of months.
Shaping A Healthier Future Update On 14th January, the NWL Clinical Board considered the Independent Healthcare Commission for NWL’s final review of the SaHF programme and issued their report in early December 2015. They concluded that the current programme continues to offer the best outcomes, experience and equality of access to NHS services for patients.
Board Report Summary The Trust is making preparations for dealing with major incidents (terror attacks) in light of the recent tragic events in Paris. NHS England and Department of Health are seeking confirmation and assurance from all acute Trusts that they have suitable plans and systems in place to respond to a similar style Marauding Terrorist Attack (MTA) in the UK.
- Income & Expenditure position is a year to date deficit of £76.3m which is £10.3m behind plan.
- CIP delivery to date is £13.5m which is £1.5m behind planed forecast outturn remains at £88.3m, in line with plan, but this remains high risk.
- The Trusts Financial Sustainability Risk Rating (FSRR) with the TDA is currently 1.
- Capital expenditure is £24.3m to date, £5.7m behind plan.
Neonatal Mortality The data are collected nationally by MMBRACE-UK (Mothers and Babies : Reducing Risk through Audits and Confidential Enquiries across the UK) This reports 2 years later, so at the end of 2015 the outcome was for 2013.
The Trust was green for stillbirths (expected position), yellow for extended perinatal deaths (better than expected by up to 10) and amber for perinatal deaths (up to 10 % greater than expected). MMBRACE-UK recommends review of amber and red gradings. This has been completed and no pattern has been found requiring remedial action. Using our own data, subsequent years have been reviewed and the extended perinatal mortalities numbers are low.
Only items of particular interest are noted below – a huge number of issues were covered in the papers.1. Primary Care Co-Commissioning: Hillingdon Clinical Commissioning Group (CCG) entered Primary Care co-commissioning arrangements with NHS England in April 2015. Currently this is restricted to General Practice as dentist, pharmacists and optometrists continue to be wholly commissioned by NHS England. Originally it was proposed that the eight North West London CCGs would work jointly with NHS England, but it has now been agreed that Joint Committees will be held locally and only meet in common when necessary to secure strategic alignment across NWL.
- General Medical Services (GMS): Most work under this nationally negotiated contract.
- Personal Medical Services (PMS): 10 work under this locally negotiated contract with premium funding to support specific service initiatives.
- Alternative Provider Medical Services (APMS): One such contract is held in Hillingdon. This is locally negotiated and can be held by a non-GP who employs salaried GPs.
- Historically higher levels of violent crime in Hillingdon
- Higher rates of homelessness
- Higher rates of sexually transmitted infections and tuberculosis
- People diagnosed with diabetes is higher than average in Hillingdon
Certain lifestyle factors increase the risk of ill health including smoking, poor diet, lack of regular exercise and higher levels of alcohol consumption and/or binge drinking. 24% of Hillingdon adults are estimated to be obese. Age and other related conditions also affect health and wellbeing. Many people over 65 years have one or more long term conditions. It is also estimated that 4,600 Hillingdon children have a specific mental health need which requires support.6. “Like Minded”: This North West London CCG's mental health programme recognises that too many people think that mental illness will not affect them, but it could. It affects more people than cancer, heart disease, stroke or diabetes. In the course of a year almost one in four people will have a diagnosable mental illness. The CCG's mental health programme faces eight major issues:
- Too many people face mental health needs alone
- Not enough people know how to keep mentally well
- Quality of care needs improvement for those with serious and long term mental health needs
- Too many people experience common mental illness, such as depression and anxiety, in silence
- 3 in 4 mental health disorders start before the age of 18 years
- New mothers, those with learning difficulties, the homeless and people with dementia do not get the right mental health care when they need it
- Too many people with long-term physical health conditions do not have their mental health taken into account – and vice versa
- Our systems often get in the way of providing high quality care
Following a CQC inspection in late April the private obstetric service was suspended from 1st May in order for the resources to be focused on the NHS service. It is likely to remain closed for the foreseeable future.
The triage system in Accident & Emergency has also been strengthened following the CQC visit.
St Albans hospital is to undergo a £900,000 upgrade. Day surgery facilities will be improved and there will probably be more day surgery cases transferred to that site. Work is being undertaken to improve performance as the 4 hour wait times for A&E, Referral to Treatment targets, Diagnostic wait times, ambulance turnaround times and number of cancelled operations were consistently missed in the past year. The theatres on the Watford site are to be upgraded as they are not fully compliant with modern recommendations for ventilation etc. The theatres will be closed while this work is undertaken, but the situation will be managed by forward planning, day surgery where possible and the hire of a mobile theatre.
Interviews for the position of Chief Executive were held, but no appointment has been made. The job description and person spec are being tightened with assistance from the Trust Development Authority and the post re advertised. In the meantime Ms Jac Kelly will remain in post.
Finance: The Trust ended the year 2014/2015 with a deficit of £13 million, slightly better than forecast, however the projected deficit for 2015/16 is £32.8 million, a figure that the TDA does not like!! The problems are manifold: the physical hospital estate is wholly inadequate for modern healthcare with over half in a poor or bad condition. Watford Hospital is crowded and dominated by emergency and unplanned care, while significant parts of St Albans and Hemel Hempstead sites are under utilised and costly to maintain,
IT infrastructure and systems are underdeveloped and outdated. This impacts operationally and creates inefficiencies in how care is delivered. Staff experience delays due to limited access to IT and out of date technology with clinicians queuing to view test results, complete discharge summaries or make requests.
The above paragraph is copied from the report almost verbatim. It is a credit to the dedication of the staff that the hospital functions as well as it does. A large chunk of overspend is agency staff - the Francis Report following the Stafford Hospital debacle recommends a minimum number of qualified nursing staff per number of patient beds. This has led to a shortage of RGNs nationally, the attraction of agency working to qualified staff as pay is better, working hours are of choice and there is no lack of demand for staff.
There are plans:
to redesign services to meet targets, including developing a GP led urgent care centre for those patients who really require primary care
to develop a “pit stop” area where senior clinicians can assess ambulance arrivals and start treatment planning early
to develop and expand emergency and ambulatory care services for children and young people
plus serveral other measures which should help meet A&E targets and ambulance turnaround times.
Chief Executive’s Report Jacqueline Docherty thanked everyone for her warm welcome to the Trust.She stated that one of the key themes noted was the high level of staff vacancies and therefore a high level of bank and agency staff (which is very expensive). She would like to make the Trust a place where staff want to work permanently.
- Winter planning has started with the enhancement of a new 63 bedded unit at NPH later in 2015.
- 35 % of staff received flu vaccine last Winter (national target was 75%).
- Theatre 2 at Ealing Hospital opened in early April after a 750K makeover which will ensure high standards of patient care.
- Consultant Microbiologist Dr. Guduru Gopal Rao and Consultant|Neonatal Paediatrician Dr. Richard Nicholl were featured in the Mail on Sunday, 12 April, discussing the benefits of screening all expectant mothers for the bacterial infection Group B Strep.
Maternity Closure at Ealing Hospital On 1st July 2015, the move of the maternity and neonatal unit at Ealing will be completed. All patients have been contacted and as far as possible given a choice where to have their baby. They have also been put into categories of high, medium and low risk and advised where necessary which maternity unit would be the most appropriate for their care.
Election Jeremy Hunt will continue as Secretary of State for Health. Except for Harrow West, all of the local MPs in Brent, Ealing and Harrow are Labour.
A&E Performance The number of patients has reduced and a real concerted effort has been made to improve patient discharges and some of the delayed transfers of care have been addressed. Better signposting should be in place, informing patients about other walk in clinics for minor injuries.
New Medical Consultant Appointments 11 new consultants have been appointed
Acute Medical Unit Recruitment Day To support November’s planned opening of new £14 m acute medical unit at NPH, a recruitment day was held on 21 May.
Finance Budget only started on 1st April 2015 so up till now the results show a control total deficit of £6.9m which is £0.1 m favourable against budget.
New Chief Executive: A short list is being drawn up from nearly a dozen applicants. Interviews will be held on 7th May. Stakeholders are to be involved in the selection process.
Board performance: According to the improvement board representative, the Board’s performance has improved over the last two years and it is functioning effectively.
Integrated performance in February: There were fewer Clostridium Difficile cases. The Accident & Emergency Department was challenged, as were most A&Es nationally, but it had improved from January.
Improved discharge process: Discharge Matrons have proved effective in the rapid discharge programme and additional Consultant rounds have improved the flow of patients.
Cancer performance: Plans are in place to improve performance in line with targets. Patients who were not treated within 28 days in January are to be reviewed and lessons will be learned.
Unscheduled care: Data on this issue is to be brought to the Board sooner, so that swifter action can be taken to reduce the attendant risks.
Finance: Final submission for 2014-15 will be brought to the next Board Meeting. The month 11 year deficit was £17.5 million (£3.8m worse than planned).
Sexual Health services: These services have been taken on by Chelsea and Westminster Foundation Trust. The transition process is underway.
Staffing levels: Information about staffing levels is now displayed on the wards. Staffing levels are now adjusted to cover levels of patient dependence.
Recruitment and retention of nursing staff: Plans are in place to partner other trusts in a recruitment drive in the Philippines and to increase pastoral care for overseas nurses. Questions were asked about increasing the retention and use of Bank staff. More healthcare support workers have been taken on. Concerns were expressed about the time taken to recruit and train new staff.
Care Quality Commission inspection: The CQC was using the Trust’s Boardroom during its inspection, so the Board was holding its meeting in an unusual venue - apologies were given.
Health watch questions:
a) The Trust’s mortality figures: Why are these worse than national rates? Response: the Trust is in line with similar sized institutions, but further work is being undertaken to learn from the statistics.
b) Ambulance crews waiting to hand over patients: Why are up to ten paramedics having to queue in corridors to transfer their patients to Accident and Emergency Department care? Response: Winter pressures cause difficulties, but the Board will look into this situation.
Questions from the public: A member of the public wished to report that the Board has been more approachable over the last two years, which was much appreciated as previously the atmosphere was very confrontational.
At the March 2015 meeting of The Community Voice, of which Ruislip Residents' Association is a member, the guest speakers from the West Herts Hospitals NHS Trust were Dr. Michael Van Der Watt, Medical Director, and Professor Tracey Carter, Chief Nurse.
Dr. Michael Van Der Watt:
a) The aim of WHHT is to strive to deliver continuous improvement in all aspects of patient care through a partnership of clinical leadership, and to create a clear and credible long term financial strategy.
b) There are 3 main hospitals including an Urgent Care Centre, Hemel Hempstead, a Minor Injuries unit, St Albans Hospital, and an A&E department, Watford Hospital, serving 500,000 people with 600,000 contacts per year, with 4,000 medical and lay workers and 500 volunteers working in the Trust.
c) A project named "Onion" - peeling back the layers - was launched in 2013 as a catalyst for change. The Government's response to the Francis Report noted it as an example of best practice in preventing problems and delivering safe patient care. It was highly commended in Health Service Journal Awards.
d) All staff meet at 8.15am every morning to discuss any matters arising around patient care. As a result of "Onion" the Trust is celebrating success with a 28% reduction in mortality, 40% reduction in clostridium difficile, and 95.6% of Accident & Emergency (A&E) patients are seen within 4 hours.
e) An extra £9m had been invested in patient safety, including £3.9m on 160 new nurses, 50 who will be recruited from UK University courses finishing in July and September. Others will be recruited overseas.
f) Many other successes include a new Emergency Surgery assessment unit, a new dietetic kitchen, new cycle facilities and £600,000 on upgrading theatres, £25.5m investment in IT, and £16m investment in upgrading wards, clinics and many other areas.
g) As a result of "Onion" the Trust has learned from complaints, incidents and litigation, and is helping to achieve financial targets.
h) The Trust's performance against key targets has mixed results, achieving above the targets for patients’ waiting time in A&E, and for cancer patients being diagnosed and treated, while missing targets for MRSA and clostridium difficile.
Professor Tracey Carter :
a) WHHT are building on the review "Your Care, Your Future", the NHS Herts. Valley CCG clinical strategy published in 2013. Local organisations – Herts. Valley CCG, WHHT, Herts. Partnership University NHS Foundation Trust, Herts. Community NHS Trust, East of England Ambulance Service Trust and Herts. County Council, have all come together to build on the strategy.
b) The aims of the Trust are to meet the needs of patients in the way health and social care services are provided in West Herts., to improve and redesign these services and address patients' needs now and in the future, and to bring together partners from across the region.
c) An ageing population living with complex health conditions causes an increasing pressure on services and resources. The Trust aims to support patients and carers with treatment in the right place, at home or as close to home as possible, and to keep services sustainable within the budgets available.
d) Effective engagement is vital and views from a wide range of groups of people from all aspects of patient care, will be listened to, by online surveys and at drop-in events, and data will be gathered and analysed for future change by Autumn 2015. Concerns were raised about resources, and if there was enough money to sustain the care of patients. This will be addressed by good practice, due diligence and the best quality of care.
e) Bed blocking is an ongoing problem, as in all hospitals. Staff meet 4 times per day to assess different problems to expedite the discharge of patients either to home or other places of safety, with help from other community partners working together.
f) Following the Francis Report, after problems with the Mid Staffordshire hospitals, the ratio of trained nursing staff has been increased. There is a shortage nationally of Registered General Nurses and temporary staff are employed to fill vacancies. Recruitment is ongoing in UK and overseas.
g) The implementation of a certificate in April 2015 will be required for Health Care workers, and training will be in house. This will help to provide better care for patients.
Both speakers were thanked by Wendy Mahaffey on behalf of the members.
New Chief Executive appointed: This was the last Board Meeting which Samantha Jones would attend as Chief Executive of the West Herts Hospitals NHS Trust (WHHT). She left after this Board Meeting to take up a post with NHS England. She reported that WHHT is a work in progress but that the transformation work will continue to progress in the right direction under the auspices of the new Chief Executive, Ms. Jac Kelly MBE, who joins WHHT from the North Devon NHS Trust.
“Operation Onion”: This communication strategy was introduced by Samantha Jones. It was highly commended in the November Health Service Journal (HSJ) awards. It achieved a 25% reduction in hospital mortality since being introduced and a 40% reduction in cases of hospital acquired Clostridium Difficile.
The Care Quality Commission 2014 survey of Accident & Emergency Departments: Between January and March 2014 the CQC surveyed the 142 Acute Trusts with A&E departments. Its results were published on December 2nd 2014. WHHT scored “average” in all categories with “above average” in 5 subcategories. NHS Trusts are currently listed for inspection by the CQC in band priority, with Band 1 being “highest priority” to Band 6, the lowest priority. WHHT is in Band 4 (an improvement on its previous placing in Band 3) and the Trust is scheduled for full CQC inspection on 13th April 2015.
Bluebell Ward, the specialist dementia ward at Watford General hospital: Congratulations are due! This ward won an NHS Employers “Compassion in Practice” award in December 2014.
Finances: WHHT is projecting a £14 million deficit at the year end in March although this figure includes a promised £7 million cash sum from the Herts Valleys Clinical Commissioning Group toward the WHHT “Transformation” Fund. If this promised amount is not forthcoming (HVCCG has cash problems of its own) the WHHT deficit will be £21 million. The HVCCG meeting is on 29th January 2015.
Survey on local NHS and social care services: There is currently a survey in which patients, staff and public are being invited to have their say on the way in which local NHS and social care services are provided. The survey, which is quite short, is available on www.yourcareyourfuture.org.uk. The closing date for responses is 31st January 2015.