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.
Congratulations were offered to the Stroke Team at Northwick Park Hospital who for the last quarter have received the highest performance scores in the country, officially making their unit the best in England.
The lack of entertainment (TV) in the care areas at St.Marks Hospital was seen as a concern. Access to Wi-Fi was seen as a benefit for those with personal devices. A system for public access would require a public/private partnership with a provider and that possibility would be looked at as a way forward.
A number of water quality issues on a Ward at Northwick Park Hospital relating to pseudomonas aeruginosa were reported between August and September. The Trust sought expert advice from Public Health England and extensive remedial estates work has been completed. The situation is closely monitored and ongoing maintenance works continue. An epidemiological study is being undertaken as part of the outbreak investigation.
The new A&E department at Northwick Park Hospital opened on 10th December. It includes 40 individual bays, to provide patients with greater privacy. Staff were involved in the design, which incorporates a children’s A&E and Urgent Care Centre. The new facility is co-located with theatres, intensive care and ward beds.
To ease the pressure in the next few weeks, there will be an extra 20 beds at Northwick Park Hospital and 20 beds at Ealing Hospital. A second phase will see 24 beds opened at NPH around February 2015. There are long term plans for another 60 beds at NPH.
The Trust’s Staff Excellence Awards will be held on Thursday 12 March 2015. Nominations can be made by the public, colleagues or patients and can be for a single act of excellence or for a broader contribution to patient care and team building. For nominations, visit www.lnwh.nhs.uk/about-us/awards or, for paper applications, phone 020 8869 3552.
A Care Quality Commission Improvement Action Plan is in place for Northwick Park Hospital and St.Marks Hospital. Part of the problem is still lack of staff
Finance: At end of September, the deficit was £9,077k, which was £5,315k worse than budget.
Northwick Park Hospital Accident & Emergency: This department is still struggling to meet the target to admit or discharge patients within four hours but the Care Quality Commission report acknowledges that it provides good, compassionate care.
Opening of the new A&E Department at Northwick Park Hospital: The date and time have not been announced but the move is very close. It will take place in the early hours, when there are fewer patients. Plans are in place for extra beds during the transfer, to allow a smooth process but, even so, initially some minor problems are to be expected.
Infection prevention and control: Both MRSA and clostridium difficile are within their targets .
Car parking at Northwick Park Hospital: The car parking fees are locked into long contracts, so cannot be changed. Problems over early morning parking by staff relatives may be a factor in limited parking for patients later in the day – this is to be checked and addressed as necessary.
Staffing: Nurses have been recruited from the Philippines, India and Spain but it will take some time for them to be ready to start work. Staff shortages of nurses and consultants have declined.
Care Quality Commission: A CQC Compliance Manager is to be recruited to support both the CQC Compliance Improvement Plan and the Trust’s Quality Improvement Plan. The QIP has four work streams:
Governance (policies, complaints, incidents)
Workforce (staff appraisal, safe staffing)
Patient experience (acting on feedback)
Environment (equipment, facilities, buildings)
Harrow patients treated in Hillingdon: To date 159 Northwick Park patients have been admitted to Edmunds Ward at Mount Vernon Hospital, to ease the Northwick Park pressures - 112 patients for rehabilitation services and 47 awaiting arrangements for complex placements.
Ealing Hospital: In view of the recent merger of this hospital with North West London Hospitals, the Care Quality Commission’s inspection will be postponed until next year. It is encouraging that there is high staff satisfaction at this hospital.
This is not a summary – only items of particular interest are noted
Prime Minister’s Challenge Fund:
- 45 practices in Hillingdon are taking part, in six networks, covering over 275,000 patients.
- £750,000 is available for networks to use on urgent, continuing and convenient care.
- Currently 12 practices are open on Saturdays.
- 34 practices offer telephone consultations
- 38 practices offer online appointment booking
- Networks are focusing on 24 hour blood pressure monitoring , respiratory reviews, diabetic care, targeted clinics for those using A&E and urgent Care Centres, and wellness programmes
- Health and Social Care Coordinators and Primary Care Navigators have been appointed to support delivery of Care Plans and to signpost patients to Hillingdon services and resources.
- A joint team of hospital staff, community nursing and Age UK is helping people who have had a serious medical event to regain independence as soon as possible.
- A crisis management and home treatment service is helping older adults with mental health conditions
Central & North West London FT
- The CNWL mental health services in Hillingdon rreceived last year 14,000 referrals, supported 10,000 people and provided hospital care for 561 patients
- Due to resourcing difficulties there is only a limited service for children and young people with mild / moderate mental health difficulties, but CNWL provides services for complex and severe cases.
Royal Brompton & Harefield FT
This Trust, working from two sites, is the largest specialist heart and lung centre in the UK and among the largest in Europe
The London Ambulance Service
- In 2013-14 there were 44,003 Hillingdon calls to the LAS. April to October 2014 has seen a 2.4% increase in growth.
- There were 17525 life threatening Hillingdon incidents, to which LAS responded within the target of 8 minutes in 76.62% of cases – a better response rate than achieved for London overall.
- However in April – October 2014 there was an increase of 6.33% in Category A calls and that response target was not met.
- A complete restructure of Operational and Control Services management structure will be in place in March 2015, which is expected to deliver cost savings, but that is not the primary role.
- There is a national shortage of paramedics, which is being addressed by closer links to universities, and recruitment in Australia and New Zealand.
Care Quality Commission
- The CQC plans to inspect mental health trusts and independent mental health services between November 2014 and March 2015 , including Central & North West London FT. Its focus will be:
- Is it safe?
- Is it effective?
- Is it caring?
- Is it responsive to people’s needs?
- Is it well led?
Other reports received by the Committee came from: Hillingdon Clinical Commissioning Group, The Hillingdon Hospitals FT, Healthwatch Hillingdon, Local Medical Committee.
Nick Hurd MP has been working behind the scenes to encourage interest in developing the site for community use and he has been given six weeks to see what he can achieve.
NHS Property Services, which now has responsibility for the site, is offering the site to public sector organisations for 40 days. If there is no public sector interest, the site will then be up for sale.
The Community Voice, of which we are a member, has always fought in every possible way to enable this war memorial site to serve local people. Other members include both Northwood Hills Residents Association and Northwood Residents Association. The Community Voice is awaiting the outcome of Nick Hurd's endeavours before deciding how best to respond to the current threats.
Establishment of London North West Healthcare NHS Trust
- A Merger Agreement was entered into by the two Trusts, three Clinical Commissioning Groups (CCGs) - Brent CCG, Ealing CCG, and Harrow CCG, and also NHS England and NHS Trust Develop Authority.
- The Merger Agreement sets out details of the £144.3m funding support that will be available to the new Trust. It also outlines the principles that will be followed to resolve the structural deficit associated with the Central Middlesex Hospital site and the approach that will be taken should the future of that site not be resolved within the next three years.
Board appointments There will be six standing Trust Board Committees:
- Audit Governance and Risk Committee
- Finance, Investment and Estates Committee
- Clinical Performance and Patient Experience Committee
- Strategy, Organisational Development, Human Resources and Communications Committee
- Charitable Fund Management Committee
- Senior Appointments and Remuneration Committee
Clinical Quality and Safety The process to transfer Clinical Quality Commission (CQC) registration from the legacy Trusts to the new Trust will involve de-registration of the legacy organisations and simultaneous registration of the new Trust. All documentation has been completed and submitted in final draft form for preliminary review by the CQC registration team.
Regulated activities and clinical services provided at the seven currently registered locations of Ealing Hospital Trust and the North West London Hospitals Trust are unchanged by the merger. The seven locations registered under the new Trust will be:
- Central Middlesex Hospital
- Clayponds Hospital
- Denham Unit
- Ealing Hospital
- Northwick Park Hospital
- St. Marks Hospital
- Willesden Centre for Health and Care
Existing CQC registration will remain in force at all locations until the new Trust’s registration is issued.
- Approval of the banking arrangements for the new Trust was agreed.
- The new Board received an update on the 2014/15 financial position of the legacy trusts.
The merger between NWLHT and Ealing Hospital NHS Trust: This merger, to form London North West Healthcare NHS Trust, takes place on 1st October 2014. The merger has been overseen by David McVittie, Chief Executive of both Trusts , who has announced that he will retire in March 2015.
b. North West London Hospitals Trust:
Finances: The savings target of £17.4m was achieved for 2013/14 but the Trust’s planned and agreed deficit means that it did not meet its statutory obligation to break even for the year, which damages its performance rating.
Merger with Ealing Hospital NHS Trust: The underlying trading deficit persists, as do costs associated with organisational development, but both the NHS Trust Development Agency and NHS England are supportive of the merger, and £9.5m of funding has already been agreed with a balance of £1.8m still under negotiation.
Breaching the 18 week maximum wait for treatment target: The Trust has apologised to all the patients concerned and communicated with all relevant stakeholders about this problem. No patient died or suffered significant clinical harm but many were distressed by the long wait for treatment. Improving the service depends upon workforce recruitment, which may be difficult.
More demands on emergency services: In March 2014, the A&E at Northwick Park and the Urgent Care Centres there and at Central Middlesex Hospital saw rises in attendance compared with this time last year and more emergency admissions. GP referrals rose by 7.9%.
An award for improved weekend services! Dr Foster Intelligence presented the Trust with a highly commended award for its highly significant improvement over the previous year.
Infections: With 21 cases of clostridium difficile in 2013/14, the Trust was within its target of maximum 26 cases. For MRSA bloodstream infections the target was zero, so with two cases in the year it failed this target, but the outcome was better than last year, which had five cases.
Health & Wellbeing Strategy Action Plan: The strategy has four priorities a) To improve health and wellbeing / reduce inequalities. b) To invest in prevention and early intervention. c) To develop high quality integrated, social care and health care services in the community or at home. d) Better experiences of care.
Better Care Fund – Hillingdon Plan: In 2014-15 LBH Hillingdon will receive £4.772m for social care services which support health. The following are some of the factors involved:
- Plans for use of this funding must propose reduction of emergency admissions by 3.5%.
- A key component is the Integrated Care Programme (ICP) where high risk patients are identified and managed through health and social care plans. From July 2014 GPs will have the tools for active monitoring of care plans, aided by Health and Social Care Co-ordinators who currently being trained.
- The key target is all people over 75 years in Hillingdon.
- End of life care is being improved, with the use of new criteria from September 2014.
- NHS England is provided funds for Hillingdon Hospital Trust to develop integrated digital care records for its clinical services and Central & NW London FT, which will support implementation of Virtual Wards.
- Seven day working is being analysed to identify gaps in health and social care.
- The care homes initiative has started with identification of community matrons aligned to GP networks, who will be expected to improve quality within the homes
Hillingdon CCG Five Year Strategic Plan: This is part of the North West London programme “Shaping a Healthier Future”, drawn up in partnership with NHS England. Its key features are:
- Health promotion, early diagnosis and early intervention
- Out of hospital care including primary care transformation
- Integrated healthcare and social care
- Transforming mental health services
- High quality and sustainable acute health care in NW London
- Improved quality and safety of care / measuring of success
Allocation of S106 health facilities contributions:
- Several GP expansion schemes have received support
- New Yiewsley Health Centre (former Yiewsley Pool site) – work starts in September 2014 with expected completion by February 2016 to provide the new health centre, a gym and 12 supported housing units.
- Planning permission for the St Andrews Park development on the old RAF Uxbridge site included a GP surgery, which proved too small to be the CCG’s Uxbridge hub. The property developers are instead paying £624,507.94 to the CCG, which is looking for an alternative site for the Uxbridge hub.
Hillingdon CCG Finances: In 2013/14 Hillingdon CCG had an agreed three year recovery plan for its inherited PCT deficit, to restore underlying financial balance. Its 2013-14 deficit plan of £12.25m was bettered by £7m but left an underlying deficit of £15.4m. In November 2013 it was noted nationally that CCGs with inherited deficits were underfunded against the national formula - for Hillingdon CCG this equates to an underfund of about £23m per year. Hillingdon CCG is still 9% under its target allocation but a balanced budget has been set for 2014/15, dependent on help from the NW London Financial Strategy and NHS England, but still with an underlying deficit, and absence of the usual required 1% surplus until 2016/17.
Prime Ministers Challenge Fund and GP Networks: The 8 NW London CCGs submitted a successful bid for this funding to set up GP networks, improve IT infrastructure to allow patients to book appointments online and to have access to their own healthcare records, and to enable GP practices to share skills and offer services to patients across their network. There are six GP networks in Hillingdon.
Integration of Services: The 8 CCGs in NW London and seven local authorities, but not Hillingdon, were successful in their joint bid for pioneer status. Each CCG will take forward its own integration plan but will benefit from shared lessons and joint elements eg legal advice on network formations. The pioneer project pilot in the north of Hillingdon will focus on 1000 patients aged over 75 years with one or more long-term conditions – five local voluntary sector providers are working in a consortium called “Hillingdon 4 All” to support this work. The pilot proposal will be finalised in October 2014 and is expected to start by April 2015.
Medication error reporting: NHS England and the three outer London CCGs have agreed that too few medication errors are reported and have therefore set targets for increased reporting of incidents to promote robust reporting processes, encourage staff to report errors, and to identify where changes are needed.
Cancer: This is one of London’s four top priorities because UK survival rates are behind international best.