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.
The meeting began as usual with a “patient story” which in this instance involved a great deal of muddle over an Outpatient appointment. The CE, Ms Sam Jones, apologised and said that the error due to poor booking processes which remain of concern but are improving with increased staff training and improvements to the IT system.
The endoscopy units in the Trust received a national accreditation, which only one in three endoscopy services in the country, NHS or private. The assessors praised the cohesive team work and positive patient feedback. It was recognised that the units have comprehensive clinical governance and audit processes in place.
The TDA (Trust Dev. Authority) has given the go ahead for the Trust to improve IT across the three sites. £37 million is to be invested over the next 5 years.
The theatres Watford and St Albans hospitals have just undergone major refurbishment at a cost of £11 million. This money is part of the £16.2 million grant received last year to upgrade the hospital estate.
A new Emergency Surgery Assessment unit (ESAU) was opened in May this year. There was an increase of 16% in emergency cases treated last year and the number is rising continually. Watford frequently experiences more than 100% bed occupancy, which poses real risk as patients are placed in inappropriate 'outlying areas' e.g medical patients in orthopaedic beds or patients in beds in the cardiac catheterisation lab. The cardiac and orthopaedic surgeons have written to the Board to protest at this. This also has a negative effect on the treatment of elective patients (and also on the budget).
There has been a serious complaint recently about cleanliness (or lack of) on the post natal wards. A deep clean has been carried out and refurbishment of that area, particularly the bathrooms, is being brought forward. Patients and relatives should complain through the PALS service.
A new Chief Nurse, Professor Tracey Carter has been appointed and will take up her post from the end of July. She is currently deputy Chief Nurse in the Barts and the London NHS Trust.
There has been a large increase in the number of Serious Incidents reported. This is because of a new method of reporting these. Many of them relate to pressure ulcers at Gd3 or above. Very few SIs is not necessarily a sign of a good NHS facility, but often a lack of openness in the institution.
The number of RGN qualified nurses on duty on any shift is displayed for patients, staff and visitors to view in every clinical area. The information is available on the Trust website under “Patient Experience”
The 'Quality Report' for the last year will be on the Trust website by the deadline of 30th June. All the Board meeting papers are available as well for anyone wishing to read them.
Ken Appel, the Herts HealthWatch representative, asked at the end of the meeting why so many patients are referred to Harefield Hospital for angioplasty rather than having the procedure at WGH. The response was that WGH as voluntarily decided not to offer this procedure as 400 cases p.a. is the minimum number regarded as sufficient for a team to retain expertise. The Trust has been asked by the CCG to look again at this decision as many other hospitals offer the service while not performing the required number of angioplasties.
The business case for the merging of North West London Hospitals NHS Trust with NHS Ealing Hospital NHS Trust has been approved by the Boards of both Trusts and has subsequently been submitted to the Trust Development Agency. If approved, the merger will form one of the largest integrated trusts in the country, to be called London North West Healthcare NHS Trust. The launch of the new trust is expected in October 2014. It will comprise Central Middlesex, Ealing, Northwick Park, and St Mark’s hospitals, with community health services in Brent, Ealing and Harrow, including Clayponds Rehabilitation Hospital, Meadow House Hospice, the Denham Unit and Willesden Centre.
The new Trust will have over 8,000 staff, serve a population of over 850,000 with a budget of over £640m a year. For more details Tel: 020 8869 5220 for a brochure.
The two trusts already have a joint clinical strategy and share a patient administration system with 3.6m patient records.
North West London Trust Board Meeting, Wednesday 30 April 2014 at ACA
Chief Excecutive Report: Dr. Foster Intelligence presented the Trust with a highly commended award for making significant improvements in week-end performance between 2011/12 and 2012/13 (increased consultant cover, improved access to therapists and extended hours for services such as gynaecology direct referral and surgical assessment unit).
Merger with Ealing: Still problems with costs associated with organisational development
- structural funding support for Central Middlesex Hospital
- underlying trading deficit
The Trust Development Agency and NHS England are supportive of the merger and £9.5m of funding had been agreed with a balance of £1.8m still to be agreed.
18 Week Wait Referral Pathway at NWL Hospital Trust: Trust has apologised to patients affected and communicated with all relevant stakeholders, local council, GP’s, NHS England and NTDA Delivery of additional activity on 18 week pathway will depend upon recruitment of workforce. Apart from distress, evidence shows that no patients came to significant clinical harm as a result of their wait. No patient has died as a result.
Performance Report: Attendances at the main A&E Departments and Urgent Care Centre at Northwick Park Hospital and Central Middlesex Hospital saw a significant rise in March in comparison with March last year. Emergency Admissions have increased in March. Overall GP referrals were 7.9% higher than the year period of 2012/13.
Births have shown a small decline.
Friends and Family Test is reported monthly for all Trusts: The overall score are down in A&E but the Emergency Medicine Directorate team are developing plans to improve the NPH score.
Finance Report: Temporary borrowing of £20.8m has been agreed and fully utilised in year. The QIPP target of 2013/14 is £17.4m of which £17.4m has been delivered to the end of March in line with plan. The I&E planned deficit means the Trust will not meet its statutory duty to break even which will have a detrimental impact on the Trust’s performance rating.
Disposal of Foetal Remains: The Trust does not incinerate foetal remains, which are either buried or cremated on an individual basis in accordance with parents’ wishes.
Funeral arrangements for babies/non viable foetus under 24 weeks gestation are detailed in the Trust’s Pregnancy Loss Guidance.
Complaints report: Decrease of complaints compared with last quarter. The Trust response times need to continue to improve to meet the Trust’s first response to 75%. The Trust continues to support staff training in complaints management.
The Trust also received many thank you letters and notes within wards and departments.
Infection Prevention and Control: 21 cases of Clostridium difficile against an end of year position of no more than 26 and two cases of MRSA bloodstream infection were reported in the year compared with 5 in previous year.
Care Quality Commission Unannounced Inspection at Central Middlesex Hospital and Northwick Park Hospital: An unannounced inspection showed that all 11 Standards have been met (see link below) but work still needs to be done (http://www.cqc.org.uk/node/316023).
Maternity: More midwives are being recruited to make improvements following a national survey.
Accident & Emergency: Huge challenge due to increased number of patients and the need to meet the 4 hour waiting time target. Additional beds have been opened and extended operating hours to improve discharge time and to prevent patients coming to A&E in the first place. New A&E consultants have been appointed. The £21m new A&E department should open in Autumn 2014.
Merger Update: Timeline has been delayed by three months and the staff notified. Delays arise due to independent organisations not having signed off the finances through their own Boards.
Staff Survey: This Trust is in the top 20 % of Trusts for Health & Safety training and Equality & Diversity training. Improvements are needed in training staff who experience bullying and harassment from patients/relatives.
Joint Clinical Strategy Event: Clinicians from the six clinical areas are developing a joint clinical strategy ahead of the merger with Ealing Hospital NHS Trust, presenting their vision for future services to benefit patients.
Income And Expenditure Budget 2014/15: The Trust has been awarded more than £320.000 to buy technology for nurses, midwives and care staff. The Trust is one of 75 NHS Trusts in the country which will be able to invest in new technology projects to improve patient care and safety. The budget shows a deficit of £21.5m after savings of £15.6m from the Cost Improvement Programme.
Shaping Healthier Future: Emergency services at Central Middlesex Hospital are being closed. The financial implications are a reduction of income and the need for increased efficiency at the Northwick Park Hospital site. There will be an Urgent Care Centre at CMH, as there is already at Northwick Park Hospital, operating 24/7.
The paperwork for the meeting was voluminous, so this is a very short summary of the main points.
The Trust scores in the 2013 National staff survey, published in Feb 2014, have improved. To questions “do you think care of patients is the top priority” the numbers agreeing have risen from 64% to 73% and on the statement that the Trust acts on patients’ concerns the number agreeing had risen from 66% to 74%.
The Trust has received a donation of £5,000 from the Jane Kasler Foundation, which has been spent on a new defibrillator.
The number of stroke patients admitted to the ward within four hours has improved slightly since the last meeting and the hospital death rate has improved substantially. This rate has reduced by 20% over last year and is below 100 for the 1st time. This measurement is a calculation taking in hospital type, number of beds, area etc. The standard is 100 so falling below this is a morale boost for staff and an indicator of the quality of clinical care within the Trust.
Work to reduce hospital acquired infections continues and the number of C.Difficile infections has fallen to 22 this year. While still above the trajectory it is lower than last year. Isolating patients with potentially infective diarrhoea remains a problem.
The Trust had an unannounced inspection from the CQC on the 17th December last year. The Trust failed the inspection in several areas, such as staffing in one bay (8 beds) on AAU, four of the areas of seven inspected failed on cleanliness and infection control and there were also concerns on quality monitoring. All the “fail” areas were deemed to have minor impact on service users and an action plan to deal with the problem areas has been agreed.
There has been an 8% growth over plan in A & E activity.
The Trust has a year end projected deficit of £13.5 million against a planned surplus of £600,000. Part of the deficit is due to the increase in non elective activity which also leads to elective activity having to be cancelled and further loss of income. Talks are ongoing with the HVCCG and the Trust Development Agency (TDA).
A new Director of Finance has been appointed.
In response to a question from the public the CE Sam Jones confirmed that construction of the Health Campus was always intended to begin with the building of new houses. The Trust will finalise its clinical strategy later this year and once this is complete the Trust will know what services will need to be developed on the site. The Trust is working closely with Watford Council and Keir Group in the development of the Health Campus.
This shared database will help progress towards the merger by accelerating the integration of other joint systems - including A&E, radiology, and bed management in Ealing Hospital, Central Middlesex Hospital and Northwick Park Hospital.
The Trust has contacted 810 people to apologise to them all, to reassure those for whom there were no clinical concerns and to tell others that their case is still under review.