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 with Mrs. Sam Jones (CE) making a statement about the recent publicity regarding delays to patient referrals with a potential cancer diagnosis. Patients with a suspected cancer diagnosis should be offered an appointment to see a specialist within two weeks of referral. Where patients had had to miss the first offered appointment, an alternative should be offered at the very first alternative time and procedures should be in place to ensure that this happens. These procedures were not followed and many cancer referrals had not been followed up. Over 800 patients had been contacted and in more than 600 cases no action was needed (the number of cleared patients is expected to rise). Three patients had their cancer diagnosis delayed, and one of these three has died. Sincere apology was offered and re-assurance given that tracking procedures had been strengthened and weekly reviews of referrals is now implemented. The Trust is fully committed to providing “safe and compassionate care for patients” first and then making the budget fit that commitment.
Four new non executive directors (NEDs) were introduced. It was clear from the beginning that these NEDs had been fully briefed.
Other CE Matters.
- A Care Quality Commission report on Maternity services showed that there was overall satisfaction with the services provided, but there is still an issue with the cleanliness some of the facilities e.g. toilets.
- February 28th is the closing date for any submissions regarding the Watford Health Campus proposals. The Trust is fully supportive of the plans. These can be viewed and comment forms accessed, via the Trust’s website or Watford Council website.
- Progress is being made in the appointment to substantive Executive posts to replace the interim ones. A Director of Finance has been appointed and interviews for the post of Director of Nursing were due to be held.
Infection Prevention and Control.
Clostridium Difficile – Five cases in November gave a Year To Date figure of 22 against an annual ceiling of 24.On a positive note, present trends will produce a full year value of about 30 which is about a 33% reduction on last year.
MRSA. – There were no trust acquired cases in November, so the YTD total remains at one, from April 2013, against an annual ceiling target of zero.
Performance (some extracts):
- Mortality. Improvement from 110 to102 (The standardised aim is100). The raw figure has dropped by 20% in recent months.
- Patient Transfer.Targets are being met but there is an admission that there is a problem under the surface with (for instance) too many patients in hospital for > 14 days.
- Stroke Admissions. Admission to ward in < 4 hours is still not being met – YTD is 74% against a target of 90%. It is difficult to ring fence beds when A&E admission pressure continues. A remedial action plan is in place and there is still a commitment to make Watford General Hospital a regional stroke centre. A Stroke Clinical Lead has been appointed but there is a requirement for him/her to give three months’ notice from current post.
- Complaints. The backlog has been cleared and the YTD figure for response within one month is 94% against a target of 100%.
There is a YTD deficit of £4.2M which is £7.0M worse than the plan (i.e. the plan was for a surplus of £2.8M at this stage). The reasons continue to be largely the same as historically i.e. agency staff costs (despite the increased number of nursing staff employed), under performance on elective activity, over performance on non-elective activity (the problem is that the excess is only funded at 30% of the tariff), increased established salary bill.
Savings made to date are £4.4M against a planned value of £7.8M but at least that’s £4.4M better than failing to make any savings!
The Trust will probably post a deficit for the year. The Trust Management is in discussion with the CCGs and the Trust Development Authority (TDA) re finance.
Although the papers presented are still substantial they are now more focussed and the discussion is more focussed with an expectation that the author does not have to even summarise the paper. The burden on non-execs is therefore considerable.
The allotment lobby group sent a representative to attend the meeting. In a question from the floor it was mentioned that this group has requested a judicial review of the proposal to compulsorily purchase the allotments to accommodate the new Health Campus. If this request is granted it will mean at best a delay until the outcome of a review is published.
An article in The Daily Telegraph on 20th November 2013 reported that in a ward with surgical patients at Watford General Hospital, one nurse was caring for 22 patients at night. The Community Voice, of which we are a member, wrote to the Chief Executive expressing concern and asking for her comments. Her response is awaited.
A few days later, The Health Service Journal - in its 29th November edition, suggested that some acute hospitals provide a third less nursing care per occupied bed day than their peers, noting that at one extreme the ratio of nurses is over three time the number of occupied bed days and at the other extreme the ratio is only 1.33 - for West Herts Hospitals Trust, which includes Watford General Hospital, the ratio was quoted as 1.42.
Updates on staffing will be reported as information becomes available.
NB This includes points of particular interest only – it is not a summary of the meeting. The Health and Wellbeing Board is responsible for setting the overall strategy for health and wellbeing in Hillingdon including Hillingdon's NHS services. It receives reports from the Hillingdon Public Health Director, as Public Health is now the Local Authority's responsibility.
Update on Health and Wellbeing Strategy Action Plan:
- Priority 1 – Improving health and wellbeing and reducing inequalities: The key targetis an additional 7,000 people taking part in regular exercise by March 2015. This is on track – new activities include free swimming, planned cycle rides, healthy walks, exercise programmes for children etc.
- Priority 2 – Invest in prevention and early intervention: Targets include avoidance of long-term care through a re-ablement programme, development of community mental health services to meet people’s needs, fewer low birth weight babies, immunisation of children and older people to prevent infection, focus on good eye health and support for sight loss – all on track
- Priority 3 – Developing integrated, high quality social care and health services in the community or at home: Targets include involving all GPs in the integrated care programme by the end of 2013, extending TeleCareLine Service to 3,000 extra people by March 2015, providing extra care / support to reduce reliance on residential care – all are on track
- Priority 4 – A positive experience of care: Increase the percentage of people in receipt of personal budgets to at least 70%, complete a review of stakeholder engagement – all on track
Public Health Action Plan:
This plan concerns the integration of Public Health into the Council post transfer on 1st April 2013. The key task is to deliver improved health outcomes.
- Some subtasks are mandatory – National Child Measurement Programme; NHS Health Checks; Sexual Health; etc.
- Others are non-mandatory – school nursing; programmes to improve diet / nutrition; programmes to promote physical exercise and address obesity; drug and alcohol abuse services; stop smoking services
- Other components promote strategic relationships in the local health economy - support education and training for young people, support families and local employment
Allocation of S106 health facilities contributions:
- NHS Property Services is responsible for the the S106 process and the allocation of funding
- Some GP surgeries are receiving allocations of monies which would otherwise be returned to developers, but there remains a risk of losing some monies because no project has been identified for their use
- £11,440 from the Windmill Public House development in Ruislip Manor, which must be spent by February 2014, is earmarked for King Edwards Medical Centre
- £185.986 from the RAF Eastcote development, to be spent by September 2014, is earmarked for expansion at Southcote Clinic
Ms Samantha Jones, Chief Executive West Herts. Hospitals NHS Trust, made her first visit to The Community Voice at its meeting in October 2013. The main points of her address are summarised below:
1. Ms Jones started by declaring that healthcare is her passion. Her views on the NHS have been influenced by her own experience, both as a paediatric nurse and as the mother of four year old twins. She stressed repeatedly that NHS care should always be focussed on its patients’ needs.
2. She went on to outline the values that she seeks to establish in her role as Chief Executive. Things that go wrong should be dealt with openly and honestly, with support for staff who report failings in patient care. Hiding truth should not be tolerated.
3. Watford General Hospital is very old and parts of it are not fit for purpose, but services must be provided there. A grant of £67m would be needed to redress all backlog maintenance.
4. The Trust was proud of its successes. It was amongst the UK’s top 40 hospitals in the recent CHKS awards. It had a very positive inspection by the Care Quality Commission last January. It had achieved improved inpatient survey results. 94% of patients reported that their privacy was respected and 90% would recommend the Trust’s services to family and friends.
5. The Trust had retained level 2 standard for its maternity services and it had engaged in a £537,000 upgrade of those services. RAID, the Rapid Access, Interface and Discharge model of care, had been launched to support people out of hospital. Improvements in other facilities included two new wards at Watford, replacement of the CT scanner at Hemel, improvements to the theatres at both Watford and St Albans and updating of the Watford pathology department, as well as road resurfacing at Watford and St Albans.
6. All national targets had been met except for underachievement on clostridium difficile infections, where 46 cases were recorded in the year against a target of 33 cases maximum.
7. In moving forward the Trust has been influenced by both the Francis Inquiry and the Keogh Review, with renewed determination to learn from complaints and to change its methods of working to focus on patients’ needs. Basics such as hand washing must always be emphasised. Progress has been made, but there is still some way to go before complete success is achieved.
8. The Trust looks forward to the implementation of plans for the Watford Health Campus, work which is led by clinicians, with input from patients and public representatives.
Ms Jones then answered a wide range of questions, which raised many interesting points, including:
Many conditions are best dealt with at specialised centres which can deal with large numbers of patients and provide better equipment and staffing levels. Stroke services and mental health services were quoted as examples. To obtain the best care, it is necessary for patients to travel to such centres, as highest quality of services cannot be provided at small local sites.
Watford General Hospital provides good care for elderly patients but needs to do more for dementia patients. It does not provide mental health services.
The Trust employs over 4000 staff, the largest proportion as nursing staff, but it has a shortfall of 149 nurses, which it is trying to recruit. Last year it spent £20m on the use of agency nurses.
Patients and many staff want the NHS to provide 24/7 services but to achieve this the NHS will have to change, which will inevitably take time to organise.
The speaker was thanked on behalf of the audience, which was endorsed by loud applause from all those present.
Mr Manolis Heliotis, Clinical Director for Head and Neck, North West London Hospitals NHS Trust, spoke to The Community Voice in September 2013. The main points of his address are summarised below:He started by explaining that his background is Greek. As a Director of the North West London Hospitals Foundation Trust he currently has substantial administrative responsibilities for Head and Neck services – the biggest in London – as well as his hospital’s Ear Nose and Throat services, but his major role is as a surgeon at Northwick Park Hospital.
His patients sometimes come from far away. Patients from abroad bring the NHS a sound income.
His department engages in both extensive research and training programmes, covering many head and neck problems such as congenital deformities, trauma injuries and reconstruction following cancer. It has a national reputation and is at the forefront in developing new treatments.
The North West London programme “Shaping a Healthier Future” proposes centralisation of major services in order to respond to demand and improve the services available. In the speaker’s own hospital major surgery is provided only at Northwick Park Hospital, where the necessary resources are based, but considerable preliminary and post-operative services are provided in local hospitals over a wide area. Investigations are usually undertaken at Northwick Park, and also inpatient surgery, but day-surgery is often undertaken at local hospitals. His Department has five maxillo-facial surgeons, who work closely with dentists, and they have video links to other hospitals.
London is divided into four sectors for major trauma injuries. St Georges Hospital covers the South West Sector; Kings Hospital covers the South East; The Royal London Hospital covers the North East; St Mary’s Hospital covers the North West. Ambulances take trauma patients to one of these trauma centres, which provide orthopaedic surgeons, neuro-surgeons, maxillo-facial surgeons, vascular surgeons and other specialists.
A slide was shown indicating the wide area covered by the Northwick Park’s maxillo-facial service and this was followed by a short video of operations in progress.
Mr Heliotis then answered a wide range of questions, which raised the following interesting comments:
His department has links with most local hospitals, but it does not cover spinal or ophthalmological conditions, so it rarely works with the Royal National Orthopaedic Hospital at Stanmore.
Despite current NHS financial difficulties, the NHS is better provided with equipment than the private sector, and a concentration of experts making a good case for new equipment is usually successful in obtaining the resources. However shortage of nurses and support staff can cause problems.
Cleft lip and palate services were are one time provided at Mount Vernon Hospital and Community Voice supported patients in opposing their loss from the site. However, eight national centres were introduced. Currently Great Ormond Street Hospital provides services for this group of children, with links to Northwick Park for adult patients.
Although there have been facial transplants, these remain at a pioneering stage of development.
A number of members gave testimony of good services received by patients.
The speaker was thanked on behalf of the audience by the Vice Chairman, James Kincaid, which was endorsed by loud applause. However it was noted that a long-standing member, Owen Cock, had wanted to give this vote of thanks as he was personally very grateful to the speaker as a patient, but unfortunately he was unable to attend.
1. This AGM was held at Northwick Park Hospital on 18th July 2013.
2. There were few members of the public present – probably less than twenty.
3. After the Chairman, Peter Worthington, had opened the meeting the Chief Executive, David McVittie, gave his report in which he noted:
- The Trusts serves a population of half a million people in Brent and Harrow.
- In 21012-13 its budget was £380m.
- It employs 4770 members of staff.
- It provides centres of excellence for stroke, vascular services, and maxillofacial services and also provides regional rehabilitation services.
- Its stroke team was the British Medical Journal’s Clinical Leadership Team of 2012
- 92% of its patients would recommend its services to family and friends.
- Its mortality rates are amongst the lowest in the country
- It stroke services rank amongst the best in England
- It took part in one of the biggest integrated care pilots in the country
- Its hemato-oncology department is one of the top research centres in UK.
- The Trust’s proposed merger with Ealing Hospital NHS Trust is progressing well and this will merge local community and acute services
- The Trust has a £50m building programme including £14m to rebuild theatres and £21m to rebuild the emergency department.
- In looking ahead the focus is on quality and safety, improving patients’ experience and satisfaction, developing the workforce and ensuring financial sustainability.
4. A presentation was then given by two consultant physicians from the Stroke Unit, Dr Joe Devine and Raj Bathula, in which they noted:
- The Unit was set up after the Darzi report - it is one of eight Hyper-Acute Stroke Units in London
- It opened in February 2010 and has 6-8 admissions per day.
- It has specialist stroke nurses and thrombolysis 24/7, with consultants rounds every day.
- It has Transient Ischaemic Attack clinics every day, with carotid artery imaging and surgery available every day too.
- Both admissions for stroke and attendance at TIA clinics rise every year. In 2012 it had a total of 1321 patients, the highest number for any of the London HASUs.
5. The Finance Director, Kishamer Sidhu, gave his report, noting that the trust did not meet its three year statutory break-even target but that it expects to balance its books when it has merged with Ealing Hospital NHS Trust.
6. This was followed by a question and answer session.
This meeting was held at Northwick Park Hospital.
Income and Expenditure (I & E) budget for 2013/4 envisages a final deficit of £20.3m, very much as last year, except that the Trust’s QIPP plan requires savings of £17m. After 2 months, indications are that the control total deficit is £394m less than budgetted, while the savings plan looks to be lagging behind, having achieved only 3.65% of its total target for the year. As the Finance Director said with masterly understatement, “requires further action”.
2. Shaping a Healthy Future (SaHF)
Work continues on this project, alongside (or despite) Ealing’s continuing efforts to avoid closure of its A& E facility, with two OBCs required by September:
1) developing emergency and maternity services at NPH; and
2) in conjunction with Brent CCG, plans for elective services at CMH.
3. Merger with Ealing:
The target date for merging is still April 2014, with however some continuing uncertainties over costs of such as the preparation of the FBC. Some cost support is being discussed with CCGs, particularly Brent .
There were no cases of either MRSA or C-diff. in the past month.
5. Accident & Emergency:
There was a lengthy but inconclusive discussion of ways and means of mitigating A & E delays revealing a stepping up of recruitment efforts in nursing but no immediate solutions beyond the marginal increases in emergency beds which D. McVittie referred to at Joan’s and my recent meeting. It looks like hopes are being pinned on the opening of the new and substantially enlarged A & E scheduled for April 2014.
6. Towards Foundation Trusts status:
Non-FT hospitals such as NWLHT are, from April last, required to submit self-certifications on a monthly basis to the NHS Trust Development Authority (NTDA) as to their progress in surmounting obstacles en route to FT status. The latest such has been accepted subject to attention being paid to some areas of clinical non-compliance which had warranted amber rather than green “traffic lights” and which are in process of being recalibrated, whatever that may mean!
Footnote from Health Service Journal 5.7.2013:
This Trust has proposed a £17.4m saving plan for 2013-14 and £12.4m of the sum has been identified with £631,000 delivered so far, but the latter figure is £58,000 behind target.
Introduction: Nick Barton, Chief Executive of Action on Addiction, spoke to the Community Voice in May 2013. The vision of Action on Addiction is to free victims from addiction and its effects. There are many strands to its actions – research, prevention, education, treatment, rehabilitation, and support for families, particularly children. It trains people working with addicts and their families and it campaigns on behalf of people who suffer as a result of addiction.
Addiction is driven by a conscious or unconscious urge to feel different. This causes an intense relationship with the substance or behaviour, which leads to many harmful consequences.
Families face chronic stress with daily hassles, relationships that deteriorate, great uncertainty and threats of many kinds. Family members feel disempowered.
The speaker would focus on the families of addicts, the impact of addiction on them, the help available, why so little help is available, plus the particular help provided by Action on Addiction.