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.
Metropolitan Line to Watford Junction Station: The proposed diversion of the Metropolitan Line to Watford Junction has recently been agreed and is expected to be operational by 1st January 2016. This is great news for Watford General Hospital as the plans include a new station to serve the Watford Health Campus, to the benefit of both that hospital and Watford Football Club.
Progress towards other plans for Watford Health Campus: Five major construction companies are interested in building the proposed new road to serve the Watford Health Campus. Work is expected to start in September or October 2012. When open this road will greatly improve access to Watford General Hospital. The hospital will be rebuilt in phases. The first phase will be the building of a multi-storey car park. It may be six or seven years before rebuilding is complete.
Progress toward foundation trust status: The West Herts. Hospital NHS Trust is progressing towards achieving this objective and it hopes to be ready to apply to the Department of Health by 1st March 2012. The earliest possible authorisation date is September 2012. In answer to questioning, assurances were given that, if that status were obtained, the Board would continue to hold Board Meetings in public.
Performance indicators: Overall the Trust is performing very well, notably against key 18 weeks and A&E targets, where there have been dramatic improvements in dealing with all emergency work. MRSA and clostridium difficile remain at record low levels – MRSA one case against target of maximum four in year, and nine c. diff. cases against annual trajectory of 33. Letchmore Ward continues to have one side-room ring-fenced for patients with c. diff. associated diarrhoea. Also, for the first time for several months, all cancer targets were met for the month of December.
The Red Suite, with surge capacity, continues to be used extensively. In early January emergency admissions reached a level which required the Trust once again, reluctantly, to occupy the Catheter Laboratory too. However, the Trust has been able to achieve its admission targets, despite the upward trend in attendances.
Maternity and neo-natal provision: In 2011 the Trust undertook a ¾ million pound project to provide additional capacity for these services at Watford General Hospital. The completed project provides a new Triage Bay and Transitional Care Unit in addition to extra bed capacity on the delivery suite and in both the ante and post natal wards. The Trust is expecting to care for 5.900 deliveries per year.
Finance: The Trust expects to achieve its planned surplus of £3.6m (plus a technical gain of £1.5m bringing the total up to £5.1m) in 2011/12.
The contract negotiation process has just started for 2012/13, in order to have contracts agreed in March. Representatives of Herts Valley CCG will be involved in the negotiations, which will be largely driven by PCT staff while the CCG is being established.
The Trust has the basis for a strong plan for next year, which will be developed over the next two months. It is hoped to produce a budget for the Board to approve in March. An overall financial risk rating of 3 has been achieved this year and is expected to be maintained next year – a requirement for achieving FT status,
The joint PCT/CCG budget to date shows an underspend of £4.2M which is projected to be £6.8M by the end of the year. It was agreed to release £6M for use. There is also £12.1M still uncommitted from the Transformation Reserve.
Overall satisfactory, with just 4 key indicators needing further attention.
When a range of indicators related to infection control, referral to treatment and cancer waiting times are compared across the 39 PCTs in this SHA cluster, HPCT is rated 5th overall.
The focus of the report for this meeting was on ‘healthy living’ including ‘smoking’ (ahead of target to meet the 2011/2012 smoking cessation target); ‘breast feeding’ (above the national and regional figures) and ‘health checks’ (underachieving due to poor data returns from some GP practices).
Part 1. : The areas funded include “preventative services for older and vulnerable people”, “careers’ support”, “counselling”, “sexual health” and “support to military personnel and their families”. Funding is from Health and Community Services (£13M), HPCT (£1.3M) and Herts County Council (undeclared in this report). To put this is context the HPCT contribution is about one third of a days overall budget for the PCT.
Part 2. : End of Life Care. There is a target of 40% for people who die at home (including care home). Year to date figure is 37% (34% for year 2010/11). A strategy group has been set up to deal with this. However concern was expressed that this ‘top down’ figure does not necessarily reflect patients’ wishes.
Part 3. : Out of Hours GP services. Consistently over 95% compliant with the National Quality Standards and with locally agreed commissioner requirements.
Clinical Commissioning Group (CCG) report.
There are 3 in Hertfordshire. The one which covers South West Herts (specifically the Watford and Three Rivers area but also extends to St. Albans) is called “Herts Valleys CCG”. The board is almost complete (a nurse and doctor member still need to be appointed) and they are on track to be authorised without conditions in Oct 2012. Confident that satisfactory progress is being made in taking over their new roles as the NHS changes are implemented.
Report mostly concerned with the QEII and Lister hospitals redevelopments.
In West Herts a group has been set up to deal with the remaining issues for the redevelopment of the Hemel Hempstead hospital.
Neither of the two merging trusts believes it is capable of achieving foundation trust status alone - Ealing Hospital is too small and North West London Hospitals has long-standing financial problems.· However, they believe that by merging together they will be able to meet foundation trust requirements.· The stakes are high as Trusts not achieving foundation trust status are threatened with amalgamation or closure.
This proposed merger will be of particular interest to patients of Northwick Park Hospital and Central Middlesex Hospital, which together form North West London Hospitals Trust. Northwick Park is a popular local hospital providing a very wide range of services - it incorporates St Mark's Hospital and it provides one of the eight Hyper-Acute Stroke Units in London. Its easy access from the Metropolitan Line Station makes it convenient for many Hillingdon residents.
- No ward/dept. visits due to other meetings – will resume before next Board meeting.
- Costs have been reduced from 101% to 94% of the national average.
- Procedures which the trust has developed for dealing with ‘never events’ are highly regarded and are in demand from other hospital trusts e.g. Allenbrooks.
- Confirmed that there are no ‘hidden waiters’ i.e. people who have missed the 18 week target and for whom there is reduced incentive to process urgently.
- Application for Foundation Trust status is on schedule.
Chief Executive Report.
Good performance on Infection Control, most A&E indicators and the 18 week treatment targets. Less satisfactory on the A&E time to treatment and the 2 week and 62 day cancer targets. The former is improving and should be on target by the year end. The 62 day cancer target only involves a few patients and so a low percentage can be misleading unless individual circumstances are taken into account which usually is not possible.
Surplus to Oct of £1.7M against a forecast of £1.4M. There continues to be an issue over the cost of agency (not ‘bank’) doctors who cost the trust significantly more than if they were on the payroll. This is due (if I understand the situation correctly) to these people setting themselves up as a limited company for tax purposes with the agency. There is also an issue over some consultants who are being paid for more than 10 sessions per week where the extra sessions can be administration or research. Concern was also expressed that there is no consultant cover overnight but there was also recognition that many worked long into the evenings beyond their contracted hours.
MRSA – 1 in Sept giving a total to date of 1 against a trajectory for the year of 4.
C. Diff. – None during Sept. and Oct. Total to date is 7 against a trajectory of 33.
MSSA – 2 in Sept. and 5 in Oct. But all were community acquired.
Nursing Quality Indicators.
Continuing good trends on issues such as ‘slips, trips and falls’, ‘commode cleanliness’, ‘hospital acquired pressure ulcers’. A new indicator of ‘normal births’ shows a decline from 61% in June to 51% in Sept. The target is 60% and this is being investigated.
A new initiative is for a non-executive director to carry out a detailed review of the complaints received in a given month. For August there were 67 (65 in 2010) from 80,000 patient/visitor events. 40 were available for reading. (A further 6 were actually commendations for excellent service !!). The review concluded that the replies were comprehensive with an excellent level of detail (up to 9 pages), with personal apologies from named individuals.
This is getting complex with a third index being introduced by DoH which measures things differently e.g. making no allowance for palliative care and including deaths within 30 days of discharge. On the Dr. Foster index the current score is 87 (100 is the benchmark – below is good !). On the new index the score is 106.
A national initiative (the Carter Review) has recommended that Pathology services are centralised into hubs serving several hospitals. Great concern was expressed that the quality of service (especially for the infection control teams) will be seriously prejudiced since samples will travel up to Bedford. There will be redundancies and there is a serious staff morale problem.
The Outline Business Case (OBC) for the merger of these hospitals was approved by the Boards of both NHS Trusts on 2ndNovember 2011. While this is not a final decision to merge, it is a significant step towards that goal. The OBC is subject to approval from NHS London’s Capital Investment Committee.
The two Trusts will now develop a Full Business Case, providing detailed information about the new organisation. This is expected between November 2011 and March 2012, with the merger planned for 1st July 2012, subject to all the necessary approvals.
The OBC makes the case for merger and organisational change. Any service changes would be subject to a full, separate, statutory public consultation, led by commissioners. Any consultation on service changes is likely to start in June 2012 and decisions by commissioners would be expected to follow in Autumn 2012.
Only LINKs, not the public directly, are involved in consultation on the actual merger. Brent, Ealing, and Harrow LINks are members of the Programme Board which is overseeing the merger process and they will be hosting some events about the proposed merger.
General surgery has been replaced by increasingly specific subspecialisation - from orthopaedics in the 1980s - to upper limb, lower limb, spines in the 1990s - to hip, knee, foot today. This requires a greatly increased number of specialists and specialist teams to provide 24/7 services, and some conditions require access to a number of teams e.g. major internal bleeding needs specialist endoscopists, radiologists and surgeons 365 days per year. This is costly and financial pressures are great, since NHS services must be affordable.
There is good evidence that volume of work and experience are essential for clinicians to hone their skills, but a critical mass of patients is needed to provide their expertise. Centralisation is inevitable – but that is in conflict with the desire to provide services close to home. Achieving the correct balance is challenging. IT advances open more new options. Patients can now be monitored remotely and as a result more can both be treated at home and continue to live at home longer.
We did also get an over view about Northwick Park itself. The North West London Hospitals Trust provides services for half a million people living in Brent and Harrow, with a budget of £370m and over 4,320 staff. It has three hospitals - Northwick Park, which is one of London’s major acute hospitals - St. Mark’s, which shares the Northwick Park site, is a national centre of excellence for bowel diseases - Central Middlesex is a local Brent hospital.
Its mortality rates are among the lowest in the UK. Its stroke care is in the top 25% in the UK. 90% of patients with respiratory conditions rate its services excellent or very good. Its infection control is excellent – only four cases of MRSA against a target of eight. It is applauded for its children’s Sickle Cell and Thalassaemia services, its enhanced recovery programme for hip and knee replacements, and its work on preventing elderly patients’ falls. It has introduced touch screen devices for patient feedback and electronic patient records to reduce waiting times for its sexual health patients.
Its current objectives are to achieve Foundation Trust status – plus potential merger with Ealing Hospital Trust – and to further improve its services, with specialised services available at all hours. Neither North West London Hospitals nor Ealing Hospital can achieve Foundation Trust status alone. North West London needs a bigger patient base and Ealing is struggling because it is too small. They could enhance each other, but their merger is a massive task. We hope Professor Shaw will come again to update us on what comes next.
Jan Filochowski was guest speaker at this month’s meeting of The Community Voice, of which RRA is a member. He brought a lot of good news. A year ago he predicted challenging times ahead, which had proved true. His trust had to make £20m savings and work in new ways, which was achieved without any compromise on patient safety. The trust was still working towards foundation trust status but it now has 6,600 members. Elections for Governors will be held later this year.
Some special achievements were noted. 95% of inpatients are now assessed for risk of venous thromboembolism (VTE), which can be fatal. The Trust is tendering for a partner to build a Private Patient Unit at Watford Hospital and a new diabetes centre is coming there too. Resident staff are now housed in excellent accommodation on the adjacent Football Club site. He understands that agreement in principle has been given for the Metropolitan Line to be extended to Watford Junction with a stop at Watford Hospital. The new access road will be completed before Watford Hospital is rebuilt.
This article was published by NHS Hertfordshire early in 2011 - but its message is universal
You've got a cold. Do you pop into your local pharmacist and buy a pack of paracetamol or make an appointment to see your GP? You've twisted your ankle. Do you spend 4 hours in A&E or be seen and treated in a minor injuries unit or urgent care centre?
These are some of the questions that NHS Hertfordshire wants users of health services in the county to think about to make sure that we all make the very best use of NHS services.
It is more important than ever before that we use NHS services efficiently. This means that we should go to the right place for the right treatment. By doing this we can all help make sure that we get the maximum out of the NHS – something that we all contribute to. So we are asking patients to use services responsibly and think about what is the right service to use.
Watford General Hospital has an A&E department. The staff there are specialists who are trained to help people with very serious, life-threatening illnesses and injuries – heart attacks and strokes for example.
Other conditions that need urgent attention but are not life threatening can be treated at an urgent care centre or minor injuries units. There is an urgent care centre at Hemel Hempstead Hospital that's open 24 hours a day, every day of the year and minor injuries units at St Albans City Hospital (open 8am to 8pm every day except for Christmas day) and Mount Vernon Hospital (open 9am to 8pm every day). Urgent care centres and minor injuries units can treat a wide range of injuries from cuts and grazes to bites and broken bones.
So it could be that patients travel slightly further in order to be treated in the most appropriate service, leaving our A&E departments to do the thing they do best - helping patients with the most serious, life-threatening health conditions.