Hillingdon PCT Board meeting-19 June 2007

Mike Robinson - Chairman

1. Chief Executive’s Report
Earlier in the meeting the Chairman confirmed the appointment of Yi-Mien Koh, (YMK) previously acting CEO, as substantive Chief Executive.

Yi-Mien Koh - Chief Executive Officer

YMK gave a clear exposition of the need for a comprehensive healthcare plan for Hillingdon, which, while being compatible with the terms of Healthcare for London, would in turn provide a strategic framework for decisions to be taken on various projects ranging from the redevelopment of Hillingdon Hospital to future plans for the N & P site. She laid great stress upon the need for a major shift of care into community settings and away from the traditional concept of hospitals as treatment centres for every ailment.

2. The OBC for Hillingdon Hospital Redevelopment Programme
Having regard to her report, it was surprising that the OBC for Hillingdon Hospital YMK seemed ready to endorse, was a revised version of the 2005 plan based on a set of assumptions which might no longer be valid in the light of recent policy changes and constructed without the benefit of the strategic framework she had earlier described.
I had the opportunity to make this point during the discussion (see para. 3 below) and to draw attention to the absence of any reference to Mount Vernon in either the NWL Strategy document or in YMK’s earlier presentation. Both points were accepted by the Chair, but by then it was clear that several non-execs. had reservations about the plan, not in principle, but, echoing my point about the absence of an overall Hillingdon framework, the wisdom of committing over £200m. to one project alone and being stuck with such a development for the next 25 years (PFI). Anne Chad also made a good point about the vagueness of parking arrangements in the plan.
It was eventually agreed to support the OBC, after the recommendations put forward had been somewhat revised and with a clear brief to the CEO that her draft letter of support to David McVittie should be amended to emphasise that an agreed pan-Hillingdon strategy was a prerequisite, to which the range of services and facilities of the new hospital should be tailored. A majority of the PCT Board clearly thought that the hospital should be a good deal smaller/less costly than proposed, considering the substantial expansion needed in primary care services in the community.

3. Northwood & Pinner Community Hospital
Discussion of this paper had been pre-empted by Mike Turner, who raised his hand during the OBC debate and on being allowed to speak, launched into a typical Mike peroration
on N & P, “on behalf of Community Voice, in the absence of Joan Davis” (thanks, Mike!) He did not say anything we would seriously disagree with and at least it meant the Chair felt obliged then to let me speak too, but actually about the OBC (as above).

Barbara Wood - Director of Estates and Facilities

Barbara Wood gave a brief outline on the returns from the consultation of NPCH.
The Board agreed the recommendations, viz. the permanence of both the closure of the hospital and of the relocation to MV, and the redevelopment of the site within the (financial?) envelope of a pan-Hillingdon strategy. I made the point that permanent re-location at MV must not be in the present cramped and inadequate facilities, but be completely re-provided, a point strongly supported by Anne Chad.
Public consultation on this next stage is scheduled for December 2007.

James Kincaid. 22 June 2007

North West London Hospitals Trust Board 20 June 2007

The meeting was held earlier in the month than usual, because of the need to approve the accounts for submission to the SHA before the end of June.

The main features were the following:

1. Accounts The final audit shows that the Trust has made a slight surplus for the year, some £23K – but it might actually be about £70K, as a payment from a PCT was still expected. After years of having a deficit of several millions this was a welcome change. The accumulated deficit still has to be paid off, of course. The detailed notes to the accounts and the auditors report provided a lot of extra information, including an insight into the way the various parts of the NHS work.

2. Annual Report We had the draft before us, an interesting and nicely presented document. The most comic ‘glitch’ that I saw referred to a baby whose birth weight was given in kilograms and ounces.

3 Infection Control In a week that saw newspaper reports that very few hospitals nationally are controlling MRSA and other infections it was interesting to learn that this trust actually has decreasing rates of infection, but still above the NHS targets. Additional money is being made available, from 1 July, to the infection control team.

Paul Samet

Harrow PCT meeting, 5 June 2007

This was the first meeting with the new procedure rules, whereby the public are invited to make comments in the initial 15 minutes of the meeting, before any other items of business are dealt with. One of the suggestions made was that it might be useful to have a question session at the end of the meeting.

Finance: subject to audit, there is a small surplus, £427K, first time that the PCT has ever not been in the red.

We were given a detailed explanation of the ‘Balanced Score Card’ (BSC) system of indicators for assessing performance. There are about 300 separate targets, the BSC combines the most important ones into a set of 20 items, much easier to follow.

An interesting item was how to deal with the closure of a practice, in particular how to reassign patients to other practices. After lengthy discussion it was agreed that patients will be given details of other practices in the area and should make their own arrangements.

‘Change for the Better’ and the future of North West London services had the same papers as the hospital trust board in the previous week.

Quite a lot of discussion on Harrow Council’s discussion paper ‘Fair Access to Care Services’. The Council is strapped for cash and is proposing that only people with critical needs should be supported. The PCT is proposing a robust response to this, pointing out that Harrow’s efforts to save money will only lead to additional expenditure for the PCT and the hospital. The Harrow paper gives no details at about the number of people involved in the various care categories or how much money is at stake. So, how can one make any sensible comments about the proposals?

The public part of the meeting finished with saying farewell to Andrew Morgan, who is leaving in mid-July for his new post at Bedford PCT.

Paul Samet

West Herts Hospitals face challenging times

The Trust has plans to centralise its emergency services at Watford and its elective services at St Albans City Hospital. This makes financial sense, makes provision of 24 hour emergency services easier and aids infection control, but means some patients will have to travel further for services, which of course is controversial.



Pressure groups in Hemel are outraged about the outcome of the recent public consultation and are going to Judicial Review on this on 21st /22nd June. They bitterly resent the proposed loss of their A&E and other services. Promises from the Trust that an Urgent Treatment Centre at Hemel will cater for 70% of current patients do nothing to satisfy protestors, nor the promise that diagnostics, outpatients and therapies will continue on the site, with a further expectation that the Primary Care Trust will set up a general hospital for other services.



Watford Hospital hopes to have its rebuild completed by 2014, but this is part of a bigger plan for the Watford Campus, which involves nine other partners including the County Council and Watford Football Club. The financing of the rebuild will be very tricky, needing expensive private finance and requiring the Trust to vastly improve its current financial position.



This year and next the Trust must concentrate on paying back its £11.5 million overspend from last year. It is making many economies, from obliging staff to take holidays at fixed times, (so that wards can be taken out of use), to pressing all orthopaedic surgeons to reduce the length of patients' stays to match the best records of their own colleagues, which could save over a million pounds a year.



Sadly the Board had a very poor showing in the recent National Inpatient Survey. The Chief Excutive, David Law, expressed disappointment and concern, but he promised vigorous action to remedy shortcomings and also promised to report progress to both the Board and the public in the months ahead. (We will watch this closely).



Joan Davis

Harefield speaker

This month's speaker was outstanding! Patrick Mitchell, Operations Director of Royal Brompton and Harefield Trust had us spellbound. He went right back to the early days of the hospital to remind us of half forgotten memories, then carried us forward over a lifetime's triumphs, finally painting a picture of current achievements and today's options and challenges. We ended bursting with pride that this wonderful hospital is in our own area. We could have listened all night!


Of course the future remains uncertain, and our speaker admitted that failing to gain Foundation Trust status last month was a sad disappointment, but he remained confident that this will be achieved before long. NHS London backs the Trust's application and the Trust meets the criteria but there is some uncertainty about future research funding which needs to be clarified before the application can succeed.




Harefield's buildings are old and need to be replaced. The Trust is committed to rebuilding locally, either at Harefield or possibly at Mount Vernon. Other options have already been rejected by the Board. However the Trust needs to become a Foundation Trust in order to have the freedom to go ahead with its plans, particularly the financial freedom to borrow money against its huge assets.




Many of our members are among the 11,000 people who have signed up to support the Trust if it obtains Foundation Trust status. We will be watching future developments closely, both the world class clinical successes - which continue to capture the headlines - and the Trust's plans to build a spanking new hospital to carry its work forward.




Joan Davis

North West London Hospitals, 30 May 2007

A different ‘feel’ to the whole thing, with a new CEO (Fiona Wise), a new Finance Director (Margaret Ashworth), a stand-in Director of Operations (Sarah Warner, the new director will be Daniel Elkeles, starting on 2 July, coming from St George’s). And some fairly new Non-Execs. All very brisk and business like, taking only 2¼ hours, instead of the usual 3½ or more.

Fiona Wise gave the encouraging news that NWLHT is not on the list of London hospitals ‘requiring help’. Following some TV coverage of things at Central Middlesex there was a hastily arranged visit by Gordon Brown. A new McMillan Cancer Information centre has been opened. Finance seems satisfactory: subject to audit the trust will break even for the year 2006-7.

There was some discussion about the ‘Change for the Better’ exercise, highlighting some of the differences of views between Harrow and Brent. We then moved to the NWL Strategy, with a paper from the PCTs. Much of this seems to be involved with co-locating services with A&E.

Results of the (national) Annual Patient Survey were presented. It seems that they were not very good anywhere, with London as a whole being worse than the rest of the country. NWLT scored 30 ‘red’ and 28 ‘amber’, no ‘green’ – not good! Many of the questions were qualitative (such as ‘did you have to wait a long time?’) and were then marked quantitatively, a doubtful procedure.

For some time the Trust has been reporting more than expected readmissions within 28 days, without the cause being known. Careful analysis has now shown that this is entirely due to 2 high risk areas, nephrology and haematology. For everything else the Trust has lower than average national figures. Interesting.

Paul Samet