North West London Hospitals Trust Board, 27 Feb 2007

Here are some of the more interesting items from this meeting. As so often before, I was the public.

1. Brent Birth Centre There has been a consultation about the future of this (midwife-led) unit. Although it has a capacity for about 1200 births per year the actual numbers were about 300. So, the unit was making a steady loss. There was support for the proposal to move the facilities to Northwick Park, as part of the maternity unit there. They held 2 public meetings: attendance was dismal, 1 member of the public and a journalist at one, 1 member of the public and a member of staff at the second. And not many more responded to a questionnaire. Past problems in maternity at NPH feature in some of the responses. Interestingly, numbers of Harrow women opting to give birth at NPH, rather than at Watford, have gone up recently, as a result of the good grading of the NPH unit.

2. Finance This appeared in several guises: repayment of a capital loan, business plan, capital plan, current financial position. It is very doubtful if they will break even on the year, current estimates are for a deficit of around £600,000. There are discussions with the SHA about all this, of course. It is difficult to know why this has happened. The number of patients seen by the hospital is well above the expected numbers, so they ‘overperform’. This affects many facets of activity, such as A & E failure to meet the ‘98% with 4 hours’ target (A & E attendances so far this year are 21,000 above expected numbers (15%) and I suspect it also affects other items. The trust is now completely ready for the mandatory ’18 week target’ from initial GP referral to carrying out all tests and consulatancy, leading to start of treatment. This has contributed to the financial difficulty, because a lot of additional work had to be done.

3. Health Care Commission Standards for Better Health This reporting of compliance is very satisfactory, all areas are now compliant at year end, although 2 were not compliant until part of the way through the period.

4. Question by me I asked about the newspaper report that several trusts were parking ambulances with patients outside A & E, to keep them out of the ‘4 hour target’ period. This trust does not operate such a practice, I was pleased to hear.

Paul Samet

North West London Hospitals Trust Board

What's new in Hillingdon PCT?

Hillingdon PCT’s use of BUPA to check its hospital bills is being watched throughout the NHS. The three-year contract, first of its kind in the country, was signed on 31st January. Hospitals code each episode of care they provide. High coding leads to high bills. BUPA’s first task is to check and challenge invoices received by the PCT where coding could be too high - a task the private sector no doubt perfected long ago. Maybe the NHS will learn a few new tricks!

Our local hospitals are all in a frenzy to meet their “18 week” target by end of year, on 31st March. This target covers time from GP referral until treatment actually starts. Treating enough patients before that dead-line is speeding up hospital activity and of course causing lots of bills. Net result is that Hillingdon PCT – and no doubt other PCTs too – suddenly find their careful financial predictions start to look silly. Hillingdon PCT still hopes to break even at year-end – but is no longer as confident as once it was.

Hillingdon’s new Referral and Management Centre is up and running, with 461 referrals in its first two weeks. The aim is to treat patients near home rather than sending them to hospital. The PCT thinks this is great - cheaper than hospital care. What do patients think? I hope they are being asked!

Breast-feeding is in the news. It is said to promote long-term health benefits, including preventing obesity. However, Hillingdon’s breast-feeding rate is the worst in London. So, local young mums can expect to be pressured to feed their babies as nature intended. Problem is that some of them can’t and some don’t want to do this. How far should they be pressured? Should Hillingdon Hospital and PCT be penalised? It is noteworthy that these questions were not asked in the PCT Board meeting!

Joan

Watford Hospital / West Herts Trust miracle??

This Trust has had lots of bad patient publicity, plus terrible national ratings, but at last there is some light at the end of the tunnel.

After financial deficits for years, the Trust expects to break even in 2007-08. The crunch will come in March, the end of its financial year.

Infections are gradually being mastered, with only one hospital acquired MRSA case in January. Four other MRSA cases came in with patients, so now the focus is working with the Primary Care Trust and nursing homes to fight that infection outside the hospital.

Hospital staff know the Trust’s policy is “Wash hands before touching a patient” and “If you fail to do this twice, then you are fired!” – but this has not been put to the test. Some staff members have been warned, but no one has dared to offend twice!

Government targets drive the system. It is already too late for the Trust to reach targets for the whole of this year, but its recent progress has been so astonishing that it expects to reach targets in 2008-09.

Over 99% of its A&E patients are now treated within four hours – which is one of the best results in the whole country!

Cancelled operations are now down to the national average, just one or two cancelled in each hundred ops.

More and more patients are starting treatment within 18 weeks of being referred by their GPs – hard to achieve because of all the diagnostic tests that need to be done, plus finding beds and slots in treatment facilities. The main obstacle to achieving this target is beds blocked by 'delayed discharges' – patients kept in hospital because they have nowhere else to go. Solving this depends on the Local Authority or PCT providing services or care homes. But even this problem is getting better, dropping from around 50 such patients a few weeks ago to around 30 today.

In its own way all this is near miraculous. It’s a bit too early for congratulations, but there definitely is light at the end of the tunnel.

Joan

Star studded Ara Darzi team!

Our February meeting, was exceptional in many ways. It was our first meeting in 2008, starting the year well with a report to members on the presentation of our 77,781 signature petition to "Save Cancer Services at Mount Vernon Hospital" to Ben Bradshaw, Minister of Health (see earlier report, of 13 December 2007).

The main item of the evening was a forum on Lord Ara Darzi's proposals for healthcare for London, which are currently the subject of public consultation. The panel of guest speakers was totally exceptional -

Don Neame, representing NHS London,

Dr Sarah Crowther, Chief Executive Harrow Primary Care Trust,











Professor Yi Mien Koh, Chief Executive Hillingdon PCT,












Gareth Jones, Director of Strategic Planning West Herts PCT.

Don Neame introduced the topic. Copies of the consultation document, and a shorter summary version, are available from FREEPHONE 0808 238 5430.

Responses must be received by 7th March 2008.

The main proposals are:

1. Very specialised services concentrated in only a few hospitals across London e.g. major stroke services, trauma services, major children's services, 24 hour A&E services.

2. More services in the community, closer to home, some in polyclinics.

3. More services at home e.g. end of life care, more home births

4. Polyclinics serving up to 50,000 people, either in central buildings or as networks of smaller health centres and surgeries, staffed by GPs, providing a wide range of shared diagnostic and other services, open extended hours.

5. Local general hospitals providing hospital services for the majority of conditions, with emergency surgery provided separately from elective surgery.

After the introduction, Gareth Jones gave a brief update on the outcome of the recent Herts public consultation on health services (see previous report) noting that Herts is in some ways already implementing the Ara Darzi proposals.

All the guest speakers contributed to the subsequent discussion and answered questions from the audience. These ranged widely, from concern about the future of the Northwood & Pinner Community Hospital site, concern about the much needed new health centre in Yiewsley, and the impact of the various Ara Darzi proposals on the two London Boroughs that we cover i.e. Harrow and Hillingdon. A Herts member emphasised the importance of maximising the advantage of the adjacencey of Harefield Hospital and the Mount Vernon Cancer Centre Centre, both of which serve a much wider population.

Time ran out far too fast. Our speakers had long journeys home and had generously given up the evening to come to our meeting, so our promise to end their session promptly had to be honoured - but the flow of questions and comments could have continued indefinitely.

When our speakers had left we turned to more mundane things - a round up of progress on local NHS finances, the £1m Mount Vernon Cancer Centre Appeal, reports on local hospitals, and so on.

This was an excellent start to our year. Our next meeting is at Mount Vernon Hospital PGC, at 7.45pm on Thursday 6th March, when the guest speaker will be Leonora Stjepic, CEO RAFT, speaking about the Restoration of Appearance and Function Trust's work and plans.

Joan

Hillingdon Hospital News - January 2008

Presentation to the Board on “Healthcare for London” proposals – Hillingdon PCT Chief Executive, Yi Mien Koh, aided by her Chairman, Mike Robinson, told members of the hospital Board about the Ara Darzi proposals to centralise major trauma, major stroke and major children’s services into just a few hospitals, and to transfer many hospital services into the community. Unsurprisingly, some of her audience felt threatened by these proposals and were very critical. This item took a big chunk out of the meeting, so other items were cut short.

Professor Yi Mien Koh, Chief Executive, Hillingdon PCT

Heathrow’s January Crash - the near-disaster at Heathrow earlier in the month led to 18 minor casualties, a mercifully light outcome, but it showed that the hospital is ready for anything, so congratulations are due for all the forward planning and staff preparedness.

Infection Control – targets for the year for cases of MRS and clostridium difficile were breached long ago. The best to hope for now is improvement month on month, which happened in December, so progress is being made. Also, external agencies have been complimentary about the measures the Trust has introduced. A new start in April will be very welcome.

Hillingdon Hospital rebuild - demolition of Tudor and Willows buildings is starting now, to be followed by construction of the exciting “Pilot Ward”, due for completion by August 2008. This will be used by the Department of Health and the Trust to test out the use of single bedroom wards. If patients and staff like the pilot, this research will influence the design of the new Hillingdon Hospital and other hospitals across the NHS.

The new Mount Vernon Treatment Centre – building is on schedule and due for completion in December 2008. The existing Princess Christian building is being redesigned internally. Some staff are being moved out temporarily during this work. When everything is finished, everyone will rejoice!

Money – despite an unexpectedly high seasonal deficit in December the Trust remains, much to its credit, on target to end the year in surplus.

Foundation Trust bid - the Trust is still a lot short of the number of members it needs to show that the public backs its application for Foundation Trust status. Get application forms from Tel: 0800 8766 953 – or from Joan, (see top of web page for details), who has several thousands!! Give them to family, friends, neighbours and other contacts – try taking them to the work place, the golf club, or wherever you can.



Joan

What is happening in West Herts PCT?

Various interesting facts were reported at the PCT’s Board Meeting on 31st January.

Finances – Amazingly, the PCT has cleared its historic debt of £26m and still predicts an under-spend of £1m for 2007/08 - which means it will be able to spend over £27m more next year than it did this year! Increases in prescription costs will have first call on this money, followed by improvements to mental health services. The PCT also hopes to keep some in reserve, as a hedge against future problems.

Ambulance response time targets – criteria have got tougher, so response times now start when a call for assistance is received, instead of when the caller’s details have been recorded. This adds around 45 seconds to all response times, making it more difficult to hit targets. The good news is that this pressure is leading to extra investment in both the ambulance service and the West Herts Hospital’s turn around team – which is all good news for patients.

PCT national targets – what happens in Watford Hospital has impact on the PCT as its major purchaser of services so, if the West Herts Hospital Trust fails targets, then almost inevitably so does this PCT.

The PCT is therefore pleased that West Herts Hospitals Trust had no cases of MRSA in December – although it breached its full year MRSA target long ago. Sadly, that Trust’s Clostridium difficile cases are also over target for this time in the year. Of course patients simply want infections to drop to zero - even one infection is one too many!

The 18 week target from GP referral to start of hospital in-patient treatment is currently the PCT’s biggest challenge. 85% compliance is required. West Herts Hospitals Trust may reach this target by the end of March, but that would mean it achieving only 80% success for the whole month, causing both the Hospital Trust and the PCT to fail the full year target. This national target has greatly reduced waiting times right across the country – but patients want waits to drop even further, as they already have for emergencies such as cancer.

In the Annual Health Check the PCT expects to fail three old targets and four new targets – diabetic retinopathy screening / A&E treatment within four hours / choose and book / time for diagnostics tests / additional community matrons / sustained treatment for drug users.

It was noted in discussion that the plethora of national targets, SHA priorities, and Local Area Agreement demands, seriously limit the PCT’s freedoms.

Next PCT Board Meeting - is to be held at the Moor Park Golf Club, Rickmansworth at 10am on Tuesday 25th March – it would be great to see a lot of people in the public gallery, to show that local people care about their NHS services!

Joan

North West London Hospitals Trust Board, 30 January

This report picks out some of the highlights of the meeting.

1. Maternity Services. The trust achieved a rating of ‘fair’ in the recently published Healthcare Commission ratings. This puts Harrow among the top 8 of London trusts. The maternity department was also awarded a ‘level 2’ in the Clinical Negligence Scheme for Trusts (CNST) – which considers safety not negligence (as the title would seem to imply!). Seeing that 2 years ago the department was ‘under special measures’ and last year reached level 1 this is a considerable achievement.

2. ‘A&E 4 hour target’ The trust does not reach the 98% target, but comes fairly close, with 97.2. But there is more to it than the simple number. The numbers attending A&E are well up on the planned attendances, by about 10%, indeed in recent months the numbers attending have been the highest ever seen by the trust. There is no explanation of why numbers are so high. The trust receives some additional finance for this excess above expectation but apparently only part of the actual cost. All this seems a little unfair, not only the finances but also the trust’s reputation are damaged by this increased activity over which the trust has no control.

3. Infection Control Numbers of cases of MRSA and C. difficile are going down, although still above targets (but, then, this is true almost everywhere). C. difficile shows seasonal variations, nobody seems to know why this should be so. The trust has had a small cluster of Acinetobacter baumannii cases, first appearing last September. The Health Protection Agency and the SHA have been made aware of this and of the steps taken by the trust to eradicate it. All the appropriate agencies have agreed that the trust’s actions have been correct. As part of this report we also had the (first) quarterly report by the trust’s Matrons, 5 of whom attended the meeting. (And very smart they looked, in their distinctive uniforms.)

4. Cervical Cancer Screening Annual Report This was presented by Dr Tanya Levine. The trust’s unit provides this screening service for several other trusts as well, for instance Hillingdon and St Mary’s. There is a national target of 2 weeks, announced by the Prime Minister no less, for the time between tests and results being available to patients. The difficulty with achieving this is the lack of staff for handling the work: although the unit has had a 50% increase in its work load there has been a reduction in its staffing. A matter of the left hand not knowing what the right hand is doing?

Paul Samet
1 February 2008