Our April General Meeting

As usual we will be meeting in the Post Graduate Centre at Mount Vernon Hospital on the first Thursday in the month, April 3rd. Doors open 7.30pm for a prompt start at 7.45pm Visitors are welcome. Parking is plentiful in the main car park, off Rickmansworth Road, and is usually free.

This month we will be receiving an update on news from Northwick Park Hospital, as our guest speaker is Fiona Wise, Chief Executive of North West London Hospitals NHS Trust.

Also, unusually, we will have a second guest speaker, Sarah Brierley, who will tell us briefly about East & North Herts Hospitals Trust's bid to achieve foundation trust status. She is Deputy Direct of Strategic Development of that Trust.

Our AGM is on 1st May so our process for electing officers is already underway. This meeting will be a good chance for members to organise nominations and seconders for next year's Executive Committee.

Do come along!

All the Board Meetings come together!

This week has seen a bevy of NHS Board Meetings in public, seven in two days! I have attended four of them – West Herts PCT, Hillingdon PCT, NHS London and Hillingdon Hospital.

Some themes are common to them all. They are all challenged by national targets, particularly the target to treat in-patients within 18 weeks of referral by GPs and the target for A&E departments to treat 98% of patients within four hours – hospitals are challenged as service providers, but PCTs are also held responsible as purchasers of services, and strategic health authorities are responsible for their whole patch.

They are all concerned with money. However, none of the NHS bodies in our catchment area are causing major concern this year. Hillingdon PCT has made a mammoth effort and has achieved break even, but still carries forward £42m of historic debt. NHS London expects to carry forward a combined total of £300m surplus from its patch this year, but it has plans to make good use of it all in the months ahead.

Infections are another common concern. Huge input of both money and effort has been made to combat these threats. The MRSA bacteraemia plan for London is 70 cases or less per month, achieved in 6 of the last 10 months reported. Clostridium difficile cases are now 14% lower than last year in London - and West Herts PCT reports that it now has one of the lowest rates of this infection in the country. Hillingdon Hospital had no MRSA cases last month.

Every PCT in the country has to make plans for a new health centre or polyclinic in the year ahead, offering an 8am to 8pm walk-in service seven days a week. West Herts PCT expects its new health centre to be in Hemel Hempstead. Hillingdon PCT is considering Yiewsley as its most likely site.

Another common theme for PCT’s is the current requirement that they split off their “provider” services from their “commissioning” services, managing their clinics and district nurses, health visitors etc at “arms length”. They are all busy setting up their new arrangements. Separating the purchasing of services from provision of services is intended to avoid conflicts of interest, promote better services, and eventually to allow new providers to tender for service contracts.

Lastly, how and when hospitals will achieve foundation trust status is a common concern. Central and North West London Foundation Trust achieved success in 2007 (it provides mental health services to most of NW London area). Royal Brompton and Harefield’s application ground to an unexpected halt because of uncertainties over new ways of funding research. The Hillingdon Hospital is expected to get FT status next February, Royal National Orthopaedic Hospital in May 2009 and North West London Hospitals in December 2009, when possibly West Herts Hospitals will too.

In all directions NHS staff are busy with end of year summaries, whole-year targets and milestones. March 31st is the dead-line for this year’s statistics. April 1st will bring a clean sheet, to start a new financial year.

Joan

Is Waford General Hospital waking up at last?

The March Board papers of the West Herts Hospitals Trust paint an amazing picture of recovery, after years of being in the doldrums.

Finances are doing well, with an expected whole-year surplus. This will be only a small sum, but the Trust will be out of the red for the first time in many years!

A&E times and some infection rates are currently amongst the country’s leaders, even though whole-year targets will be missed due to earlier shortcomings.

Progress is being made on all fronts, with a new mood of optimism and pride in achievement. It is too soon to stop crossing fingers but all the signs are positive.

Now we wait to hear praise from patients – too often sadly missing in recent years. That will be the real test of good progress.

Joan

Mount Vernon Cancer Centre – Open Day

What a day! Donald Edwards and I were on site for five jam-packed hours. Nothing we could write here would do justice to all that we saw. Donald took photos, which are often more powerful than words, so this brief account is mainly pictures with comments.
Over 60 people went on tours - groups of around eight persons, each with two members of staff, one to lead and talk, the other to bring up the rear and save anyone getting lost, just like a school party. Everywhere we went specialised staff were waiting to tell us about their work. Some of their comments may be seen in the text below.





We started with Chart Lodge, set up to provide a home-from-home for patients undergoing radiotherapy three times day over several days - comfortable twin and single rooms, self catering with TV, phones and all mod-coms, a delightful place to stay and free to patients and a companion if they wish. Others using the Lodge pay a modest £15 per night single and £25 per night double, which keeps the facility self financing. From there we moved on round the site.


Rosemary Lucey & Cherrie Mackie at the Lynda Jackson Macmillan Centre
The Lynda Jackson Centre Macmillian Centre has been a model for other cancer support centres across the country. It offers support of many kinds to all cancer patients, wherever they are being treated. In addition, Mount Vernon patients can enjoy a wide range of complementary therapies - reflexology, aromatherapy, Indian head massage and so on.

The Chemotherapy Suite currently provides treatment in an open setting. There are plans for improved patient facilities here, to be funded from the ongoing charitable appeal to raise £1 million for the Mount Vernon Cancer Centre.Research in the Marie Curie Wing will be another recipient of support from the £1 million appeal. Clinical trials are the bedrock of improvements in cancer treatment. The chemotherapy suite is a day treatment centre treating on average 30 patients a day. Patients receive both simple and complex cytotoxic drug regimens and also targeted therapies. It currently has 12 reclining chairs and 1 bed. The unit has been at the forefront in the development of nurse-led services, particularly in relation to pre-treatment assessment and oral chemotherapy.The unit is continuously striving to improve the service and is currently piloting the training of phlebotomists to insert peripheral cannula and also the commencement of a ‘breakfast clinic’ for certain groups of patients to receive their treatment early in the day with breakfast provided.

Margaret Sullivan CEO - The Paul Strickland Scanner Centre

The Paul Strickland Scanner Centre remains at the forefront of world-class scanner technology with the latest CT scanner, 2 MRI scanners and a second PET/CT scanner about to be installed. The Centre continues to support the vital diagnosis, treatment and research into cancer conducted by our colleagues in the Cancer Centre. In the past many patients have travelled long distances to use the Scanner Centre’s services, especially for PET/CT. This has decreased as more PET/CT facilities have become available around the country.




Preparing Highly Toxic Drugs for chemotherapy patients. Pushpa Parma - Senior Supervisor
Baxter Healthcare Ltd is a commercial company supplying the highly toxic drugs used in chemotherapy. This expensive medication prescribed in complex regimes for patients who can be very vulnerable to infections, is prepared in totally controlled facilities to ensure sterility and safety of the product at all times.












Michael Bishop, The 'Bio-Engineer'
Physics and bio-engineering are little known but essential components of the cancer centre. The highly skilled workforce both service and check the complicated equipment to ensure that the correct amount of radiation is delivered to the area to be treated. It also creates bespoke items to meet individual patient need, such as supports to immobilise limbs or heads during radiation therapy.
When new equipment is delivered the physics staff can spend between 2 and 3 months taking measurements to ensure the characteristics of the machine are known. These checks are repeated throughout the machines life as part of a rolling program of quality assurance.




Dr. Marj Girling, Head of Nuclear Medicine & Physicist Nadir Nazir & Janis Brown. The Gamma Camera & Pre-Treatment Simulator, Alita Frank

Nuclear medicine allows radioactive markers to be administered to the patients and then tracked as they pass around the body, thus identifying abnormalities in the patient.Planning radiotherapy requires very specialised skills, pin-pointing exactly where radiation will be administered and ensuring that the patient is in precisely the same position each time they are treated .

Nuclear Medicine uses the application of radioactive materials to aid the diagnosis and for treatment of patients. Different radioactive isotope/chemical combinations are used depending on the part of the body under investigation or being treated. These decay naturally, emitting gamma (g) and beta (b) radiation.

Depending on the examination required, tests can just involve a series of simple blood tests, a collection of urine samples or being scanned. But all examinations involve the administration of a radioactive material either as a small injection or in a capsule form.
All the scans are performed on a dedicated Gamma camera, which detects the radioactivity within the body and creates a computer image of the area of interest. The scans produced are usually viewed in conjunction with images from other modalities, such as, MRI, CT, Ultrasound and X-rays. These other imaging techniques demonstrate anatomy (what the skeleton or organ looks like), whereas the nuclear medicine scans demonstrate the physiology or metabolic activity (i.e. how the organ is working).
As well as diagnostic tests the department also uses different radioactive isotopes for different kinds of therapeutic effects, the therapies vary from treating a hyperactive thyroid to alleviating bone pain for bone metastases.
The nuclear medicine department at Mount Vernon Hospital consists of a multidisciplinary specialised team that includes 3 senior radiographers, 1 technologist, 4 physicists and 2 administrative staff.

The new “linac” building at Mount Vernon has 5 bunkers with a new linear accelerator in each bunker – this build and the replacement program within the rest of the cancer centre will bring the total to 9 linear accelerators. A linear accelerator (LA) is a complex piece of equipment that produces the high energy “xrays” that are used to treat the cancer. As these “xrays” are high energy the LA is housed in its bunker which is basically a room with very thick walls that stop the radiation (equivalent to ~ 1.5m of high density concrete). These new LAs are now treating patients, this means that patients are receiving state of the art treatment in the desired time period. This new build also houses the physics planning offices (a lot of high powered computer technology involved) and the admin and clerical offices – the secretaries now have good working conditions reflecting their importance in patients journey from diagnosis of cancer to treatment.





Dr. Peter Ostler, Clinical Director. TheNew PCC Waiting room . Karen Venables & Dave Polley
Mount Vernon Cancer Centre has a brand new state of the art Brachytherapy suite that was financed through a donation from a generous local resident. This Brachytherapy suite houses the Brachytherapy machine and the planning technology required and also has an open bore MRI for radiotherapy planning (one of the only planning MRI machines in the UK). Brachytherapy means that the radiotherapy is delivered directly into the cancer, and in so doing limits the radiation dose to the surrounding normal tissues. This facility has enabled the cancer centre to lead the UK in the field of Brachytherapy.




Michael Sobell House - The indoor aviary - --- Healthcare Assistant Joanne Rayson
Michael Sobell House is a specialist palliative care unit which cares for individuals with advanced illness, mainly cancer but increasingly those with lung conditions, heart disease, renal disease etc.
MSH consists of a 16 bedded inpatient unit and a day therapies unit, which provides a range of services to patients and carers. A multi professional team are available to provide a variety of care including medical and nursing care, rehabilitation support, bereavement care, social & psychological support, complementary therapies etc.
In addition an Outreach service is available to care for those who at the end of their life and wish to die at home.
MSH also runs a 24 hour palliative care telephone advice line which is available 365 days per year and answers queries from patients, carers and health professionals.
MSH also boasts an education service which provides palliative care education and training for a variety of multi- professional staff including Doctors, Nursing Homes and Community Teams.
MSH is an integral part of the Mount Vernon Cancer Centre which is NHS funded, however it is strongly supported by the Friends of MSH who fundraise for many of the services provided.

Everywhere there was optimism, enthusiasm, and conspicuous dedication to the work of this fabulous place. Aren't we lucky to have it on our doorstep! The 77,780 people who signed our petition earlier this year know it is second to none.

Chairman Joan Davis Donald Edwards - Publicity Officer

Harrow PCT Board Meeting, 4 March 2008

We had a huge agenda before us, something like 1000 pages. The public part took about 3½ hours. Unsurprisingly, I only give highlights!

Finance The PCT expects to break even, with the return of top-sliced monies helping in this. A lot of detail, some overspends balanced by underspends (for instance, cost of medicines has gone down markedly).

Corporate Governance Documents These get revised annually but the changes are not indicated. Board members, with experience elsewhere, insisted that the changes should be clearly indicated, showing the changes from earlier versions, so that it is easy to see what has been changed. There was also a request that the whole style should be more ‘user friendly’. Victory for experience over NHS bureaucracy.

Draft Annual Public Health Report Another massive document, with much interesting material about the variations since 2004. Harrow is more deprived than previously. The general public perception is that Harrow is a wealthy place but that’s not true in all parts. In the measles outbreak about a year ago most of the cases in Harrow were health workers, who presumably caught the disease from a case in A & E, and needed hospital treatment. The general uptake of MMR vaccination is pretty good in Harrow but this incident shows that there have been gaps in the past.

Obesity The PCT had asked the Council’s Scrutiny Committee to carry out a review. There are 19 recommendations in all, covering childhood obesity, adult obesity with special reference to diabetes and cessation of smoking.

Next Steps in the ‘Healthcare for London’ Consultation Sarah Crowther, the new Chief Executive, told us about this. The London PCTs have had very different experiences with the ‘road show’. Some had very good audiences, about 300 in one case, Harrow had about 50 in all, some even less than that. Clearly, there is no right way of doing this. And now? Sarah explained there will be three levels of activity:
i) PCT will deal with local problems;
ii) Neighbouring PCTs will consider common problems;
iii) London PCTs together will discuss the ‘whole London issues’.
Sarah thinks these discussions will take up the whole of the 2008-9 financial year. Some of the discussions will involve local councils and the SHA, but it seems that the PCTs are legally the only bodies that can make decisions on reconfiguring services.

Paul

East & North Herts Hospitals Board Meeting February 2008

Through a quirk of history, this NHS Hospital Trust controls the Mount Vernon Cancer Centre. So, to keep up to date, we try to be represented at the Trust’s Board meetings, which is often not easy. This time our thanks go to Jean Dixon who travelled all the way to Hertford Hospital to keep us informed.

The main item of news is that the Trust has balanced its books, got rid of its debts and is controlling its infection rates, so it is now all set to apply for foundation trust status. In fact it embarked on public consultation on this issue on 3rd March – to see the document, go to the website http://www.enherts-tr.nhs.uk/consultations then follow the links. This consultation ends on 30th May.

To back its application, the Trust needs to get a large number of foundation trust members, representative of the very wide area that it serves. There is a map in the document, really too small to be read, listing most of the electoral wards that it covers.

However the Mount Vernon Cancer Centre’s patients come from far and wide, so Jean asked how people outside the listed area would find out about the foundation trust plans. Peter Gibson, Head of Public Affairs, said there will be press releases, but most people will find out through the Cancer Centre, patient groups and local Councillors.

So watch this space. We will do all that we can to keep up to date on this web page.

Joan