No. 2 Video - Security at Mount Vernon Hospital

In these days, where the news seems to always have stories of violence, even hospitals, which one would think were havens of peace and quiet, are not exempt. Notices about abusive language and violence to the staff are alien to most people who cannot understand anyone behaving this way to people who are trying to help them.
Dr. Ashish Rawal PhD., is a security guard, usually on night shift, till he completes his studies before, hopefully, joining Michael Sobel House as a complementary medicine therapist.
Donald
Publicity

Herts Review of the Mount Vernon Cancer Centre

For people who love the Mount Vernon Cancer Centre, the new Herts PCTs Commissioning Review appears as yet another hurdle to face. The report on our June meeting outlines our concerns. However it is heartening that Hillingdon PCT, at its meeting this week, reaffirmed its support for cancer services at Mount Vernon.

Its Chief Executive, Yi Mien Koh, recalled that in June 2006, when facing the possibility of services being moved from Mount Vernon to Hatfield (a threat now abandoned), the PCT Board had agreed.
“a) Proposed increase (to alternative cancer centres) in journey times and additional cost to individuals are unacceptable.
b) The preferred option is for safe and affordable supported ambulatory cancer services to be available at an accessible local site to Hillingdon
c) On the assumption that cancer services are to be withdrawn from the Mount Vernon site when Hatfield opens, the PCT will request that The Hillingdon Hospital considers the inclusion of ambulatory cancer services in its redevelopment plans”.

She went on to state:
“I would like to take this opportunity to reaffirm Hillingdon PCT’s position taken previously, which I have conveyed to the two North West London PCT Chief Executives on the review steering group.”

And then she added:
“I have also expressed to David McVittie HPCT support for The Hillingdon Hospital to bid to take over Mount Vernon Cancer Centre from East & North Herts NHS Trust.”

There was no dissent around the table – Hillingdon PCT Board shares our views!

Joan

Hillingdon - out of the wood! Or is it?

Last year Hillingdon PCT broke even for the first time in five years – a fantastic achievement! However its backlog of debt is over £42 million – which the NHS says it must pay back. £7.7 million is the amount it is supposed to find in the current year – a crippling burden. Is that fair?

The NHS is not democratic, so there was no way Hillingdon people could have stopped the debt arising. Punishing the PCT is pointless – all the old Board have long since gone. Punishing patients, children, old people who simply happen to live in the Borough is equally unjust.

At the NHS London Board meeting this week, The Community Voice made an impassioned plea for special help for Hillingdon. If that plea falls on deaf ears Hillingdon will continue to have some of the worst accommodation in the NHS, since without money there can be no building of a new health centre in Yiewsley, nor replacement of The Hillingdon Hospital. The 1940s temporary wards in that hospital are at last being pulled down – but that is only a first step. A great deal needs to be done and with a huge NHS surplus in 2007-08 there is money in the bank to do it – it just needs a little creative accounting to set the money free. We are watching and waiting!

Joan

Basic facts from NHS London - June 2008

Board meetings last two or more hours. Our report must shrink to about two muinutes. Here goes - just the basics!

Priorities for the year: The SHA has six priorities for 2008-09.

1. Consultation on delivering Healthcare for London
a. PCTs or groups of PCTs will develop proposals for local services e.g. polyclinics. PCTs will be asked to plan delivery of the total HfL programme by producing a five year Commissioning Strategy Plan.
b. There will be pan-London consultation on major trauma and stroke pathways.
c. Maternity pathways could require local or sector consultation.

2. Commissioning
a. The Department of Health has developed a programme called World Class Commissioning which outlines a set of competencies for PCTs.
b. Pan London skills are being developed / also sector co-operation.
c. All London PCTs will be expected to submit commissioning plans to NHS London by November. They will then be assessed against performance on health outcomes.

3. Performance
Key targets are:
a. A&E: London achieved 97.3% of the four hour wait standard for 2007-08, just below 98% target.
b. Maximum of 18 week waits from GP referral to treatment: True now for 82% of inpatients - target 85% next December / and true now for 93% of outpatients - above 90% target for December
c. Healthcare acquired infections – MRSA has dropped by 52% over three years and clostridium difficile rates fell 15% last year.
d. Modern matrons: the target was to double the number by May 2008 - the London number rose from 436 to 906.

4. Trust transformation
To stabilise Acute and Mental Health Trust performance across London

5. Public health initiatives
Priority is to combat smoking and obesity, the main causes of strokes and heart attacks

6. Improving internal effectiveness
To deliver future programme of work

All this will take money, so it is important that the London surplus for 2007-08 was £280million – 2% of its total resources. Compare this with its 2005-06 deficit of £174 million - there is obviously no financial excuse for failing to achieve the above priorities!


Joan

The Unseen Workers of Mount Vernon Hospital

The Catering Department of Mount Vernon Hospital has a very busy team. They produce not only the meals for the patients but also for the canteen which is alongside, for the staff, visitors and patients.
On my many visits to the hospital, for The Community Voice and in the days when I inspected the power plants and equipment in the hospital, I visited many places on site not seen or even given much thought by the average patient. I have often had a meal in the canteen and never had reason to complain. A good selection at reasonable prices. The catering department is a thankless department, no matter where it is, on a ship, a factory canteen or the messroom of an army barracks, all they get are complaints, not many people stop to thank the staff for producing a good meal!
Here is a chance for you to see some of these wonderful people who's interest is, like the nurses and doctors, to make your stay the best they can.
Over the next few weeks you will be able to watch some of these people at work.

The next video is Security.

Donald
Publicity

Hillingdon views on polyclinics

At it meeting on 17th June, Hillingdon Council’s Scrutiny Committee summoned local NHS representatives and asked for comments on Lord Ara Darzi’s proposals for polyclinics.

Dr. Mich Garsin, representing local GPs, was highly critical. Local GPs object to big new buildings serving 50,000 patients, an extreme form of polyclinic – money could be better spent on improving existing surgeries. However GPs are happy with federated models, based on existing surgeries, but with greater GP co-operation. That model would improve patient services and combat GP isolation. Patient surveys show that patients want to keep surgeries near home, they fear having to travel further to see a GP, and they do not want extended surgery hours. He also feared private sector involvement, noting that United Healthcare – which he said is discredited in its country of origin - has bought up large numbers of old surgeries as part of a bid to get into the NHS by the back door, as failing surgeries are the most likely to be converted into polyclinics.

David Serle, representing Hillingdon Hospital, said that hospitals want to do the right thing for patients, but in order to remain viable they need a critical mass of both patients and finance.

The Scrutiny Committee Chairman, Mary O’Connor, made clear that the word “polyclinic” is so emotive that in the Joint London Overview and Scrutiny Committee, which she chaired, the word was almost banned!

Yi Mien Koh, Chief Executive Hillingdon PCT, (Pictured above) was confident that her PCT endorses the broad outline of the proposals and it will be ready to start public consultation on its local proposals in September.

Joan

West Herts PCT can start to invest again!

Money issues

At its special meeting on 17th June the PCT presented end of year progress reports for 2007-2008. There was a cause for pride. It had paid back its historic deficit of £42.7 million and achieved financial balance. It even made a small surplus - a splendid achievement!

So now eight Urgent Care Centres can be developed across Hertfordshire and spending can be increased at local hospitals. This will help Watford Hospital. An extra £1.5m will be available in 2008-2009, to fund more elective activity, more outpatients and more A&E. All good news!

The PCT’s Commissioning Review of Mount Vernon Cancer Services is underway.

A “Service Users Reference Group” has been set up to advise this Review but we are concerned that its geographic composition is unlikely to be representative of all patients. This could disadvantage patients like us, on the fringe of the huge area served by the Cancer Centre, as we have very different concerns from people in central and northern Hertfordshire or Bedfordshire. Details about composition of the Group were promised for the July Board Meeting.

Hertfordshire LINks

Herts. is slow in setting up Local Involvement Networkds. Again an update was promised for July.

Professor Lord Ara Darzi's proposals, "Leading Local Change"
The two Hertfordshire PCTs have no expectation of holding public meetings on the Ara Darzi proposals, although public consultation runs until 4th August 2008. These PCTs held public meetings last year on “Delivering quality health care for Hertfordshire” before setting their own strategic goals, which will be fed into the current consultation.

However staff groups, voluntary organisations and some public organisations will have input into the consultation by means of displays, informal presentations, and a media campaign. See website www. eoe.nhs.uk/vision – or ask for a consultation document from NHS East of England, Victoria House, Capital Park, Fulbourn, Cambridgeshire.

Joan

Decision day for Healthcare for London!

All London PCTs and Surrey PCT have worked together in their response to Lord Ara Darzi’s proposals for London’s healthcare. Today they held a joint meeting in public, to reach decisions and recommendations. Their decisions are binding on all the PCTs but their recommendations can be implemented according to local needs.

Around sixty people were present to represent the public. A few came to air their concerns, but most were NHS or local authority representatives who were there simply to observe.

The 126 page final report and its five accompanying documents, some with over 100 pages, contributed to the total £1.1m spent on the consultation. (All the documents should be available from PCTs and on-line – but they can also be borrowed from me on request).

The out-come was always predictable, but the reality was still a shock. After an hour and a half’s introduction and detailed discussion about the consultation process and the case for change, there was a slot for public comment, and then the long-awaited final report was passed out to the public. Some of the audience promptly jumped to their feet and raced away – presumably members of the media!

At that precise moment the Committee started to consider its 19 decisions and over 80 recommendations, printed in draft form in the report. However, the speed was so great that there was seldom time to read the draft wording of groups of proposals taken together. A few minor amendments were proposed and quickly agreed. And then it was over! Obviously any real debate took place long ago – this was simply an occasion for rubber-stamping.

So, concentration of services for strokes, trauma, complex emergency surgery and specialised care for children was agreed. Longer hours of access to GPs and more care in the community were agreed too. A polyclinic model of service was approved, but with provisos about precise services being determined locally. Local consultation will be necessary before any service changes are implemented. All just as expected.

Joan

Our July Meeting

The next meeting of The Community Voice will be on Thursday 3rd July at 7.45pm in the Post Graduate Centre, Mount Vernon Hospital, when we will be holding a Forum on:

"Carers - their rights and their needs"

This will be led by guest speakers from Herts. Social Services, Hillingdon Carers and Harrow Age Concern. These speakers will provide insight into many aspects of our topic including experience in the various localities where our members live - Hillingdon, Harrow, Three Rivers and Watford. The audience will then be free to contribute comments and questions. As usual, visitors will be welcome.

Joan

What were the current issues at our June meeting?

Apart from NHS rationing and postcode lottery – raised by our guest speaker - we considered a range of both local and national issues:

1. Hertfordshire PCTs Commissioning Review of Mount Vernon Cancer Centre:



We consider the Chief Executives of Kensington , Chelsea and Westminster PCT and Harrow PCT as inadequate to represent our concerns on this Review. The Cancer Centre is sited in Hillingdon and more patients from Hillingdon use the Cancer Centre than from any other London Borough so we contend that Hillingdon PCT should be represented. We are contacting Ben Bradshaw Minister of State about this, as he received our 2007 petition with 77,781 signatures calling for cancer services to stay at Mount Vernon (pictured above).

2. Health Centres in Yiewsley and Northwood: We applaud proposals for health centres in both Yiewsley and Northwood (picture above), but accept money is tight. Yiewsley has greater need and will swallow any available NHS cash. We welcome the Northwood Health Centre’s plans to explore moving its services into the adjacent Northwood & Pinner Community Hospital. Hillingdon PCT’s current policy to retain and use all its estate for NHS purposes is also re-assuring.

3. Local Involvement Networks – LINks:

We discussed progress in setting up these new organisations to represent the public in the NHS. (picture above of the launch of Hillingdon LINks on 5th June). We decided to apply, as an organisation, for membership of the three local LINks - in Hillingdon, Harrow and SW Herts - and we urged members to do so individually too.

4. BMA petition to save GP surgeries: This proved controversial as many members felt the BMA had over-reacted to the Ara Darzi proposals for polyclinics, although some supported the petition. Most members felt local interpretation of “polyclinic” would reflect local needs, leading to better facilities in local health centres.

5. Foundation trusts meeting in private: We are escalating our campaign calling for Foundation Trusts to hold their Board meetings in public. Other NHS trusts are obliged to do this – so Foundation Trusts should do so too.

We also touched on our New Members Meeting on Monday 9th June, our application for a London Health Commission award, and our proposed visit to the House of Commons.

This one meeting covered a huge amount of ground! We had plenty to think about and discuss.

Joan

The word the NHS most hates to use? Rationing!

1. 
   
   Our June guest speaker, Dr Martin Rhodes, Medical Director Harrow Primary Care Trust, confronted the most difficult topics in the NHS – postcode lottery and rationing – and challenged his audience with “What would you do if you had to decide?”
   
   His first example set the scene. A patient’s former PCT had paid for a homeopathic treatment, which his GP testified worked for him, but there was no clinical trial evidence to support his application. Should Harrow PCT pay for it now?
   
   The audience was split – some said “Yes”, some “No”. Dr Rhodes then outlined the factors his committee used to make its decision:
   1. Every PCT’s first obligation is to balance its books so rationing is a fact – even though the NHS hates to admit it.
   2. If NICE (National Institue for Health and Clinical Excellence) has ruled nationally that the NHS provides a treatment, then it must be provided, regardless of cost.
   3. If NICE has not ruled – and it takes around two years to do so - there are respected bodies that give assessments more quickly, based on clinical evidence from random trials.
   4. Clinical trials repeatedly show some patients benefit from dummy treatments, NOT the drugs being trialed - called the placebo effect - so how a particular patient responds to treatment is considered irrelevant.
   5. Fairness - if one patient is allowed a treatment then all similar patients must be allowed the treatment too, regardless of age or personal factors.
   6. The cost of one patient’s treatment may be small, but if there are large numbers of similar patients or the treatment must continue for a very long time, the total cost may run into millions.
   7. Exceptional cases may warrant special decisions e.g where a patient is allergic to a standard treatment.
   8. When the patient claims psychological distress, the advice of an independent psychiatrist is considered.
   
   In the example considered, item 4. prevailed and Harrow PCT refused to pay. Such cases sometimes go to appeal but if the decision process is fair, then decisions are upheld.
   
   Few treatments are cures. Most extend life, some by just a few weeks of poor quality life. NICE tries to balance different factors by estimating the treatment cost for one extra “Quality Adjusted Life Year” – a QALY. It generally rejects treatments costing over £30,000 per QALY.
   
   Several sad cases were considered together by the speaker and audience. The public often condemns adverse judgements as heartless – but most of us came away grateful that we do not personally face these difficult choices.
   
   Joan

Harefield Hospital, Cardiothoracic Theatres - Open Day

On the 20th of May 2008, Harefield Hospital held an open-day at one of the Cardiothoracic Theatres . It ran from 10am to 4pm and was a huge success with many visitors both young and old alike,at times having a go, hands on experience. It certainly was an eye-opener to what is involved in the various procedures carried out in this wonderful hospital. Recently, the Trust was named England's Best Heart Hospital. "Royal Brompton & Harefield is 'leader in its field' according to the Independent newspaper".

Thanks to the Royal Brompton and Harefield Trust, I have prepared a series of 11 videos for our Community Voice site, which I hope to put on, maybe two a week.
Today we start with Number one.

1. Introduction.Theatre waiting room with an interactive nature window. Organ Donation information. Instruments used in the theatre.

2. Information on Blood Donation. Hand-washing procedures.

3. Tools used in Thoracic surgery and Cryogenic surgery.

4. The Perfusionist.

5. Short Term Ventricular Assist Device (VAD).

6. 'Harvesting' a vein from the leg for By-Pass surgery.

7. Heart By-Pass Procedure.

8. Mechanical Ventilation.

9. Demonstration using a pigs heart, disection for valve renewal etc. Part one.

10. As 9, showing, the various artificial heart valves available. Part two.

11. The staff who took part in the open-day.

Donald Edwards