North West London Hospitals Trust Board 27 August 08

Performance In the past the Trust found it very difficult to meet the national target of ‘98% of A&E patients treated within 4 hours’. In April there was major reorganisation of how A&E operates and since then the 4 hour target is being met consistently, recently the figure was well over 99%. As a result the trust is now 75th in a national league table of A&E performance, whereas it was 144th in March.

Infection control is also improving. MRSA figures are slightly above target, but one is dealing with small numbers anyway, 15 so far this year instead of 11, so a single case alters that percentages significantly. C.Diff is well below target, but there are doubts about what the target actually is! The numbers are going down all the time, elsewhere they seem to be rising.

Utilisation of Operating Theatres and Cancelled Operations It seems that the trust’s utilisation of its operating theatres is a little under 70%, against a national target of 80%. The Medical Director pointed out that the utilisation could easily be increased by being slower at one’s work and, secondly, the trust does more operations than some other local hospitals with a much higher theatre utilisation So, there is more to it than a single figure as an indication of what happens in practice. And similarly with cancelled operations. It is not always administrative incompetence but there may be good medical reasons, such as the patient’s condition on the day is not as it had been expected to be when the operation was scheduled, that cause an operation to be cancelled. Both of these items showed that having a medical opinion is often a useful counter to an administrator’s views of what should be done.

‘The Productive Ward’ There was an interesting presentation on a scheme initiated by 4 trusts and now being spread to others, of how some reorganisation, including standardised layouts for stores and common procedures, can result in a big increase in the time that nurses spend with patients. In the pilot schemes there was an increase from 25% to around 50%. The trust is intending to introduce these new methods of working in the coming months.

Paul

August News from West Herts Hospitals Trust

1. General progress
The turn-around of the Trust is being maintained. It is now meeting national targets for treatment within 18 weeks of referral by a GP, also the target for patients to receive treatment within 4 hours of arriving at A & E. Infections are low and reducing steadily. Additional work is increasing income and providing a small financial surplus. Cancelled operations are fewer. Delayed transfers have been reduced by opening an intermediate care ward at Hemel Hempstead. All this is a huge achievement.


2. Application for Foundation Trust status
The East of England SHA is now satisfied that the Trust can move towards being a foundation trust, possibly achieved in December 2009.

Public consultation on the Trust’s proposals will run from 23rd September until 16th December 2008. The Chief Executive, Jan Filochowski, has offered to come to a Community Voice meeting to explain the proposals to our members.


3. Watford Hospital
The Outline Business Case for the new hospital is now being prepared.

The last issue of the Health Service Journal, 14 August 2008, featured this £200m private finance initiative health campus, which is expected to take account of environmental issues – rainwater will be piped off the hospital roof to water the football pitch and there are hopes of cutting energy consumption by 27%.


4. Staffing issues.
Attention now focuses on recruitment, to reduce reliance on agency staff, which is expensive and less satisfactory than permanent staff.

From April to June the Trust recruited 90 new members of staff, compared with 27 for the same period last year. 14 additional midwives are due to start work soon.

The Trust is starting to replace junior doctors with experienced nurse practitioners at night. This improves quality of care, because issues arising at night generally require nurse intervention, and it also leads to financial savings.


Joan

News on the Mount Vernon Cancer Centre Review

A “User Involvement Group” has been set up to feed the views of patients and the public into this Review. I am privileged to be a member. Other members come from across the wide area served by the Mount Vernon Cancer Centre.

We met for the first time on 7th August. There was a lot of support for the Cancer Centre. Several members have been patients there.

The first task of this Review is to reconsider the 2002 Varley Report, which recommended moving the Cancer Centre off the Mount Vernon site, a recommendation that still stands although so much has changed since then. A report is expected in November 2008 to address this issue.

Assuming that the Varley recommendation is rejected, the main task will then be whether radiotherapy should be provided at Mount Vernon alone or at Mount Vernon plus one or more satellites in Hertfordshire. Numerous factors must be considered including clinical factors, demographics, workforce and transport issues as well as plans in neighbouring areas. The Review’s final report is not expected until late in 2009 but there may be an interim report in Spring 2009.

This first meeting boded well - an encouraging start to a long process. The Community Voice has championed the Mount Vernon Cancer Centre through many dark days but, at long last, a strong ray of light is appearing on the horizon.

Joan

No. 9 Video. - Nuclear Medicine

The Nuclear Medicine department is hidden away at the end of the main building on the lower ground floor, with the Endiscope Unit on the first floor.

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.

London congestion charge, is your treatment costing you?

Are you or a relative travelling into central London for NHS cancer treatment? Did you know that you could be entitled to a refund of the £8 Congestion Charge you may have paid? We are carrying out a survey to assess how well the congestion charge reimbursement scheme is working. If you pay the congestion charge to get to your treatment in London, please fill in our survey and tell us about it. Visit: www.macmillan.org.uk/campaigns and fill in the survey online, or contact rhaughton@macmillan.org.uk or on 020 7840 2036 for a copy. We know that people living with cancer face all kinds of unexpected extra expenses such as for travel, prescriptions and child care. So Macmillan Cancer Support successfully campaigned in 2004 to have the Congestion Charge reimbursement scheme put in place. We now want to hear cancer patients views on and experiences of it.

Please contact the above, NOT Community Voice.

Donald
Publicity

North West London Hospitals Trust Board Meeting 30th July 2008

A successful bid
The trust has made a successful bid, subject to ministerial approval, to establish a clinical and laboratory service in the south of England for the diagnosis of patients with atypical and complex Ehlers-Danlos syndrome (this is a group of heritable disorders of connective tissue). A second such centre is being established in Sheffield, to cater for the north of England.

Midwife-led Birthing Centre
The Brent BC transferred successfully to NPH on 1st July. In its first 19 days there were 35 deliveries. This rate matches c.670 births p.a., whereas the unit in Brent had about 300 deliveries p.a. As one of he aims of the move was to increase the use of this service these initial indications suggest that the move was the right thing to do.

Performance
The trust now regularly meets the 98% target for A&E, exceeding it quite comfortably. Recently, on one of the hottest days of the year, they had the largest number ever of patients attending A&E, many with respiratory symptoms. Even so, they coped within the target. Well done!.

Finance
Finance is always a problem in the NHS, sometimes for odd reasons. It’s not that the money doesn’t exist, just that it’s in the wrong place. For instance, the trust has been given approval to appoint a number of junior doctors but the funding for their salaries has been delayed. Many parts of the NHS delay paying bills, so that their cash flow problems are eased, but this tactic leaves somebody else with a cash flow problem. This way of working was described as ‘problem transference’.

Paul