No. 10 Video. Karen Blackbond, General Manager, MVH

Hillingdon PCT's September Update

Areas where PCT is not meeting targets:
a. Choose and book – DoH reported level in July was 33% - Referral Management Centre is achieving 46% of all routine admissions. (Target 90% - but note HPCT is in top half of London PCTs)
b. Cancer - 62 days to start of treatment – 93% in June v target 100% (5 breaches since April)
c. Chlamydia screening a national priority – 1.5% in June v month target 4%
d. Immunisations and vaccinations a national priority
e. Workforce sickness – 5.6% in June v target 3.5%
f. Workforce appraisals – 26 in June v target 74
g. Contract management
h. Smoking cessation – 285 quitters in June v month target 386

Finance
a. Month 5 spend is £2.1m above budget - acute activity continues to rise, increasing by 7% this year.
b. Recent increase in pharmacy fees will cause a part year £1m cost – no extra cash yet from SHA.
c. Continuing care costs continue to rise as more people are becoming eligible.
d. Full year forecast is still to break even by using all reserves.

Cervical Screening
Hillingdon PCT’s five year target is to screen 80% of women aged 25 – 64 years, which would be expected to reduce deaths by about 95%. In 2007-08 Hillingdon achieved 74.42% (a drop from previous year). Only 13 of 49 GP practices in Hillingdon achieve 80% target. Two new managers are being recruited.

Balanced scorecard / patient satisfaction for GP services
The balanced scorecard reports on a range of factors to indicate overall perfomance and allow comparisons. Data for Quarter 3 in 2007-08 was presented alongside data for Quarter 1 2008-09.

Considering this data in a positive light:
a. 48 out of 49 GP practices, 25% are in the top group for management of diabetes and chronic heart disease (for which payments are made to GPs depending on their performance).
b. Using the green /amber / red system only 2 practices are in the red band for access to GP services versus 4 practices last year.
c. Three practices are in the red band for clinical cost effectiveness of prescribing versus 6 last year.
d. Two GP premises have moved out of the red band this year.

However close examination of the data published shows that
a. Only 3 out of 49 GP practices were green across all the good services indicators – and one of those is a practice serving patients with a high deprivation score, from premises rated red, which clearly shows that good service can be achieved where there is sufficient determination by the GP practice.
b. Conversely, 46 out of 49 practices still need to improve, despite an action plan introduced last year.

Also data from the Department of Health patient survey over five measures of access to GP practices, carried out earlier this year by the Ipsos Mori survey of 11,894 people, shows data for every practice by name and indicates that 20 out of 49 practices were below average in all areas identified. Also that:
a. For % of patients satisfied with telephone access, the Hillingdon average was just above the London average and just below the national average - but 13 practices were below all those averages.
b. For ability to get an appointment within 48 hours, Hillingdon was below national but above London averages – but 26 out of 49 practices were below all those averages.
c. For ability to book three or more days in advance the Hillingdon average was better than both national and London averages – but 18 practices were below all those averages
d. For ability to book with a specific GP, Hillingdon was just above the national average and above the London average – but 15 practices were below all those averages.
e. For satisfaction with opening hours, both Hillingdon and London were below the national average, but 28 practices were below all those averages.

The above outcomes are despite the PCT initiating an action plan in September 2007 to work with the 10 practices then having the least level of patient satisfaction.

In-depth work with up to 20 practices is now being undertaken to support improvement in the level of satisfaction over the five measures, including follow up with five of the practices identified for specific action last year.

Joan

Hillingdon's External Scrutiny Committee

This Committee's September meeting co-incided with Hillingdon Hospital's AGM. This was unfortunate as the scrutiny agenda included both Hillingdon LINk and the Mount Vernon Cancer Centre consultation. However, both meetings were in Hillingdon Civic Centre so I attended the first part of this meeting, before going on to the hospital's AGM.

HAP gave a presentation on its administrative support to Hillingdon LINk, which I heard, but I was unable to stay to hear the Scrutiny Committee’s questioning.

I happened to see the Chairman later and learned that the Committee demanded an update from HAP in six months’ time and, most importantly, had agreed its excellent draft response to the Mount Vernon Cancer Centre consultation, taking precisely the same line as agreed by Community Voice at its September meeting - confirming support for the Cancer Centre to stay at Mount Vernon and for the Review Group to look at the possibility of the Cancer Centre having satellites on other hospital sites, with the proviso that finance, staffing and support issues are resolved so that ALL cancer services are first rate for patients.

Joan

West Herts news

West Herts news comes from the September meeting of the Primary Care Trust Board


Hemel Hempstead changes
a. Management of Hemel’s intermediate care beds passed to West Herts PCT from 1st September.
b. An Urgent Care Centre will open at Hemel on 1st October.
c. Local outpatient and diagnostic services will stay at Hemel, together with a rehabilitation stroke unit.
d. The PCT proposes a new General Hospital in Hemel, but the site is not yet determined.
e. Negotiations for a NHS Surgi-Centre at Hemel are ongoing, planned to open in Autumn 2010.
f. There is delay in transferring acute services from Hemel to Watford due to construction problems.

Changes to services at Watford General Hospital
a. The Acute Admissions Ward has been handed to the Trust, for phased occupation from February.
b. Phase 1 of Children’s Emergency Department is now in use - it is well received by staff / patients.
c. A revised stroke pathway is to be introduced in October.

Mount Vernon Cancer Centre Commissioning Review
Public consultation is underway and ends on 4th November, with three options:
a. Move the Cancer Centre to a District General Hospital – the Review Group recommends rejection of this.
b. Develop cancer services on the Mount Vernon site.
c. Make Mount Vernon Cancer Centre a hub, with satellite cancer services on other Herts sites.

NHS dentistry access in Hertfordshire
a. The number of patients treated in the previous 24 months is down by 13.4%.
b. As a result of a new NHS contract in April 2006, four dentists decided to treat only private patients.
c. Hertfordshire is quite well served by NHS dentists and a large number can take more patients.
d. Standards for access to NHS dentists are proposed for Hertfordshire patients:
Urban routine treatment within 3miles and 15 minutes travel time,
Rural routine treatment within 12 miles and 30 minutes travel time,
Urban emergency treatment for those in pain, within 10 miles and 24 hours,
Rural emergency treatment for those in pain, within 12 miles and 24 hours.

New contracts for NHS services in South Oxhey and The Mount, Prison
The Archway Surgery has agreed a three year contract to serve both these groups of patients.

Finances
a. The PCT is required to break even in the current year with an under-spend of £1m.
b. Its current under-spend is £1.57m excluding contingency and earmarked reserves and uncommitted funds – it could end the year with £5.2m surplus, so it is considering how best to use at least £0.5m.
c. Proposals for investment include improving its cardiac and cancer re-hab. services / strengthening stroke prevention and services / increasing partnership funding e.g. Age Concern / Carers in Herts.

Targets
a. Data variability at Watford General is causing concern for the 18 weeks target for admitted patients.
b. The main risk for Provider Services is community paediatrics – data completeness is a problem due to the way the national formula calculates the target.
c. The ambulance services are in danger of not meeting targets.
d. Both East & North Herts Trust and West Herts Trust met their clostridium difficile annual targets.
e. Neither Trust met its MRSA target – E&N 33 cases v target 22 and West Herts 37 cases v target 18.

Hertfordshire staffing issues
a. Additional staff are being recruited to improve access to Psychological Therapies.
b. Workforce sickness is low at 4.77%, which is below national average for PCT staff.
c. Staff non-attendance at training sessions is to be penalised at £50 if not cancelled in advance.

Hertfordshire LINk
The launch is to be on 20th November. Shaw Trust has been appointed as host organisation.

GP Patient Survey in West Herts - results 2007-08
a. There has been a small decline in patient satisfaction levels for telephone access/ 48 hour access / ability to see a specific GP.
b. The PCT is writing to the Senior Partner of every underperfoming GP practice.

Joan

Items of news from Hillingdon Hospital

At its September meeting the Trust Board was updated on several interesting items including:


1. New consultant appointments
The Trust has attracted strong candidates in virtually every specialty of its recruitment programme. This year it has already appointed new consultants in ophthalmology, obstetrics and gynaecology, paediatrics, neurology and orthopaedics plus two consultant appointments in anaesthetics which have still to be confirmed.


2. Hillingdon Hospital’s Pilot Ward with single room accommodation
The prefabricated building was delivered early in September. Its build quality and space layouts are very good, matching traditional or permanent build quality. Excitement about the research potential of this pilot ward extends far outside Hillingdon Hospital to the wider NHS, the health construction industry and the political world. “Open events” are to be held for staff, public and external professional groups over 2 weeks from end of October.


3. Referral Management Centre
Problems with the RMC are causing delays resulting in some patients not receiving appointments within the schedule for their pathway. This leads to a risk of missing diagnostic and treatment targets. Daily reports are now exchanged.


4. PCT/Hospital relationship
Whilst there are still a number of challenges, there is real effort on both sides towards real practical progress in this relationship. Both parties now recognise the need for a shared vision for the future health economy.


5. Finance Low income was expected in August, but has been worse than expected. The biggest swing was in the medicine division where income dropped sharply whilst costs rose. Efficiency savings improved over the same period, so the Trust is only £41k behind its target, but this masks the fact that surgery and women’s and children’s divisions are significantly behind with their savings plans. Agency, bank and medical locum costs have risen significantly.


6. SHA visit
The Trust’s A&E target to treat 98% of patients within four hours is on track over the current year, but its performance was inconsistent in August - so London SHA set up a visit by an inspector who is regarded as an expert in this field. Overall she was impressed at the transformation she thought had taken place since her last visit some three years ago. She was particularly complimentary about the Trust’s emergency admission process and discharge planning. However, she had suggestions about organising work and managing patient flows which are now being introduced.


Joan

NHS London Board Meeting, September 2008

Here are some highlights from the meeting

A: Organisational Issues

• 
  Change of Chairman:
  George Greener left in August. Interim Chairman is Mike Bell. Sir Richard Sykes starts in December 2008.
  
  NHS London’s 2008-09 priorities are: Delivering healthcare for London / Strengthening commissioning / Performance regime and targets / Trust transformation / Healthy London / Internal effectiveness
  
  NHS London’s key targets are:
  A&E target, to treat all patients within 4 hours (now much better than last year)
  18 week targets from GP referral to start of treatment (95% target for non-admitted patients is already achieved / 86% is now achieved for admitted patients, but target for December 2008 is 90%)


• 
  MRSA and clostridium difficile (currently good progress towards both targets)
  Financial control (a surplus of £320m is planned for London in 2008-09; six trusts are currently overspending and six are spending too little)
  
  Other measures of success:
  Five networked polyclinics should be operational by March 2009 including Alexandra Avenue Clinic, South Harrow


• 
  A successful public consultation is expected on pan-London proposals for trauma and stroke care.


• Achievement of targets is expected for A&E patients/ MRSA / clostridium difficile / replacement of mixed sex wards / targets for start of treatment within 18 weeks of referral by a GP
  
  Outer NW London Group:
• This Group comprises Brent, Ealing, Harrow and Hillingdon PCTs. It has been set up to provide shared community healthcare services via a single NHS organisation independent of the PCTs.
  
  London Clinical and Business Support Agency:
  This was set up in July 2008 to act as a hub providing support services to all London PCTs.
  
  B: Problems in Harrow and Hillingdon

• 
  
  
  Hillingdon Hospital:
  The Trust has provided less access to genito-urinary services than expected and has had breaches in the target for cancer patients to start treatment within 62 days


• 
  
  
  In August it had problems in treating A&E patients within its four hours target (but it has remained within its year to date target)


• 
  
  
  It missed its challenging MRSA target for July (but is now on trajectory with 5 cases to date).


• 
  
  
  It missed its clostridium difficile target (72 to end of July v target 56)
  
  Hillingdon PCT:
  At month 4, £1.5m below its target of £1.4m surplus


• 
  
  
  Below London average on GP practices offering extended hours (19th out of 27 PCTs providing data).


• 
  
  
  Below London average on chlamydia screening (24th out 31 PCTs)
  
  North West London Hospitals Trust:
  At month 4 it had a deficit of £2.68m - £0.9m more than planned.


• 
  
  
  It has not been achieving its MRSA target.


• 
  
  
  It just missed its clostridium difficile target (78 cases to end of July v target 76)
  
  Royal Brompton & Harefield Hospital Trust:
  Is not meeting national 18 weeks targets for either admitted or non-admitted patients.


• 
  
  
  Joan

North West London Hospitals Board 24 September

I was unable to attend the meeting, but here are some interesting points picked up from the agenda.


1. Chief Executive's report


Maternity review. The report on three deaths during 2007/8 was published in mid-September. The review panel found these incidents were not the result of deficiencies in care bit highlighted some areas for improvements.


Mount Vernon Cancer Centre. This was a an almost straight copy of the press release but omitted the statement that option (a) [moving to another hospital site] was not being discussed by the review group. I wrote to Fiona Wise before the meeting, pointing this out and mentioning that I would certainly have raised it if I had been at the meeting.


2. Harrow Elderly Care Wards Report This refers to incidents that occurred while the wards were run by the PCT, i.e. before April 2008. There has been an inquiry into the potentially inappropriate use of restraints on elderly patients in Fletcher Ward. The problems had arisen at times when the ward was somewhat understaffed and several of the staff members were not properly trained. The PCT had been aware that there were potential difficulties but had been unable to do anything about them. [This item has been the subject of a lengthy article in the Harrow Times.]


All other items seem to have been fairly routine.


Paul

Two very different AGMs on consecutive days

Hillingdon PCT’s AGM 23rd September 2008
This was in the afternoon, low key and all over in 15 minutes, before the routine Board Meeting. Just a few members of the public were present. It launched the Annual Report 2007-2008 highlighting the PCT’s main activities, accomplishments and areas for improvement. Copies are available by telephone: 01895 452047

However the Board had much cause for rejoicing. The PCT had achieved financial break-even for the first time in many years, had met all its financial duties and all national performance targets except for MRSA, where it was only marginally below its very challenging target. This was true success and very sweet.

The Hillingdon Hospital’s AGM
This AGM on the following day reported an equally successful year. However, in contrast to the PCT’s AGM, this was an evening event in the comparative splendour of Hillingdon Council Chamber. There were displays and refreshments before the meeting, followed by reports and presentations to a packed audience, which filled the Chamber. The Chairman, Tony Valentine, was clearly delighted with the large audience, mainly members of the proposed foundation trust. He noted the strong local support for the Trust indicated by that evening’s attendance and also by the large number of volunteers who work in the two hospitals and by the success of the Patients in Partnership initiative, which is thriving.

After highlights of the year from the Chief Executive Officer, David McVittie, including progress towards the Mount Vernon Treatment Centre which will open in January, the very successful Annual Accounts were present by the Finance Director, Paul Wratton. Then there were presentations on infection control, with senior nursing staff resplendent in their new dress uniforms. This was followed by news about Bevan Ward, the pilot ward for testing three types of single-bed rooms, which will open next month – this project is a step towards final plans for rebuilding The Hillingdon Hospital. Lastly there was a detailed update on progress towards foundation trust status, which may be achieved as early as next February.

The Trust’s Annual Report was launched too. Obtain a copy of the report, or apply for foundation trust membership, or find out more about becoming a Governor by telephoning 01895 238282.

Joan Davis

Our October Meeting

As usual we will be meeting on the first Thursday in the month, on 2nd October, in the Post Graduate Centre at Mount Vernon Hospital.

Come and hear our guest speaker, Buzz Coster, talking about the wonderful work in the Lynda Jackson Macmillan Centre at Mount Vernon. Visitors will be very welcome.

Joan

Mount Vernon's Cancer Research

Our September guest speaker, Dr Paul Nathan, Medical Oncologist at Mount Vernon Cancer Centre, set off our autumn programme to a memorable start. We could have listened to him for hours, so picking out highlights is almost impossible.

He told us that research is essential in a top cancer centre but it is very expensive, time consuming and, on average, achieves success in only 10% of trials. Pharmaceutical companies will only co-operate with centres that have a good reputation.

However, research has wide benefits. Entering a trial offers patients fresh hope, usually when all other hope has been exhausted, and they generally do better than other patients. Research enables the cancer centre to attract high quality staff, which benefits the local community because all cancer patients are treated by a highly qualified team. Nationally there is a shortage of skilled staff, but Mount Vernon Cancer Centre is generally successful in attracting and retaining the staff it needs.

Advanced cancer cannot usually be cured, so improvements depend on research. After early tests on animals, small numbers of people are tested to identify safe drug dosages and any major risks, before final trials with large groups of volunteers. The major funder is Cancer Research UK, but Mount Vernon needs an academic partner to have access to those funds, so it is exploring links with either University College London or the Royal Marsden Hospital, which is very exciting.

Mount Vernon’s cancer research is led by Professor Gordon Rustin, Professor Peter Hoskin and the speaker himself, who specialises in kidney cancer and melanoma research. Of around 6,500 new cases of kidney cancer annually in the UK, most patients live only about ten months after diagnosis. Chemotherapy is not a cure but Interferon helps about 10%. Mount Vernon is one of the few centres trialing Sunitinib, which delays progression of the cancer for about 70% of patients – of 35 patients in one trial, 8 patients are alive and well three years after the trial started, a huge advance. This drug is available in some countries but not yet in UK, which has led to protests from patients.

The National Institute of Health and Clinical Excellence (NICE) was set up for cost effectiveness and to tackle postcode prescribing. It is unique in the world but other countries are interested in it as a model. NICE assesses all drugs on their increase in Quality Adjusted Life Years (QALYs). Such assessments take a long time - Sunitinib has been licensed for use for three years, but NICE has not yet finished appraisal, a devastatingly long delay for patients with an expectation of living only 10 months. Sadly, cancer drugs are expensive and on average offer only a 14 month increase in life. This is poor compared with treatments for other conditions, which is why NICE may not endorse these drugs.

Radiotherapy is in new buildings at Mount Vernon but a new chemotherapy suite is badly needed there. The Cancer Treatment and Research Trust Appeal has raised almost all the sum needed but is still £200,00 short so a last hard push is needed for success. (To find out more and how to donate see the website www.cancertreatment.org.uk or telephone: 07758 739185 - some audience members indicated that they would take this appeal to meetings of their own organisations).

Joan (with apologies for late publication due to personal pressures)

Mount Vernon Cancer Centre - good news confirmed!

Last month we said the tide was turning for the Mount Vernon Cancer Centre. On the day of our September meeting this splendid news was confirmed. However, the BBC’s mid-day television news was ambivalent, leading some listeners to think the Cancer Centre was under threat, when exactly the opposite was true!

The Review’s Publicity Officer was onto the BBC double-quick, and the next TV report made clear that the current proposal is to reject the Varley 2002 recommendation to move the Cancer Centre out of Mount Vernon. Major changes since 2002 suggest that instead of closing the Cancer Centre its services should be expanded, possibly by making Mount Vernon the hub of a system with satellite services in other hospitals.

However, in order to reject the Varley recommendations, all stakeholders must first be consulted, so public consultation is underway until 4th November. The discussion document is available on-line at www.enherts-pct.nhs.uk/mvcc - or telephone 01707 369701. The Community Voice urges all members to respond to this consultation, so that the public voice is loud and clear. We want the Cancer Centre to stay at Mount Vernon!

Joan - with apologies for late publication due to personal pressures

Brief update on Hillingdon Hospital

Just a few notes about today's Board meeting:

1. Future Board Meetings
At its last meeting the Chairman announced that when the Trust becomes a foundation trust it will hold Board meetings in public, but this was not minuted. I was allowed to raise this omission before the Minutes were agreed, so I hope the Minutes of this meeting will confirm the decision. We have waged a long campaign for Foundation Trusts to hold Board Meetings in public so it is wonderful news that Hillingdon Hospital has agreed - we want to see it in print, to be sure it is true!


2. Hillingdon Hospital’s Pilot Ward with single rooms for all patients
It was agreed to call this ward Bevan Ward, in honour of Aneurin Bevan - a very apt choice in the diamond jubilee year of the NHS that he set up..


3. Delay in referrals from Hillingdon’s new Referral Medical Centre (RMC)
The RMC assesses whether to refer patients to acute or community services. Referrals to Hillingdon Hospital are arriving 7 days after referral, which both the hospital and Hillingdon PCT agree is unacceptable. The hospital considers that referrals should arrive within 48 hours, so that treatment can start as soon as possible. This issue is being carefully monitored.


4. New CT scanner and new endoscopes
Recent recommendations for stroke patients to receive a CT scan within an hour of arrival at A&E has led to 15% increase in demand fro CT scans since last year. So Hillingdon Hospital is proposing to spend £640 k on a new CT scanner and the business case was approved by the Board. This will reduce the hospital’s need to use the Paul Strickland Scanner Centre, but the Board received assurances that this will not destabilise the Scanner Centre.

The endoscopy unit currently uses very old equipment, past its accepted useful life, and the Trust therefore proposes its replacement at a cost of £207k.


All this is good news for patients.


5. Releasing Time to Care
Pilot projects have shown that changes in ways of working can allow nurses more direct contact time with patients. The Trust expects to introduce this project to all wards, starting with a launch on 29th September involving three wards – Katherine, Jersey and Pinewood. The project is based around modules which are expected to take a year to complete. Outcomes from pilot sites found that the amount of direct contact with patients rose from 25% to 46%, with great benefits for both staff and patients.


6.Death of Michael Rosen, Non-Executive Director
After adjournment of the Board Meeting last Friday, the entire Board attended Michael Rosen’s funeral. A discreet card of condolence was available at today's meeting, which I was pleased to sign on behalf of members of The Community Voice.


Joan Davis