Minister praises Harefield Hospital for cutting-edge patient services

PRESS RELEASE
Friday 21st November 2008

Ann Keen, Parliamentary Under Secretary for Health Services, today visited Harefield Hospital where she learnt more about its leading primary angioplasty service for heart attacks and its artificial heart programme.

Ms Keen spent an hour at the hospital meeting staff and patients who had recently benefited from care at Harefield. Praising the hospital, she said, “It is a privilege and an absolute pleasure to be here. Thank you for everything you’re doing – it’s fantastic.”

Ms Keen - a former nurse whose responsibilities include cardiac and cancer services, patient safety and chronic long-term conditions – was greeted by the Trust’s chief executive, Bob Bell, and chairman, Lord Newton of Braintree. She then toured the catheter labs where director of the Trust’s heart division and consultant cardiologist, Dr Charles Ilsley, gave her a detailed overview of Harefield’s leading primary angioplasty service for heart attacks. Dr Miles Dalby, consultant cardiologist, explained how the heart attack centre has the fastest door to treatment time in the country at just 23 minutes. Dr Dalby also described the importance of Harefield’s location - optimally placed in terms of geography to care for patients brought in directly by ambulance services from a wide surrounding area.

Meeting the Minister, heart attack patient Nicolas Farr, a farmer living close to Baldock in Hertfordshire, said of the primary angioplasty service, “If there wasn’t this treatment here at Harefield I probably wouldn’t be here. It’s absolutely extraordinary how quickly it’s done.” Fiona Hughes, a relative of Nicholas’ who is a former nurse, said, “I can’t fault the care here – it is inspiring to see such good nursing.” Nicholas’ wife, Trish Farr, also an ex-nurse, added, “Everywhere is so clean. It literally sparkles.”

Ms Keen then went on to the transplant unit where Dr Emma Birks, consultant cardiologist, gave her an overview of Harefield’s pioneering artificial heart programme – the largest of its type in the UK. A number of patients were introduced to the Minister including those currently living with artificial hearts. James Jackson spoke to Ann Keen about his cutting-edge treatment at Harefield.
James had been critically ill in his late teens and was given an artificial heart to allow his own heart to naturally recover. He then had his artificial device removed.

Earlier in the day, the Prime Minister Gordon Brown and Ann Keen visited the Magdi Yacoub Institute based at the Heart Science Centre on Harefield Hospital grounds. The Prime Minister unveiled a statue in tribute to the work of Professor Sir Magdi Yacoub, who he said was regarded as a hero around the world. The Prime Minister also took the opportunity to describe Royal Brompton & Harefield NHS Trust as “a magnificent Trust which is doing so much good work in so many different areas.”

Heart patient, James Jackson, who was also present at the unveiling, commented, “I was very nervous when meeting the Prime Minister but I was really impressed by how interested he was in my condition and how positive he was about Harefield.”

Royal Brompton & Harefield NHS Trust- Press Release

Wednesday 26th November 2008

High risk profile of patients identified in transplant review

The report of the external review of recent outcomes in the heart transplant service at Harefield Hospital finds today that the overall high risk-profile of patients was an important contributing factor. The findings of both the external review of case-notes and the Trust’s internal review were consistent with the UK Cardiothoracic Transplant Audit (UKCTA) statistical analysis, which showed that heart transplant recipients at Harefield had a higher risk-profile in 2008 compared with previous years and UK centres as a whole.

Risk adjustment using the (UKCTA) risk model reduced the difference between the observed and expected number of deaths within 30 days at Harefield and at other UK centres in 2008. The centre effect estimate for Harefield reduced by more than 50 per cent with risk adjustment and the UKCTA analysis found that: “The number of cases was low (15) and Harefield was not identified as significantly divergent.” An estimate of 90-day mortality incorporating all patients transplanted in 2008 up to 31 August is awaited.

The report concluded: “The number of operations reviewed is small as heart transplantation in the UK is a low volume procedure, with only around 288 transplants carried out nationally over the 32 months of the review. As a consequence differences and changes in mortality, which may appear large, are not necessarily identified as significant from a statistical perspective.”

Commenting on the report’s findings, Professor Timothy Evans, medical director of Royal Brompton & Harefield NHS Trust, said: “We welcome the findings of this report and will continue to implement an action plan based upon its recommendations.”


For a copy of the report, visit:
http://www.rbht.nhs.uk/media/press-releases/transplantreview/ and open the PDF file at the foot of the page.

With kind permission - Royal Brompton & Harefield NHS Trust

North West London Hospitals Trust 26 Nov 08

A fairly brisk meeting. The new chairman expects all Board membrs to have read agenda papers and so manages in 2 hours what used to take about 3. Good for him.

The ‘Dr Foster’ report has singled out the trust as the most improved DGH in the country (details already circulated on the CV blog, from the press release). General pleasure at this, showing that good work can be done in elderly buildings, by trusts that the Healthcare Commission does not rate highly.

The Joint Clinical Investigation Report to Brent PCT, Harrow PCT and NWLH Trust was about the infection control procedures of the two PCTs and the hospital. A very detailed report, with several recommendations for improvement. The hospital comes out of all this very much better than the PCTs.

There is a slight improvement in the financial position, the expected deficit is now rather less than was reported a month ago. But the real problem is that Brent and Harrow send more patients than agreed in the SLA. This leads to ‘overperformance’ (who thought up that word?) and so several departments exceed their planned budgets. This has to be reported, because the Board is required to know which departments are overspending. As the hospital cannot turn away patients who arrive at its doors this really only tells one what medical conditions these patients have on arrival.

Performance The cumulative A&E rate is now 98.4%. Recently, on one day over 650 patients came to A&E, whereas the usual attendance is about 550. The reason for this sudden increase is not known. The biggest problem actually turned out to be the handling of discharge notes, rather than dealing with the patients.

Response to MVH Consultation The Trust has responded that they would support ‘Cancer Centre with satellites’, and add that they would like to be a satellite. The response letter also questions why ‘Option A’ (moving the cancer centre) has been dismissed, reckoning that close liaison with a DGH would be advantageous. But they recognise the financial problem involved.

Paul
28 November 2008

Video No. 14 Judy Valverde, Manager, Postgraduate Centre

Judy Valverde is the manager of the Postgraduate Medical Centre at Mount Vernon Hospital. This is the venue for the Community Voice meetings at 7.45pm on the first Thursday of the month.

Exciting times at Hillingdon Hospital

How often do hospitals trusts have two things to boast about together? That is the happy position of Hillingdon Hospital. Bevan Ward, its pilot ward with 24 beds in single rooms with en-suite facilities is due to open early in January (scroll down to watch the video)– and a few weeks later it will be opening its new Treatment Centre at Mount Vernon Hospital. Here are a few facts:
The Treatment Centre handover is due on 19th January 2009. First patients will come on 3rd February. There will be a formal opening later, probably in March, possibly with a royal personage to open it.

The main entrance will contain two specially commissioned stained-glass art panels.

Completion of the nearby car park is not expected until several weeks after the opening, but some disabled spaces will be ready.

At first the Treatment Centre will have two operating theatre sessions daily, but extension of services is already being considered. It will have four operating theatres, 24 in-patient beds, and 14 day-case beds.

90% of elective care and orthopaedic care will transfer from Hillingdon Hospital to Mount Vernon – but patients who particularly want to be treated at Hillingdon will still have that option.

Around 500 staff have been consulted about the changes involved. Agreement has been reached with nurses, clinicians, theatre and therapy staff; and a pharmacist is being seconded to the Treatment Centre. Consultant timetables have also been agreed.

There will be changes at Hillingdon Hospital too. Day case beds there will be reduced from 19 to 14 and Jersey Ward will be closed. This will free-up 20 theatre sessions, the equivalent of closing two operating theatres. One ward from the annex corridor will be moved into the tower block.

Altogether an exciting time!

Joan

Hillingdon PCT's battle with debt

Hillingdon Primary Care Trust continues to battle with financial problems. Its November Board papers show that at month 7 in the year it has an overspend of £4.5m. This is mainly due to unexpectedly high cost of hospital services. But an underlying cause is its £42 million historic debt. The PCT is still expected to break even in the year, despite repaying £7.7 million of the debt, plus £0.9 million for interest.

The Community Voice has made clear to NHS London that this burden is crippling local health services. We contend that the debt should be wiped out – the NHS is not democratic, local people had no control over the debt arising, so why should they suffer for years while it is repaid?

All the top staff in post when the debt arose have gone. The new NHS staff did a wonderful job last year in breaking even. Why should they be stressed by a debt they did not cause?

As an example of how this hurts local people, the Yiewsley Health Centre is one of the most neglected in the country, but there is no money to replace it. Latest news is that NHS London has set up a PCTs Group to resolve legacy debts. We hope that Hillingdon’s desperate need for help receives positive support.

Joan

Round-up from West Herts Primary Care Trust

Estates strategy
51% of the PCT’s estate is over 33 years old. Some is barely fit for purpose and there is a backlog of maintenance. Last year 9% of recorded accidents were due to such failures, but all maintenance recognised as a safety risk is treated as a priority .

Surplus premises are often developed for other NHS services, but sometimes they are sold. It was noted that this is a bad time to sell, as prices are at bottom of the market.

Finances
NHS debts across Hertfordshire in 2006/07 totalled £84m. By the end of 2007/08 all these deficits were cleared. What a terrific achievement! The two PCTs can now start to invest in improving services, but must still take care. Future requirements are hard to predict and there are many uncertainties. For example, recent NICE guidance will oblige PCTs to pay for costly drugs, which they did not expect.

Mount Vernon Cancer Services Review
The PCT Board expects an interim report in January. It is encouraging that the West Herts. Professional Executive Committee, representing local clinicians, supports Mount Vernon Cancer Centre remaining on its current site, as the hub of a system with one or more satellites.
Update on Hemel Hempstead / Watford General Hospitals
There is much change afoot here. The Hemel Hempstead beds are no longer linked to Watford General Hospital, instead they are used for primary care provided by the PCT. In time they will be moved to a new hospital - a January workshop is to consider where best to build it.

A new Urgent Care Centre opened in Hemel Hempstead in October 2008, as first step towards closing the A&E there. Transport services are being strengthened, to support centralisation of health services at Watford General. The new Acute Admissions Unit at Watford will open in March 2009.

Change is in the air!

Joan

Good news from North West London Hospitals

Here are press releases by North West London Hospitals Trust about two very interesting news items.

LOCAL HOSPITALS ‘MOST IMPROVED’ SAYS DR FOSTER HOSPITAL GUIDE 2008
The North West London Hospitals NHS Trust is one of the ‘most improved Trusts’ in the country for reductions in death rates, according to Dr Foster’s Hospital Guide published this week.
Improvements in care at the Trust have led to it being singled out by Dr Foster for making reductions in its mortality rate of around 30%, over three years.
The Trust’s Director of Nursing, Elizabeth Robb, said: “Our mortality rates were already below the national average but the sustained improvements we have made in 2007/08 puts us amongst the top acute trusts in the country for last year.”
Tom Moloney, Chief Executive of Dr Foster Intelligence, said: “We’re pleased to highlight in this year’s Hospital Guide that North West London Hospitals NHS Trust continues to reduce its mortality rate and is one of the most improved in the country. Clearly this is good news for patients and families and testament to the continued hard work of all hospital staff.”
The improvement is the result of an initiative at the Trust to introduce checklists across eight key areas such as stroke, diarrhoea and vomiting, heart failure and MRSA. The checklists set out for staff the top five things they can do that are known to improve care and save lives.
The idea was developed from the Saving 100,000 Lives campaign. Started in the United States in 2004 by the Institute for Healthcare Improvement, this aimed to reduce hospitals’ deaths by 100,000 in two years by hospitals following best practice.
“We adapted this and set a target of saving 110 lives and decided to pilot checklists for eight key areas” said Elizabeth Robb. “The good news is that before we started this project our mortality rates were already below the national average. At the end of the year our mortality rate dropped from 84 to 71 (100 represents the national average expected mortality rate). If you equate this to actual lives saved it is 285.”

STATE-OF-THE-ART THEATRE CUTS RECOVERY TIME FOR PATIENTS IN HALF
A new £500,000 state-of-the-art laparoscopy theatre at St Mark’s Hospital in Harrow, opened today by TV presenter Lynn Faulds Wood, founder of Lynn’s Bowel Cancer Campaign, and TV broadcaster John Stapleton, offers not only less invasive surgery but also faster recovery times for patients.
St Mark’s is one of only a few hospitals in London to use laparoscopic or “keyhole” surgery for advanced complex procedures such as removal of the bowel. In laparoscopic surgery, cameras are inserted into the body so the surgeon can watch what he or she is doing on a monitor. Only a small cut needs to be made – this considerably improves the outcome for patients, with a reduced risk of infection and shorter hospital stays.
The new theatre, one of only a few in the country, combines the latest high-tech equipment and high definition imaging, allowing surgeons to carry out complex surgery while making only small incisions. Equipment in the theatre is suspended from the ceiling by mechanical arms so that lighting and camera angles can be controlled by computers at the simple touch of a button.
Robin Kennedy, Consultant Surgeon at St Mark’s said:
“As one of only 16 hospitals to become a national training centre for laparoscopic colorectal surgery we will be using this theatre to train surgeons of the future. The new system also creates high definition images which are essential for the teaching we do both in the UK and worldwide.
“This theatre is purpose built for the keyhole surgery techniques we now use to remove the bowel. Combined with our enhanced recovery programme we are able to reduce the time in hospital after major bowel surgery. In the past people used to have to stay 10 or more days and take at least two to four months to recover fully. Now they stay four days and look fully recovered after two to four weeks.”
The theatre will treat 1,000 patients a year.

Note of explanation about “Dr Foster”
Dr Foster, the publisher of the annual Hospital Guide, provides independent information on health services in the UK. It is now the market-leading provider of research, analysis and communication products to NHS organisations.

Paul

Video tour of The Bevan Ward - Pilot project for single rooms

The exciting news is that Bevan Ward, now on show to staff and with invitations in the local press for members of the public to see it too. This pilot ward has 24 beds, in three wings each colour coded, green, blue and lilac. Each wing with eight rooms of different design to the other two. The purpose of this pilot is to research the benefits for patients of having single bedrooms with en-suite facilities. Research will compare current and pilot ward facilities, to find out what effects the new facilities have on patient outcomes.
This video tour we hope will give you a good idea of what you can expect.
Internal fitting-out is still in progress so excuse any extraneous noise, when complete it will provide a quiet and peaceful experience.

Donald

December Meeting of The Community Voice

Our next meeting is on Thursday 4th December. As usual this will be at the Post Graduate Centre Mount Vernon Hospital at 7.45pm. We are looking forward to hearing about developments at the Paul Strickland Scanner Centre as its Chief Executive, Margaret Sullivan, is to be our guest speaker.

Business will be kept to a minimum at this meeting, to allow time for us to socialise afterwards with mince pies and

seasonal drinks for eveyone attending.

How the year has flown - it is almost time to say "Happy Christmas!"

Joan

Audience spell-bound by speaker

Jan Filochowski, Chief Executive of West Herts Hospitals Trust, held full sway over members of The Community Voice at our November meeting. He spoke for over an hour, answered questions as they arose, and his audience would have kept him there till midnight if the Chairman had not intervened.

Such a basket of good news is rare in NHS circles. A year ago his Trust was failing, with high rates of infections, long waiting lists, targets not met, heavily in debt with plans for rebuild of its hospital on hold and no hope of achieving financial trust status. Today all that is changed. Now it is amongst the best in the country for several targets and there is a surplus in the bank. Plans for rebuilding the hospital are moving positively ahead and consultation on becoming a foundation trust is already under way. Wow!

All this was backed from the audience with a recommendation that Watford General A&E is now wonderful – quick, efficient and kind. What a turn-around!

To apply for membership of the foundation trust telephone 08444 776321

Joan

The Bevan Ward in Pictures

The Bevan ward has 24 beds, in three wings, each with a different colour scheme, lime green (?), blue and lilac. In each colour scheme there are four rooms on each side of the corridor. Each colour scheme has its own individual design. The purpose of this scheme is to research the benefits for patients of having single bedrooms with en-suite facilities. The building is portable and the life on this site is expected to be 5 years. Experience gained will be used in the design of the new hospital. More information in a previous entry, Thursday 30th October 2008

Donald

Secure drugs lockers in the drugs store.



Secure drugs store and dispensing room.



Patients social meeting area.

Lilac rooms shower & Toilet suite

Blue rooms shower & toilet suite

Green rooms shower and toilet suite

Lilac rooms

Blue rooms

Green rooms

Lilac corridor

Blue corridor

Green corridors

Design layout of the Bevan Ward

Artist's impression of Bevan Ward alongside Hillingdon Hospital.

Hillingdon Hospital NHS Trust – New Staff Uniforms

The process for devising the new uniform choices has been extremely thorough.
The Trust needed to consider multiple facets such as the control and prevention of infection, combined with the welfare and safety of the patients and staff. In doing this, a number of open staff consultations took place where views were shared with representatives from all groups of Nursing, Midwifery and Allied Health Professionals. In addition, advice was sought on the equality related aspects of the of the uniform i.e. age, gender, religious and cultural requirements including specific individual needs where relevant.

The agreed choice of style, colour and fabric is as follows:

Styles
1. Tailored style tunic top with collar and scrub type trousers with a drawstring waist.
2. Tailored Scrub top (without collar) and scrub type trousers with a drawstring waist.
3. Dress in the same fabric as above.
4. Clip on/off sleeves can be provided.
5. Staff can order a mix of these ranges if desired.

Colours
▪ Matrons – Purple tunic/ scrub top and black scrub trousers
▪ Sisters – Navy tunic/ scrub top and navy scrub trousers
▪ Staff Nurse – Royal blue tunic/ scrub top and royal blue trousers
▪ HCA – Petrol blue tunic/ scrub top and petrol blue trousers
▪ Site Practitioners – Grey tunic/scrub top and black trousers

Fabric
Toray Antimicrobial

Footwear
It has been agreed that ‘Crocs’ may be worn but only in black and meeting Health and Safety standards i.e. no holes and only those Crocs with supporting straps over the heel.



With thanks to Cathy Moran, Deputy Nurse Director

North West London Hospitals Trust Board, 29 October

Trauma Centres and Stroke Centres Following the ‘Darzi proposals’ there is currently a process of planning for the trauma and stroke centres that were proposed.
The trust is not bidding to become a major trauma centre but is supporting the bid by Imperial Healthcare Trust to become one. The services of the trust’s Maxillo Facial Trauma services would be available to Imperial and there could be rehabilitation services, using the Regional Rehabilitation Unit at Northwick Park would be a help for that. The hope is that Northwich Park Hospital could be designated as a (simple) ‘trauma centre’.
The trust is bidding for NPH to become a designated Hyper Acute Stroke Unit (HASU), supported by ‘stroke units’ at NPH and CMH and a TIA clinic at NPH. A HASU would receive all stroke patients in its area for the first 72 hours of their care, with subsequent transfer to the Stroke Units. The initial transfer into a HASU is intended to take place within 30 minutes of an ambulance arriving to pick up the patient. It is believed that Northwick Park is well placed geographically to deal with stroke patients in the North West area. The intended 30 minute transfer would not be achievable if the HASU were further into London.
In the discussion it was pointed out that the NHS tariff for such units is well below the expected cost of running them. These bids assume that appropriate finance will be made available, otherwise all bids are off. The hope was expressed that all bidders should take the same stance on finance.

Healthcare Commission Annual Health Check This refers to the year 2007-8. The trust was rated ‘Fair’ for service and ‘Weak’ for use of resources. The resources assessment is due to not meeting the financial targets. Regarding service, the trust met most of the targets but had poor results in the patient surveys. The overall scoring system seems to be curious, the HCC uses 59 indicators but reports on only 10 of these, and the rules appear to change without warning.

Healthcare for All, with special attention to People with Learning Difficulties This followed from a national review, which highlighted the difficulties that people with learning difficulties experience in accessing proper services. Healthcare professionals are often unaware of such problems. Among the recommendations is the appointment of a ‘Learning Disability Champion’ and proper training of staff.

Quarterly Matrons’ Report The Cardiology matron reported that at CMH the ward’s toilets were male and female but in the corresponding ward at NPH there was only a mixed gender toilet. Instant decision by chairman: put a second toilet there immediately!
The matron reporting on the Lister Unit pointed out that the place was badly maintained, no redecoration had been done for some 10 years. Second instant decision by chairman: do something before Christmas!

Finance and Performance The trust has a new finance director, Kishamer Sidhu. The year to date deficit is £5.6M, some £2.4M worse than the budget. The numbers of patients seen by the trust is well above the 'Service Level Agreementss' expectations and there is no indication that Harrow and Brent PCTs are willing to increase their payments. The chairman stressed the need to have credible plans in place quickly to improve the position.
Regarding performance, the situation is quite good. The A&E 4 hour target of 98% has been easily met, it is now 98.6%. (Returning only 97.6% last year was one of the reasons for the ‘Fair’ rating; having many more patients than expected is not regarded as an excuse for failing to meet a target.)

Paul Samet