North West London Hospitals Trust Board, 28 Jan 2009

Highlights of the meeting

1. Maternity figures are lower than expected It seems that people register with the hospital but then do not come for the birth. One theory is that several of these expectant mothers are East Europeans who are returning home because of the economic situation.

2. Infection Prevention and Control The number of MRSA cases is below the target, at 22 instead of 24 so far (32 for the whole year). In fact there have been no new cases since November. C.Diff cases are also well below the expected numbers.


3. Overall Performance The numbers of patients arriving at A & E has reached record levels. Cold weather and staff sickness contribute to the difficulties. Actually, this is a general London problem, even if not national. The healthcare Commission’s survey of A & E departments has found that there are major differences in responses between national figures and London figures, reason not readily explainable. The trust performs quite well when compared with other London trusts, not so well on a national comparison.


Paul

Winter takes its toll at Hillingdon Hospital in January 2009

A very cold December combined with outbreaks of flu put The Hillingdon Hospital Trust under intense pressure. In January the Trust continues to have 30 additional beds open, to meet demand, as well as keeping more beds empty than is usual.

Winter vomiting virus is now imposing additional pressures. Some wards are already infected and are closed to new patients. The virus is more easily caught than the common cold and to curtail the risk of it being brought into the hospital, friends and relatives of patients are asked to make only essential visits.

Infections
The Trust had two MRSA cases in January making a total of 13 so far in year, breaching the whole year target of 12 cases maximum. The Board learned that three of the patients identified with MRSA had no symptoms, so it is possible that contamination of samples could have occurred. It was also noted that in January last year that there were 28 cases of MRSA in year, so there has been dramatic improvement despite failing the target. (Note too that every Trust has a target based on its own past performance, and that Hillingdon Hospital’s target is lower than many similar hospitals.

FinancesDecember’s financial performance was better than the same month last year and so the Trust’s financial position is as planned for this point in the year.
Joan Davis

Cancer Waiting Time Targets

The following targets were introduced between 2002 and 2005:
Two Week Wait Rule:
If a GP suspects cancer, the patient must be seen by a consultant within two weeks

31 Day target:
A cancer patient must receive first treatment within 31 days of “decision to treat”

62 day target:
A patient referred by a GP must receive first treatment within 62 days of GP referral.


Targets from January 2009 are:
Consultant upgrades (62 day pathway)
If a consultant makes a cancer referral, treatment must start with 62 days.

Screening Referrals (62 day pathway)
Similarly if screening leads to a cancer referral, treatment must start with 62 days.

Subsequent treatments:
Patients with a recurrence of cancer or needing subsequent cancer surgery or chemotherapy, should be treated with 31 days of being fit enough to have the treatment.


From 1st January 2010
All referrals to a symptomatic breast service, regardless of suspicion of cancer, must be seen within two weeks


From 1st January 2011
Patients with a recurrence of cancer or needing subsequent radiotherapy or other cancer treatment, must be treated within 31 days of being fit enough to have the treatment.


There are also new rules about how 31 days and 62 days are counted. The clock cannot now be stopped for patients to consider options or go on holiday, so reported compliance is expected to fall.

Joan

Hiilingdon PCT can see light at the end of the debt tunnel

Last month it was proposed that London’s 31 PCTs should all pull together to resolve London’s historic debts. The Department of Health offered a sweetener of £100m, so the deal has now been agreed, throwing a life-line to Hillingdon PCT which is still burdened with huge debts.

Providing Hillingdon PCT breaks even financially up to March 2011, including debt repayments of over £8m in each of those years, then its remaining £19m debt will be met by the other London PCTs. In the meantime Hillingdon PCT can borrow from the other PCTs to enable it to provide essential local investment. This is all fantastic news.

Less good news is that Hillingdon PCT and The Hillingdon Hospital are facing some difficulties in resolving coding problems that govern how much the PCT pays for the hospital’s services. Pending resolution, Hillingdon PCT is withholding payment above the level of its commissioning agreement. It is hoped that mutual understanding will be reached, but the hospital could seek resolution via arbitration.

The Urgent Care Centre at Hillingdon Hospital is breaking even for the PCT, but the hospital’s A&E Department is losing income in consequence. In contrast, the PCT’s Audit Committee found that the Referral Management Centre (designed to keep people out of hospital and provide services closer to home) shows no evidence of value for money, nor of improving the patient experience and it has had a negative impact on the relationships with The Hillingdon Hospital and GPs - but it has been successful in providing services more locally for 70-80% of GP referrals. This sounds like win some, lose some

Targets and ratings continue to absorb much time and energy. Sub zero temperatures in December plus a local flu outbreak caused The Hillingdon Hospital to breach its A&E target to treat all patients within four hours of arrival. It also had two MRSA cases that month, one above target, but this target demands reduction of previous performance, which started from a low number. So, despite breaching its target for this time of year, this hospital continues to have relatively good MRSA infection control compared with similar hospitals.

The PCT’s Healthcare for London event in the Chimes, Uxbridge, last November, showed that the public has little awareness of what the PCT actually does. The PCT’s new strategy aims to improve public awareness and participation in its affairs and it is inviting both Hillingdon Local Involvement Network, LINk, and other lay representatives to join a number of its committees.


Joan

West Herts Hospitals under winter pressure

The Board of the NHS Trust heard both good and less good news at its first meeting in public in 2009.

Good news is that it is keeping MRSA numbers low with only 11 cases so far this year. It is also meeting national targets to treat patients within 18 weeks of referral by their GP. Its £1m surplus so far this year is further good news, although this is a smaller surplus than forecast, so it was greeted with muted approval.

However there were some bad things too, including seasonal pressures on beds impacting on A&E performance in December, which therefore failed to treat 98% of patients within four hours of arrival.

Worse from the patients perspective, was an admission that for some aspects of mandatory staff training there is currently a compliance of only 40% - this appeared to shock some members of the Board and certainly shocked the public who heard the report.

Also there was an admission that some wards are operating with less that their agreed complement of staff, because recruitment of additional staff has not been sufficiently successful. Bank and agency staff have been used, but they are costly, and that expense has undermined the Trust’s financial planning.

After a number of Board meetings with only good news, this meeting was less self-congratulatory than other recent meetings. However this Trust’s remarkable recovery from dismal failure must not be forgotten. It has accomplished near miracles and it is that success which makes this Trust well on its way towards achieving foundation trust status, which at one time was unthinkable.


Joan

Harrow PCT 20 January 2009

Highlights, not a complete report.

The annual OFSTED assessment of services for children and young adults in Harrow was quite satisfactory: on the 7 areas considered Harrow achieved 2 grade 4 and 5 grade 3.

Performance Report The A&E 4 hour target is causing some worries, with a great increase in attenders recently, staff sickness problems have caused some difficulties. Some of these are seasonal problems but all the London PCTs have seen them. Childhood immunisations are below the intended trajectory, again a London problem with figures below national averages.

There is a new pharmacy contract and £1 M has been set aside to deal with it.

Medium Term Financial Strategy This has now been agreed by all 31 London PCTs. The cooperation of the London PCTs has clearly impressed the DoH, which has provided an additional £100 M for London, so that the levy on PCTs can be reduced from 1.3% to 0.8%. For Harrow this means a reduction of £1.2 M.

Sex and Our City Another joint report from the PCTs, giving information on sexual health needs assessment and available services. Expenditure varies widely across the boroughs but it is also clear that spending more does not necessarily provide better services. Much further work has to be done.

Registration with the Care Quality Commission The CQC is the new body that replaces the Healthcare Commission in April. All providers have to register and declare that they meet criteria of service provision. The item that requires some rapid action is training on policies and protocols for the prevention and control of hospital acquired infections. All relevant staff must have received appropriate training within the last 12 months, Harrow has to give such training to some of its staff. Non-provision of training could mean that registration is refused and the PCT would not be able to operate.

Paul Samet
21 January 2009