Hillingdon Round-Up late March 2009

Hillingdon Hospital’s Foundation Trust application
This application is now on hold. The fact that the Trust has not met its MRSA target is a factor, but not insurmountable as the numbers are actually low. The valuation of the Trust’s estate appears to be the main stumbling block.

The Hospital Trust’s Finance
A surplus is still forecast for the end of year despite a very difficult month in February.

Hillingdon PCT’s Finance and Performance
The PCT is forecasting breakeven for 2008/09, meeting its statutory duty for the second year since 2002 – this achieved despite in-year repayment of £9m for its historic debt (leaving £35m debt to carry forward into 09/10).

On performance of national priorities and targets, Hillingdon is in the top half of London PCTs, which is very encouraging.

However there are problems between the PCT and Hillingdon Hospital over signing 2009/10 contracts – the due date was missed due to differences about coding and local prices for non-tariff services. NHS London has asked both parties to resolve their differences locally.

PCT’s Commissioning Strategy
Preliminary results from the World Class Commissioning process showed Hillingdon PCT’s scores to be mid-table for London, with it named as an exemplar by NHS London for information based decision-making. This accolade is very sweet in view of the PCT’s chequered history.

NHS London is working with all 31 PCTs to implement sector commissioning arrangements. The North West London Commissioning Partnership, an acute services commissioning vehicle covering 8 PCTs - Brent, Ealing, Hammersmith & Fulham, Harrow, Hillingdon, Hounslow, and Kensington and Chelsea, and Westminster - expects to go live on 1st July 2009.

Third Runway at Heathrow
In response to the PCT’s letter, the Permanent Secretary of the Department of Transport has confirmed that a formal health impact assessment will need to be conducted as part of any planning application by BAA, if further development were to be supported by the government. He reiterated the government’s firm commitment that Heathrow will not be extended until the air quality and noise limits have already been met.

PCT’s Premises
The PCT’s Public Health and Joint Commissioning teams moved to the Civic Centre on 16th March, signifying the PCT’s intention to work jointly with London Borough of Hillingdon.

Provider Services
By end of March the PCT’s Provider arm expects to be accredited as an Autonomous Provider Organisation (APO) ready to start operating independently, although still a sub-committee of the PCT operating with delegated powers. Its key priorities for investment in 2009/10 are: safeguarding children and adults, health visiting, speech therapy, community dentistry and TB.

Joan

The Mount Vernon Cancer Centre is safe!

Success, at long last! The 2002 Varley Review recommendations have been overturned – so, no more talk about moving the Cancer Centre away from Mount Vernon.

Instead all efforts will be directed towards making Mount Vernon the hub of a system with satellite services further north, in Hertfordshire or Bedfordshire, to provide routine radiotherapy for those who currently have very long journeys.

The current Review’s Interim Report is being launched on Monday 30th March, at a stakeholders’ conference, but the document is already in the public domain. The main issue now is to ensure that services remain first rate in both Mount Vernon and any satellites. No one wants second-class services, even if they are close to home.

This success is a triumph for local people. The two Community Voice petitions – each with over 70,000 signatures - were a lot of hard work, but the outcome is very sweet. When ordinary people pull together, they can make things happen!

Joan

West Herts Hospital Trust better and better!

On 19th March, again it was all good news for the Board of this Trust.

The move of all acute services from Hemel Hempstead Hospital to Watford General Hospital was concluded without a hitch. This is a triumph as the move is acknowledged to be the biggest such project in today’s NHS. The Chief Executive, Jan Filochowski, had insisted that the original date be put back, to allow step by step transfer, and the outcome fully justified his caution, as all went well. Both staff and patients like the new Acute Admissions Unit (AAU) at Watford and the Urgent Care Centre at Hemel is thriving too, with over 350 patients per week.

Disclosures about Stafford Foundation Trust have made all hospitals edgy, but this Trust has below national average mortality rates in all departments, so it has no concerns of that kind.
Furthermore, it is meeting all those elusive NHS targets. Its infection control is first rate, well within target for MRSA cases and a national star for reduction of clostridium difficile cases. Performance on 18 weeks waiting list targets is above national targets. It continues to exceed all three national cancer targets. Bed pressures have eased slightly. Delayed transfers of care have reduced in number in recent weeks.

The Trust's Healthcare Commission Quality of Care rating is now balanced between “good” and “fair” depending on it achieving 98% for the A&E target over the whole year (it reached 100% on the previous day!). This target was not in doubt until the February snow storms caused unusual pressures and caused a temporary fall below target.

Add to all this that the Trust has a small financial surplus this year and expects to clear its historic debt next year. All good news.

But what about the patient experience? Are patients happy too? Survey results indicate that there is an improvement in patient satisfaction. So, what more can anyone want? I guess there are cracks somewhere and some patients fall down them – but the general picture is still amazing, unusual and good.

Joan

Hillingdon Hospital update from David McVittie on Thursday 2nd April

Everyone knows that The Hillingdon Hospital is long past its “sell-by date”, with dilapidated buildings too old to repair. So where should the hospital be rebuilt? The Board of The Hillingdon Hospital has well developed plans to rebuild on the present site but some people, led by John Randall MP, call for the rebuild to be on the old RAF site in Uxbridge.

Why does The Hillingdon Hospital Board reject that proposal? Has the current recession changed the options? Come to our 2nd April meeting, at 7.45pm in the Post Graduate Centre Mount Vernon, to have an update from David McVittie, Chief Executive of The Hillingdon Hospital.

He may touch on other issues too so come with your questions ready. Why does the Healthcare for London consultation propose to stop Hillingdon Hospital from providing 24 hour care for stroke victims, despite it offering an excellent service? Should we be fighting to keep what we’ve already got? How is the Trust’s foundation trust application faring? These and other questions may feature in our meeting. Visitors are welcome, as always.

Joan

Good News for Cardiac Patients!

Dr Nigel Stephens charmed his audience at our March meeting, talking about the Cardiology Department at Northwick Park Hospital, which he has led for 13 whirlwind years of change.

He noted that before 1961 there were no visual pictures to assist cardiologists, so little could be done to help patients. However, in the USA between 1959-61, there were major advances with the development of angiograms, open-heart surgery and heart-lung machines. By 1976 balloons were being introduced into arteries and ten of the early patients are still alive today. By 1988 the first coronary stent was introduced, a flexible tube supporting the artery and this technique is still in use today.

The last five years have seen even more advances, with more emphasis on speedy treatment and primary angioplasty now the favoured method of combating heart attacks. As a result there is now only a 5% chance of dying during a heart attack compared with a 20% chance only a few years ago.

At Northwick Park, angioplasty was introduced in 2002 in an exclusively consultant service. It has had outcomes second to none, with a total of over 2000 patients treated.

Heart failure used to be a cinderella discipline but cardiac resynchronisation can now transform life for some patients and 50 cases have received that treatment at Northwick Park.
However there is no open-heart surgery or heart transplants at that hospital.

Over the last five years national waiting–time targets have led to many improvements. In 2004 16 people waited 18 weeks for treatment – in contrast today 230 people are waiting barely six weeks - and the wait for angiograms is only three weeks.

Surprisingly, although many people go to A&E departments with chest pain, only five in a 100 cases are due to serious conditions - and today, new A&E technology can identify which of these are heart attack cases needing urgent treatment.

Dr Stephens talk was entitled “Good news for cardiac patients”. We came away convinced that this was an apt title.

Joan

Good and Bad News from Hillingdon Hospital

Firstly the good news
Both Mount Vernon Treatment centre and Bevan Ward are open and much appreciated by both staff and patients.

It is encouraging that there have been no cases of infection in Bevan Ward – single rooms and isolation remain the most powerful tools against infection.

The Treatment Centre is receiving out-patients as well as elective surgery patients, but the operating theatres are not yet being used to full capacity.


Now for the bad news
There were three cases of MRSA in January and two more in February making a total in year of 16 cases, four above target. Everyone was clearly devastated.

27 pages of the Board papers and most of the Board Meeting discussion were devoted to MRSA. Every case is documented and analysed in detail. All elective surgery patients are now pre-tested for this infection. Hand hygiene is closely monitored. Pressure sores are vigorously avoided. It is difficult to know what more could be done.


And no news on the Foundation Trust application
At the time of the Board meeting hopes were high that there would be an announcement within hours – but these hopes were dashed by silence. Until such an announcement is made no one can be sure of the outcome.

Joan Davis

Hillingdon Primary Care Trust News

The February PCT Board meeting was jam-packed with facts, so here are a few snippets of special interest to patients:

The Hillingdon Referral Medical Centre The RMC currently processes over 80% of GP referrals to hospital consultant services. Patient satisfaction surveys for dermatology patients are currently underway – so these patients can say what they think of the service.

Physiotherapy Services Additional investment is being provided to reduce waiting times. No one in Hillingdon should then wait more than two weeks to see a physiotherapist. Weekend services are to be developed and the “physio-direct” telephone service.

Early intervention for psychosis The PCT has failed its target of treating 38 new patients in the year. However the new consultant started in post on 1st January 2009 so the PCT hopes to do better in future.

GP surgeries extended hours Good news for patients - over 55% of surgeries now offer extended hours – so fewer patients now need to go to A&E in hospitals.

Patient Choice From 1st April 2009 patients will have right to choose where they have treatment when referred for their first outpatient appointment, but this choice is at Hospital Trust level, not site level – so, if you choose The Hillingdon Hospital, you could find your treatment is provided only at Mount Vernon Hospital, since both these hospitals are part of the same Hospital Trust. Patients can choose any hospital in England that provides the required service and meets the NHS standards, including independent and private hospitals that appear on the Choose and Book list.

Podiatry Service This service is supporting the Hillingdon Age Concern’s Toenail Cutting Service by providing training and support when problems arise – good news, particularly for older people.

The Rapid Response ~Service This service, started in September 2006, to look after patients for a short time in their own homes, has now extended its hours to 8.30am to midnight, for 365 days per year.

Health Visitors The national shortage is being tackled locally by supporting staff to undergo part-time training – so the PCT is trying to grow its own Health Visitors!

Parkinson Disease Specialist Nurses A bid for funding two part-time specialist nurses is underway and appointments are expected early in 2009.

Joan

Harrow PCT Board, 3 March 2009

Interesting highlights only.

1. Rebranding As from 2 April the PCT is to be known as ‘NHS Harrow’. It is believed this will be more meaningful to the public than ‘Harrow PCT’. On legal documents, however, it will still be ‘Harrow PCT’, as that is the officially registered name.

2. Operating Plan for 2009/10 A huge item, of some 140 pages, but discussion took no longer than 10 minutes. It is the detailed plan covering just about everything the PCT expects to do during the next year, spelled out in excruciating detail.

3. Emergency Planning Annual Report How to cope with emergencies that can be foreseen, such as a potential influenza pandemic..

4. The ‘World Class Commissioning’ Panel Report In spite of the rather fatuous name, this is the report of a panel of NHS experts, aided by some with healthcare experience abroad, on how well Harrow PCT does its work. According to the panel, not as well as the ‘self assessment’ that went alongside. But they recognised that the PCT had a bad period in the past and has come out of that, with a largely new team that shows promise.

5. Transfer of Commissioning Responsibility for Social Care Needs from PCT to Harrow Council This considered the transfer of people with learning disabilities from the PCT (i.e. NHS) to the local Council (i.e. local government financing). The number of people involved is not very large, the sum involved is under £4 M, but the problems involved are very major. Very few other councils have shown any willingness to accept the financial responsibility as this will be in competition with all other local authority funding instead of being safely sheltered within NHS funding. It will be interesting to see how Harrow and NHS Harrow cope with this.

Paul

North West London Hospitals trust Board, 25 February 2009

1. The fire and the power failure. The fire at NPH on 11 February started with the generators in the basement, causing a lot of smoke to rise through the main ward block. Nobody was injured, about 170 patients had to be moved, no one suffered more than ‘some discomfort’. A culture of regular fire drills helped, with staff knowing what to do. Problems included moving patients connected to various items of (electrical) equipment. A & E was out of action for a few hours. Some patients were moved to other hospitals. One of the consequences of the fire is that there is a temporary reduction in the number of beds available but it is hoped this will be only for a short time.
A few days earlier there had been a power failure, soon after midnight on one of the coldest nights. The power supply in Sudbury failed, affecting about 900 homes and the hospital. The emergency supply kicked in immediately apart from one unit, which had to be started manually. The whole incident took about 4 hours to resolve.

2. Finance. There has been a lot of newspaper publicity about the reduction of next year’s budget by about £32 M and naturally this was an important item. The expectation is that the in-year financial outcome will be a ‘break even’ situation. As the stated intention is to make these savings without affecting the quality of the service there is much interest in how this can be done but nothing was said about this.

3. Performance All quite satisfactory. The number of MRSA and C. Difficile cases is well down on the (not to be exceeded) targets. The trust gets some bad ratings from the Healthcare Commission surveys but the reason is interesting. Patients are given questionnaires, to be returned by them to the Commission. It seems that the proportion of NWLH patients who submit such questionnaires is lower than the HC would like – and the trust gets a bad grading because of this. This seems unfair to me. There is more: the questionnaires are only in English yet the NWLH Trust clientele is roughly 50% non-English and the questionnaires are many pages long.

Paul