Hillingdon PCT at Christmas 2008

1. Finance
Good news is that the PCT has been granted an additional £1.31m capital allocation, to be spent by the end of March 2009 on its backlog of estate needs and critical IT needs! The Trust still predicts breakeven at year end – its top priority – but it will be hard-pushed to achieve this as it is currently £5.1m overspent against budget.

2. Medium Term Financial Strategy for London (MTFS) This strategy aims to clear legacy debts of London’s PCTs and hospital trusts and to ensure implementation of Healthcare for London across the capital. A new Challenged Trust Board will ensure stringent controls and governance arrangements are in place for those trusts that are enabled to clear historic debts. If Hillingdon PCT maintains breakeven for the next two years, its outstanding debt at the end of 2010/11 will be paid off with funds provided by other London PCTs. (More details are given in the report from Harrow PCT’s December meeting). In the meantime Hillingdon PCT may be able to borrow from nearby PCTs to invest in Healthcare for London initiatives. From the perspective of Hillingdon residents, this is a major step forward, which - if the PCT can continue to balance its books - will eventually wipe out £19m of historic debt!

3. Operating framework 2009-10 / financial allocations
Hillingdon PCT is a loser under a new weighted capitation formula, which favours areas with a higher proportion of older people. Hillingdon is deemed 6.4% over-capitation, so the PCT will have reduced increases each year until it reaches its new target allocation. In the next two years it will receive the minimum growth of 10.6%, in contrast to the average of 11%, with some PCTs having considerably larger increases.

4. London Clinical and Business Support Agency (LCBSA)
This new agency, known as the “Hub”, brings together pan-London services, supports PCT commissioners and shares risks across the capital. It is expected to improve the health of Londoners and minimise costs. It will be responsible for delivery of Healthcare for London planning and The Thames Cancer Registry. Hillingdon PCT is a net gainer in the system and it is handing over its BUPA contract to the HUB.

5. London Specialised Commissioning Group (SCG) This Group, based in Croydon PCT, will operate as a single team, with five Divisional Directors. It will cover many specialised services eg Burns, HIV, AIDS, cystic fibrosis, cleft lip and palate.

6. Consultation on acute stroke and major trauma services
All 31 London PCTs are working together on these services and both East & North Herts PCT and West Herts PCT have shown interest in joining them too.

Three London trusts can meet the criteria for designation as major trauma centres by 2010 – Barts and The London / Kings College Hospital / St Georges Healthcare. Provision for some areas of north and west London are still being explored.

Twelve bids met the requirements for a hyperacute stroke unit, including Northwick Park Hospital. Hillingdon Hospital only met the criteria for being a stroke unit, but both these hospitals met the criteria for Transient Ischaemic Attack (TIA) services.

It had been intended that public consultation would start in January, but this may be delayed.

Joan Davis

West Herts Hospitals Trust - on track for foundation trust status!

It seems that miracles can happen in the NHS.

In 2006-07, for the second year running, this Trust had Healthcare Commission ratings of “Weak” for both quality of services and use of resources, one of only four trusts in the country with such an abysmal record. Last year it achieved “Fair” for both ratings - and now it is well on the way to two “Good” ratings for the current year. Astonishing!

Two years ago it was a non-starter for financial trust status and faced being taken over or broken up – now it is on track to meet the Department of Health Applications Committee in May 2009, followed by Board to Board monitoring by Monitor in the summer.

It has responded to public consultation about its proposed foundation trust membership, and has both extended its consultation to February 2009 and replaced its “Out of Area Patient (& their Carers)” category with a new public constituency “Out of West Hertfordshire Area”, which will be welcomed by residents of Harrow and Hillingdon. Its membership is at 1800 and this is expected to grow when a Membership Manager takes up post in the New Year.

What has the Trust done to achieve such progress?

· It has conquered infections – no MRSA for the last two months and well within target for the year, and amongst the best in the country for its dramatic reduction in cases of clostridium difficile.

· It has achieved, or is on the way to achieving, all the national performance targets and it is a country leader with nearly 99% of its A&E patients being treated within four hours.

· As for finances, at month 8 in the year the Trust has a surplus of £1.2m and continues to forecast a £4.4m surplus by March 2009, although overspending on bank and agency staff could jeopardise that plan so - to combat the risk - if managers fail to deliver within budget, then their delegated authority will be taken away!

The Trust’s positive approach extends to an unannounced Healthcare Commission inspection in October. First hand feedback was encouraging, but with the report still awaited, the Trust has already put into place an action plan to meet criticisms the report might contain - boxes to be stored off the floors / regular cleaning of store rooms / cleaning schedules to be standardised / sellotape not to be used on posters / English tests to be undertaken by all Medirest staff prior to recruitment. The last of these points will be music to the ears of many patients and staff – although many will ask why this fundamental requirement was not standard practice anyway!

Joan Davis

The Hillingdon Hospital Trust - progress December 2008

Progress has been steady, but without dramatic news.

Foundation Trust progress
Having gained Department of Health approval to advance toward foundation trust status, the Trust is now under scrutiny by Monitor. The process for election of public and staff Governors is underway with the election for the Council of Governors in February in readiness for authorisation as a Foundation Trust, hopefully in March 2009.

Surveys of equipment and estate
Matrons have audited the Trust’s mattresses, with 180 being replaced in early December.

The Trust’s property has been comprehensively surveyed, with a report of over 1500 pages. The buildings survey was undertaken by an external company, which reports a backlog of high/significant maintenance of over £22m, with a total backlog approaching £50m - excluding C Block at Mount Vernon, which was already awaiting demolition.

Maintenance designated high/significant risk means something that can have an effect on the delivery of core healthcare services e.g. the out-patients department roof at Hillingdon Hospital needs major repair work, for which tenders have been prepared. £30m has been allocated over the next four years to reduce this high/significant risk to £2.8m and the total backlog to £17.6m.

Safeguarding children
Following the court verdict on the Baby P case, all local authorities including Hillingdon Borough, together with their partners such as the Trust, have been taking stock of the effectiveness of local practices to safeguard children. Everyone hopes that nothing similar could fall through the safety net here.

Patients’ experiences
The Trust takes seriously the views of patients. 154 in-patient survey responses in October were, as usual, carefully analysed and league tables compiled, by ward, for each survey question. Survey results are used to improve performance and to encourage increased response levels from patients. Similar surveys are being piloted for out-patients and maternity patients. A Patient Experience Steering Group is being set up to receive and monitor survey results.

Infections
The Trust was disappointed to have two MRSA cases in November but it hopes to stay within its full year target of 12 cases maximum. However, a new Department of Health target to include screening of all day cases - approximately an additional 1000 patients per month - will be very challenging, as the Trust currently screens only 22% of these cases.

Finances Revenue was lower than expected in November and operating expenses relatively high, but the year-end forecast surplus remains unchanged. Agency and locum use exerted cost pressures, also energy and utility costs.

Joan Davis

NWL Hospitals Trust Board, 17 Dec 2008

A rather brief meeting of just over 1 hour, well out of normal sequence (as the Board usually meets on the last Wednesday of a month the ‘proper’ date would have been 31 December – avoided for fairly obvious reasons).

Healthcare Commission and the Care Quality Commission
The HC is being abolished, to be replaced by the CQC, a new regulator of health services. All NHS trusts that provide health services will have to register with the CQC. Applications for registration must be made on-line between 12 January and 6 February 2009. It seems that at this time not all the regulations are known in detail.

NHS London Medium Term Financial Strategy
This is the same item already reported on in the meeting of Harrow PCT last week. Viewed from the hospitals it is not necessarily the good thing that the PCTs think it is. The fear is that the hospitals will get a bad deal from the PCTs.

Performance
Some interesting points here. Attendance at A&E is up quite considerably, about 8% compared to last year, with the reasons unknown. Last Monday 795 patients attended A&E, about 200 more than the previous ‘record’, more than 100 of these requiring admission to hospital. This caused a big problem with the provision of beds. Incidentally, many of the London trusts have high A&E attendance on Mondays, but no one knows why this should be so.

For the first time the Trust is ahead of its MRSA target.

There is a diarrhoea problem apparently, principally among elderly patients. The medical opinion is that as many of the elderly are admitted with respiratory problems they are given antibiotics, which have unwanted side-effects. So, take care which antibiotics are used!


Paul

Harrow PCT Board Meeting, 9 December 2008

Apart from the usual business there were three highly interesting matters, involving major cooperation between PCTs. Brief accounts of these follow.

Proposals for a Medium Term Financial Strategy for London
NHS London now has a surplus of about £300 million but the local situation varies greatly. It is expected that by 2011 the historic debt will stand at £373 million for hospitals and one PCT (Hillingdon) will still have a debt of £19 million. A steering group of CEOs has developed an approach as an alternative to the top slicing approach used by the SHA, to tackle residual debts.

Basically, the proposal is that over the next 2 years PCTs are to invest from existing resources in a collaborative fund to help clear the debts of financially challenged Hospital Trusts and Hillingdon PCT. Five financially challenged PCTs (Bexley, Enfield, Hillingdon, Hounslow and Kingston) would not be required to invest in this fund until their debts are cleared. A Challenged Trust Board (CTB) of PCT and NHS London Directors would assist the local PCT in ensuring that a Hospital Trust receiving such funds was using them appropriately. In the case of Hillingdon PCT, which itself would be a beneficiary, it could expect to be monitored by this body.

London Clinical & Business Support Agency (Business Case)
A huge item, of about 140 pages! The aim is to provide a common agency for the supply of certain services and cooperative help. Very laudable, spelled out in great detail, in terms of legal contracts. If it all works as intended, PCTs will be able to give better services at reduced cost.

Provider Alliance with Ealing
Harrow and Ealing intend to form a joint agency for providing certain services (not exactly specified at this time). Again, the hope is that there will be improvements at lower costs.

James and Paul

Video No.16, Professor Gordon Rustin, Director of Medical Oncology, Mount Vernon Hospital

Gordon Rustin qualified from the Middlesex Hospital, London in 1971. He was appointed Senior Lecturer in Medical Oncology at the Charing Cross Hospital in 1984, but moved full-time to Mount Vernon Hospital to become Director of Medical Oncology in 1995. He was awarded an Honorary Professorship by UCL in 2001 and visiting Professorship by University of Hertfordshire in 2006. He has published widely on management of gynaecological cancers and germ cell tumours’, the use of tumour markers, especially CA 125, and on phase I, II and III trials. His definitions using CA 125 to define response and progression of ovarian carcinoma are internationally known as the “Rustin criteria”.
Since 1990 he has been able to translate laboratory work on vascular targeting into the clinic. As chief investigator of the phase I trials of DMXAA, CA4P and OXI4503 he has developed a unique experience of running trials of vascular disruptive agents (VDAs). He has led the world in introducing functional imaging into determining the activity of VDAs. Because of his large referral practice, he is also able to contribute patients to many other trials. For 5 years until 2008 he was chairman of the ovarian cancer sub group of the NCRI gynaecological clinical studies group.
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Watch this spot!

The spot to watch is found by tapping "Early Day Motion" into Google (or similar search engine) and looking for Early Day Motion 128.
This EDM has been tabled by John McDonnel MP, as a result of our long-running fight to get foundation trusts to hold board meetings in public - as all other NHS hospitals, local councils and parliament itself are legally obliged to do. The wording is:

That this House notes with concern that NHS foundation trusts are not required in law to meet in public, with the result that decisions that have a significant and direct impact on the provision of health services to local communities can be made by a board of directors meeting in secret; considers that this practice flies in the face of the principles of openness and transparency in health policy making; and welcomes the campaign by The Community Voice to draw attention to this issue and to call for a change in the current legislation to require NHS foundation trusts to meet in public.

We are bursting with pride at this reference to ourselves in such an august setting and by logging onto the site there is all the excitement of watching the number of signatures grow - today this EDM has 16 supporting signatures. How many will it have tomorrow? Make sure your MP is amongst those listed! Of course EDMs do not directly change the law but they are a stepping stone in that direction, so we are very grateful to John McDonnel MP for giving our campaign such a wonderful boost!

Joan

After the Christmas festivities ...

In January, our usual first Thursday in the month meeting date falls on New Year's Day - so we shall NOT be meeting! However, our mailing will go out in mid-January as usual, our Executive will continue to deal with any pressing issues, and this web-site will be updated to keep members in touch with any developing news.

February will bring us up to date with the latest idea in the health field - polyclinics. Harrow is one of the five polyclinic pilot sites in London, so we are delighted that Dr Sarah Crowther, Chief Executive Harrow Primary Care Trust, is coming to our meeting on Thursday 5th February to tell us all about it. We will meet as usual at 7.45pm in the Postgraduate Centre at Mount Vernon. We welcome visitors, so do feel free to come to this meeting to hear our interesting speaker.

Joan

Paul Strickland Scanner Centre Update

December brought us a home-grown treat at Mount Vernon. We meet in the Post Graduate Centre, just round the corner from the Scanner Centre. We heard from its Chief Executive, Margaret Sullivan, about its state of the art scanners - altogether five of them - 2 PET/CT, one 64 slice CT scanner and two MRI scanners, all replaced regularly to keep the centre always up to date. It also has a cyclotron on site, producing short-life isotopes , that allow the Centre to maximise the number of patients scanned and to undertake valuable research.

Its scanners have a huge range of potential uses, from identifying cancers to diagnosing a tear in a knee cartilage. They can be involved in diagnosis and treatment.

The success of the Scanner Centre is evidenced by its involvement in drug trials and other research, the grants it obtains, its many publications and its strong links with academia and industry. We are lucky to have it at Mount Vernon as a resource for local people - but the fact that it exists is also a tribute to the efforts of local people as it is a charity and ever grateful for the support it receives from fundraising by its many local friends and grateful patients.

After her talk, Margaret Sullivan joined members in welcoming in the festive season with traditional mincepies and seasonal drinks.

A happy Christmas and New Year to all members of The Community Voice and its many friends!

Joan

Video 16.- Dr. Edwin G.A. Aird BSc MSc PhD FIPEM MRCR (Hon)

Medical Physics is the application of physics to medicine. Its origins are from the use of physics to determine the radiation dose to radiotherapy patients at the turn of the century (20th!!). Physicists now work in many different branches of medicine. However, at Mount Vernon, they are mainly involved in the use of radiation in imaging and radiotherapy. Physicists have a very long training period before they can operate as registered workers within the NHS. Following a degree in physics there are typically at least 4-5 further years of training before registration.

After qualification, Physicists can be found working in the following areas at MVCC (radiotherapy section):

Machine (linear accelerator) quality assurance and dosimetry;

Patient treatment planning using complex computer planning to design individual dose plans for each patient treated on the linear accelerators. This now includes the latest planning techniques that use Intendity Modulated radiotherapy (IMRT) together with Image Guided Radiotherapy (IGRT).

Patient dosimetry: verifying that the planned dose is being deliveredcorrectly, including the use of in-vivo dosimetry and portal imaging.

Teaching and Training of all staff involved with Radiotherapy: Physicists; Radiographers; Clinical Oncologists.

Dr. Edwin Aird's distinguished medical history, to the present day, started when he:-

Trained at Newcastle University (Physics BSc; MSc and PhD) and Newcastle General Hospital. He worked at Newcastle General in Medical Physics; Radiation Physics and Radiotherapy Physics 1967-1985.

Head of Radiotherapy Physics, Barts 1985-1988;

He was appointed Head of Medical Physics, Mount Vernon Hospital 1988-

He is also involved with running National Centre for QA in Radiotherapy Clinical Trials for UK; and Chair of Group for QA in Clinical Trials for EORTC (European Organisation for Research and Treatment of Cancer) 2006-

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