Annual Report 2006-2007: Operating and Financial Review
- West Hertfordshire Hospitals NHS Trust
- Emergency Preparedness
- Performance and Standards for Better Health / Healthcare Commission
- Performance Targets
- Standards for Better Health
- Risk Management
- Foundation Trust Status
- Key Performance Indicators
- Serious Incidents
Download a copy of the Trust's Annual Report:
West Hertfordshire Hospitals NHS Trust
West Hertfordshire Hospitals NHS Trust was formed from the Mount Vernon and Watford Hospitals NHS Trust and the St Albans and Hemel Hempstead NHS Trust on 1 April 2000. The Trust provides health services at Hemel Hempstead Hospital, Watford General Hospital and St Albans City Hospital. We employ more than 3500 staff working in over 50 different professions to serve the people of west Hertfordshire and beyond.
The Trust's key relationships in the delivery of care continue to be with the West Hertfordshire PCT, General Practitioners/Practice-Based Commissioners, community based healthcare staff, and local social services. The development of practice-based commissioning by GPs is bringing closer engagement between GPs and the Trust and this is evidenced by the joint bids that have been developed to provide Clinical Advisory Treatment Services.
The Trust’s overarching aim is to achieve Foundation Trust status by 2008 and to open the Watford Health Campus in 2014. Work is already underway to make this aim a reality. The Delivering a Healthy Future strategy focuses on service development and service improvement for patients. Whilst service redesign forms part of this work, service improvements also began last year with a Best Value Best Practice audit, looking in detail at the Trauma and Orthopaedic Service. Changes are already underway to improve this key service.
Reaching out to our local community is a priority. An External Relationships group is developing the community based elements necessary to achieve Foundation Trust status, ensuring relationships with key stakeholders are developed and nurtured.
Emergency Preparedness
The NHS faces increasing challenges in the area of emergency planning. The Trust is committed to adopting a multi-agency approach to Emergency Planning and is represented on a number of external emergency planning groups led by Hertfordshire Resilience (formerly known as HESMIC).
The Trust continually reviews and refines its emergency plans. New legislation (i.e. the Civil Contingencies Act) and new Department of Health guidelines underpin the Trust’s Emergency Planning process and our plans for future developments. The Trust is compliant with Department of Health guidance for Emergency Planning and Pandemic Flu and is working towards compliance in Business Continuity.
Performance and Standards for Better Health/Healthcare Commission
This has been a challenging year. In June 2006, the Healthcare Commission rated the Trust as ‘weak’ for Quality of Services and as ‘weak’ for Use of Resources (for 05/06). Since then the Trust has done much to improve its performance in a number of areas. Professor Ramsay, Trust Medical Director, explained: “Quality of clinical services and efficient use of resources go hand in hand. Over the past year, clinicians have identified how we can use resources like operating theatres, beds and medicines more efficiently. We have worked hard to prevent diagnostic tests being duplicated and to increase the numbers of patients seen as day cases. Whilst tight restrictions on staffing have been challenging in some areas, our staff have worked hard to ensure wards are staffed appropriately, and I am confident that striving for efficiency will continue to improve our clinical standards.”
Performance Targets
Not being kept waiting for appointments and for care in A&E is something we all understand. This year the Trust achieved all key waiting times targets.
Standards for Better Health
The Trust is now compliant in 42 out of 44 Core Standards, representing significant progress in comparison to last year’s position where the Trust was compliant in 30 out of 44 Core Standards. The two noncompliant Standards focus on strategic partnership working and public health. Action plans that focus on these areas have been developed to ensure compliance is reached in 2007/08.
Risk Management
Significant progress has been made in the proactive management of risk. In the past year, the Trust has:
- Launched a mandatory training programme aimed at new consultants and medical staff
- Undertaken a pilot assessment of the new NHS Litigation Authority Risk Management Standards
- Achieved CNST Level 2 for maternity
- Produced a Datix User Manual for incidents and standards modules
- Commenced the process of logging risks associated with the Trust’s infrastructure
Foundation Trust Status
The Trust has spent time over the last year ensuring that it is well positioned to make an application for Foundation Trust (FT) status towards the end of the 2007/08 financial year. Advice has been sought from other Trusts that have been successful in gaining FT status and the Trust will be looking to use this advice in planning its strategy for achieving success with its application.
| In terms of national targets*, the Trust has achieved the following: *calculated on the basis of Healthcare Commission criteria |
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Waiting time for planned operations – as at the end of March 2007, no patient was waiting more than 20 weeks for admission for planned operations. |
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Waiting time for outpatient appointments – as at the end of March 2007, no patient referred by a GP was waiting more than 11 weeks for a first appointment with a consultant. |
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Waiting time for MRI and CT scans – as at March 2007, no patient was waiting more than 13 weeks for an MRI or CT scan. |
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Outpatient and in-patient booking – since December 2006, 100% of outpatients and patients having planned surgery were able to book their appointment at a time of their choice. In March 2007 the Trust achieved 25.4% of all bookings via the directly bookable route of ‘choose and book’, with the national figure standing at 20.9%. |
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Cancer two-month wait – in 2006/07 98.4% of those diagnosed with cancer commenced their treatment within two months of their GP sending the referral. |
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Cancer one-month wait – in 2006/07, in addition to those above, all patients diagnosed as having cancer commenced their treatment within one month of diagnosis. |
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Cancer data completeness – we treated 316 cancer patients between January and March 2007. |
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A&E total waiting time – the target for 2006/07 was that over 98% of patients should spend no more than four hours being treated in the A&E department before being either discharged or admitted; we achieved 98%. |
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With an annual turnover of £218.2 million, the Trust reported a deficit of £11.4 million, meeting its control total of £11.5million. |
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The Trust is on target to meet the new 18 week total waiting time by December 2008. |
| The Trust did not achieve the following targets: | |
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Cancelled operations – in 2006/07 929 operations were cancelled on the day of surgery, which represents 2.8% of elective admissions, against a target of less than 1%. |
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MRSA infections – there were 42 bacteraemia infections identified in the laboratory, against a target figure of 26 for 2006-07. |
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Cancer two-week wait – in 2006/07 99.9% of patients referred with suspected cancer were seen by a specialist within two weeks of GP referral against a target of 100%. |
Key Performance Indicators>
As part of the Trust’s commitment to continual improvement, a series of clinical and non-clinical indicators are in development. A Clinical Standards Executive has been launched which replaces the current Clinical Governance committee. Chaired by Prof Graham Ramsay, the Trust’s Medical Director, the committee will ensure that clinical standards are developed and improved throughout the Trust, supporting Standards for Better Health and investigating thoroughly trends and any potential poor practice or areas of clinical concern.
Serious Incidents
In January, an inquest was held into the death of Ahil Islam, a child who died in the care of the paediatric service (then managed by Hertfordshire Partnership NHS Trust). Ahil sustained minor burns and died from staphylococcus aureus septicaemia infection which was not diagnosed until shortly before his death.
Following the death of Ahil, the Trust, together with the Hertfordshire Partnership NHS Trust, invited an independent panel of experts to review this incident and review its practices and procedures. A detailed Action Plan has been produced in light of the panel’s recommendations.
At the inquest the Trust acknowledged that there were failings in the system. We have taken action to reduce the risk of an incident of this kind happening in the future. We have improved communications between transferring hospitals, and we have introduced a Paediatric Early Warning System (PEWS), which enables our staff to closely monitor children and detect any deterioration in their condition as soon as possible.
