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NHS Westminster Annual Report


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NHS Westminster Annual Report

  1. 1. NHS Westminster Annual Report
  2. 2. CONTENTS Contents
  3. 3. Foreword 4 About us 7 Our performance 8 Our strategic five-year plan 14 1. Reducing health inequalities 18 2. Adding years to life 20 3. Building a choice of quality healthcare 22 4. Adding life to years 23 5. Promoting healthy lifestyles 25 Directorate Reviews 28 1. Service Development 30 2. Public Health 36 3. Nursing and Quality 38 4. Finance and Performance Management 40 5. Human Resources and Corporate Affairs 44 Our Board 46 1. Members’ interests 50 Annual Accounts 54 Contents
  4. 4. NhS WeStmiNSter ANNuAl report 08/09 section FOreWOrd Welcome to the 2008/09 one NhS WeStmiNSter ANNuAl report This report outlines how the NHS in Westminster has been working to improve the health and healthcare of Westminster residents during the year. A year of improvement residents are waiting less time than ever for hospital appointments, finding their doctors’ surgeries are open longer and being better supported in leading healthier lives. we lAuNCHeD A Five-yeAR We changed our name from Westminster Primary Care £94M iNveStMeNt PRogRAMMe, Trust to NHS Westminster. This reflects our key role as to CReAte New HeAltH commissioners, that is strategic buyers, of healthcare. CeNtReS, PRoviDe MoRe Our aim is to focus local services as much on maintaining DeNtiStS AND iNCReASe tHe healthy lifestyles and preventing ill health as they do on NuMBeR oF NuRSeS. treating sickness. Our community service providers (including more than 34 different types of healthcare workers from physiotherapists to nurses) are separating from us and forming a new organisation with their counterparts in Kensington and Chelsea and Hammersmith and Fulham. This will be known as Central London Community Healthcare and will have enhanced freedom to determine its own future. This will allow us to focus on our commissioning role. Contents
  5. 5. 5 Health services for our community We spent over £390 million on health services for our residents. They are able to be treated in some of the country’s top performing hospitals. We’ve also reduced treatment waiting times. Mental health services have continued to expand with investment in community care and psychological therapies, as well as in hospitals. Throughout the past year we have also been working to bring more healthcare services closer to Our programme of polysystems, across Westminster, home, and to improve patient choice. Our investment aims to provide a broad range of health and wellbeing in community services ensures there are now more services for local communities – they are likely to nurses and therapists available locally. We have also include district nurses and physiotherapists as well as worked with local GPs to extend opening hours. GP services. Improvements are also planned in dental care, with two new practices expected in 2009. we Met tHe New 18 week tARget FRoM gP ReFeRRAl to tReAtMeNt. In the past year we have had great success with 78% oF PAtieNtS ARe Now BeiNg a proactive stop smoking campaign, which was SeeN witHiN 12 weekS. targeted at areas with the highest numbers of smokers. As a result there was a 60% increase One of the highlights of the year was Health Minister in the uptake of smoking cessation advice at Lord darzi launching our innovative community-based pharmacies where personal help is given. cardiovascular disease prevention programme. Healthy Hearts and Minds identifies residents with a more than one-in-five chance of developing cardiovascular weStMiNSteR HAS MoRe disease. Patients are then offered health advice from PHARMACieS tHAN ANywHeRe a community team of cardiologists, nurses, dieticians elSe iN tHe CouNtRy. and physiotherapists to help them reduce the risk of having a heart attack or stroke. We listened We are working alongside our partners to develop health services that meet the needs of local people, MoRe tHAN HAlF oF loCAl gPS and we encourage them to help us develop services Now oFFeR APPoiNtMeNtS that are relevant, easy to access and that make outSiDe NoRMAl woRkiNg HouRS. a real difference in maintaining health. £94m £15.5m £390m 50% will be spent over the next is what we’ve saved in was spent on healthcare More than 50% of four years to create new 2008/09 to invest in our for Westminster residents Westminster GPs now health centres, provide major health improvement in 2008/09 offer appointments outside more dentists and increase programme normal working hours the number of nurses Contents
  6. 6. NhS WeStmiNSter ANNuAl report 08/09 Health Minister Lord Darzi with Chief Executive Michael Scott, Chair Joe Hegarty and Public Health Consultant Dr Adrian Brown. Looking ahead you will find more information on our plans and NHS Westminster has developed a strategic plan strategic goals. looking forward to 2013. This includes measures Our financial performance has been strong and we that will tell us if we’ve achieved our goals. have ended the year with a surplus of £15.5 million Most importantly we are working to reduce health – which means we can invest in a major health inequalities in Westminster. Further on in this report improvement programme. Our staff have again rated us as one of the top we SPoke to MoRe tHAN 1,600 health employers in the country. We thank them for PeoPle ABout tHeiR FutuRe their commitment and hard work that makes all our viSioN oF HeAltHCARe. tHey achievements possible. exPReSSeD CoNCeRN ABout We look forward to the next year when we plan to HeAltHCARe ASSoCiAteD achieve real and lasting health benefits for everyone iNFeCtioNS AND CANCeR who uses the NHS in Westminster. wAitiNg tiMeS. we ARe ACtiNg oN tHoSe CoNCeRNS. michael Scott Joe hegarty Dr Dennis Abadi Chief Executive Chair CEC Chair Contents
  7. 7. 7 AbOuT uS: WhAt iS NhS WeStmiNSter? NHS Westminster is not a new organisation; it is the new name for Westminster Primary Care Trust. The name reflects our new focus as buyers of healthcare services rather than providers of healthcare. Where are we based? have the best of health and the best We have been based in the heart of of healthcare. Ab be yR W oa ell d ing to REGENT’S n Westminster for the last six years and M Ro aid ad PARK a Va Planned changes across the NHS le Pa rk Lis are responsible for funding all Ro so ad nG ro ve e Ro ad in Westminster reflect our big the health services across ebon Maryl Bake Reg three priorities: Ed r St en gw t Stre are reet G Ro Street lo ad Oxford et the borough. uc es te d Street rT Oxfor err ac e St reet r Road enor • choice - we will provide quality ate sv Baysw Gro d an Str Pa rk La HYDE PARK We share our boundaries ne d illy information so you can choose ca ia Pic Victor all eM Th ge with the City of Westminster, tsbrid Kensington Road Knigh Walk Birdcage Sloan how and where you receive e et Stre ad Str oria Ro Vict ee extending to regent’s Park in t ace Pal your healthcare Va ham u xh all ng Bri dg cki e Bu Ro the north, Queens Park in the ad • care closer to home - we are west and Covent Garden in the Grosve nor Road providing care closer to your home east. Our southern boundary follows and linked to other services the north bank of the river Thames. • health - we all need to think about What we do healthier lifestyles and we want to We spend over £433 million each year support you to achieve yours making sure people in Westminster 90.07% £390m Commissioning of healthcare What we spend your money on: £160m Maternity, general, Acute, A&e • Family doctors £72m Mental health • Dentists, opticians and pharmacies £43m Community health services £40m gP services • Community services £26m Prescribing costs • Hospital care £14m Dental services • Promoting healthy living £10m learning difficulties • Mental health £25m other contractual services 9.93% £43m Property and other corporate costs Who we listen to and who we We ask for your feedback through work for surveys, meetings, events and so on. We exist to improve the health and Check for wellbeing of our local residents. So we upcoming events, or call freephone listen closely to what you have to say. 0800 587 8818. Contents
  8. 8. NhS WeStmiNSter ANNuAl report 08/09 our performANce This is a snapshot of our performance over the last year. Jake Johnson with the Care Quality Commission Annual Health Check – at a glance Fit Squad 3 Our rating improved from “Fair” to “Good” – this means we delivered good quality services 3 We are in the top 20% of trusts in London 3 For the second year in a row we were rated “Good” for our use of resources – which means we spend your money wisely 3 Our substance misuse service was rated as excellent 3 An in-depth review of urgent care put Westminster in the best Performing category We were found to have improved services in: mental health, particularly crisis resolution services; helping pregnant women to give up smoking; improving access to genito-urinary clinics within 48 hours; chronic disease management; and helping people with long term conditions remain at home longer through support from community matrons. (The Care Quality Commission released its findings for 2007/08 in October 2008. Findings for 2008/09 were not released in time for this report.) Top 20% 7 Top 5 excellent We are in the top 20% We met the 18 week We are in the top 5 for Our substance misuse of trusts in London, in target seven months urgent and emergency service was rated as terms of performance ahead of schedule care in London excellent by the Annual Health Check Contents
  9. 9. 9 NHS Westminster – the local leader We are also speaking to private providers who can World Class Commissioning is a new, ground-breaking meet NHS standards and prices – to provide more approach to commissioning. It is designed to help choice for patients. primary care trusts arrange for better services more closely matched to local needs. This will result in Urgent and emergency care better quality care, improved health and wellbeing, We were rated as one of the top five performers and a reduction in health inequalities across in London for urgent and emergency care in the the community. Care Quality Commission report published in September 2008. Like every primary care trust, we were assessed for our commissioning skills in three areas: The Care Quality Commission released a major review covering all urgent and emergency services. For the • Health outcomes – our priorities for health first time, this looked at how the whole system works. improvements for local residents, including life It included all the major aspects of care, including expectancy and health inequalities Accident & emergency, ambulance services, out-of- • Organisational competencies – our knowledge, hours GP services, NHS direct, urgent care provided skills, behaviours and characteristics that will by GPs, and urgent care centres including walk-in make our organisation world class centres and minor injuries units. • Governance – our arrangements for managing The report gave us high scores for: the organisation in the most effective way possible. This includes developing areas such • public satisfaction with phone access as strategic, financial and organisational planning, to GP surgeries as well as the board’s controls and processes • the response time for GP out-of-hours services to start telephone assessments of patients NHS Westminster gained the top rating for our strategy, vision and objectives. This included the • systems in place to ensure quality and safety level of board ownership of our strategy, and the in GP out-of-hours services consistency of our financial plan to deliver on it. • facilities for people with disabilities and systems to protect vulnerable children and adults Getting treated faster – exceeding the 18 week target unfortunately, we received lower scores for: We not only met but exceeded the national target • Accident & emergency attendance for conditions for local patients to be treated within a maximum of that could be treated in other settings 18 weeks. Figures from the department of Health • patient satisfaction with GP opening times showed we met the target in May 2008, seven months ahead of schedule. We have already improved our GP opening times and are working on bringing care closer to home, by March 2009, 98% of patients who did not which will improve the opportunities for patients to require admission to hospital received treatment receive care faster and more conveniently. within 18 weeks (ahead of the national target of 95%). 94% of patients who required a planned admission to hospital were also treated within 18 weeks (ahead of the national target of 90%). Contents
  10. 10. NhS WeStmiNSter ANNuAl report 08/09 meetiNg our tArgetS Existing national targets We were assessed against 17 existing national targets. We achieved 13, under achieved one and failed two. One target was not assessed. target rating People with diabetes to be offered screening for the early detection of diabetic retinopathy Achieved Maintain a maximum wait of 26 weeks for in-patients Achieved Maintain a maximum wait of 13 weeks for an outpatient appointment Achieved Maintain a maximum waiting time of two months from urgent referral to treatment for Achieved all cancers All ambulance trusts to respond to 75% of category A calls within eight minutes Achieved All ambulance trusts to respond to 95% of category A calls within 19 minutes after Achieved the request has been made for transport All ambulance trusts to respond to 95% of category b calls within 19 minutes under achieved Maintain delayed transfers of care at a minimal level Achieved Maintain a maximum waiting time of one month from diagnosis to treatment for all cancers Achieved every hospital appointment to be booked for the convenience of the patient, making it Failed easier for patients and their GPs to choose a hospital and consultant that best meets their needs. Patients should be able to choose from at least four health care providers for planned hospital care Guaranteed access to a primary care professional within 24 hours and to a primary care Failed doctor within 48 hours Improve life outcomes of adults and children with mental health problems by ensuring that Achieved all patients who need them have access to crisis resolution services and a comprehensive child and adolescent mental health service update practice-based registers so that patients with coronary heart disease and diabetes, Achieved and the majority of patients at high risk of coronary heart disease, continue to receive appropriate advice and treatment in line with national service framework standards Maintain a two week maximum wait from urgent GP referral to first outpatient appointment Achieved for all urgent suspected cancer referrals Maintain the four hour maximum wait in A&e from arrival to admission, transfer or discharge Achieved Maintain a three month maximum wait for revascularisation Achieved Contents
  11. 11. 11 New national targets The government’s new national targets are goals for the entire NHS. These aim to improve the health of the population of england. We were assessed against 13 targets. We achieved eight and under achieved five. target rating Achieve year on year reductions in MrSA levels, expanding to cover other healthcare Achieved associated infections as data from mandatory surveillance becomes available Improve the quality of life and independence of vulnerable older people by increasing Achieved the proportion being supported to live in their own home by 2008 Increase the participation of problem drug users in drug treatment programmes by 2008; Achieved and increase year on year the proportion of users successfully sustaining or completing treatment programmes reduce health inequalities by 2010 Achieved Secure sustained national improvements in NHS patient experience by 2008 Achieved Halt the rise in obesity among children by 2010, as part of a broader strategy to tackle Achieved obesity in the population as a whole ensure that by 2008 nobody waits more than 18 weeks from GP referral to Achieved hospital treatment Improve health outcomes for people with long term conditions by offering a personalised Achieved care plan for vulnerable people most at risk; and reduce emergency bed days by 2008 through improved care in primary care and community settings for people with long term conditions reduce adult smoking rates by 2010 under achieved reduce the under-18 conception rate by 2010, as part of a broader strategy to improve under sexual health achieved Substantially reduce mortality rates from suicide and undetermined injury by 2010 under achieved Substantially reduce mortality rates from cancer by 2010 under achieved Substantially reduce mortality rates from heart disease, stroke and related diseases under by 2010 achieved Contents
  12. 12. NhS WeStmiNSter ANNuAl report 08/09 NHS WeSTMINSTer – iNVeStiNg iN better heAlth A five-year investment programme of £94 million is already changing healthcare in Westminster for the better. We spent more than £23 million on this programme in 2008/09. For NHS Westminster to achieve its ambitious goals and see a measurable improvement in health there must be a change in how we work and how we deliver care. In 2008/09 our major investments included: • £2.5 million to reduce health inequalities – including £400,000 on transforming community nursing in Westminster • £1.4 million to add years to life – including £700,000 on cardiovascular disease prevention and cardiac rehabilitation • £6.6 million to build a choice of quality healthcare – including £1 million to ensure a maximum waiting time for patients of 12 weeks for planned care; £1.4 million to increase the number of staff working at the Gordon and St Charles Hospitals for Westminster residents receiving in-patient mental health care; £1 million to ensure GP premises for Westminster residents are of the standards required; and investments of up to half a million pounds in individual practice-based GP commissioning clusters • £2.7 million to add life to years – including £770,000 invested in a community cardiac team • £1.2 million to promote healthy lifestyles – including more than £400,000 in addressing obesity in children and adults and more than £200,000 in our stop smoking service ASk youR PAtieNtS week 2008 SuRvey ReSultS 92% 92% rated their overall experience of using said they were seen on time or within Westminster’s community health services a given time frame as excellent or good Contents
  13. 13. 13 Looking forward The extra GP services at Queens Park will make it Our investment programme for 2009/10 includes easier to see a GP in Westminster. The new family £3.8 million in mental health services, £3.6 million in doctor drop-in services will be open for everyone primary care facilities and more than £6 million in who lives, works or visits Westminster from 8am to developing Westminster’s first community health 8pm, seven days a week. The new services will be in hubs or ‘polysystems’. addition to existing GP services and will make it easier for everyone to see a doctor or nurse quickly, A new GP-led health centre will bring care closer at a convenient time. Patients can book an to home and to make it easier to see a GP appointment or simply turn up – without having in Westminster. to face long, and sometimes worrying, waits. You told us… we listened A team from NHS Westminster beat 50 others paper questionnaires, and encouraged teenagers to win in the Primary Care category, at the to take part by using video booths. We spoke to Involvement to Impact Awards 2008. during more than 2,200 people and turned their feedback Ask Your Patients week, we used online and into action. Why polysystems? What is a polysystem? residents said that they want to be able to see A polysystem is a health system that provides a GP and access more health services more easily a wide range of health and wellbeing services to – especially during weekends and evenings and a local community, closer to home. Our polysystems without having to take time off work. will have a central services “hub” and a network of linked GP practices. The “hub” will be in a building similar to a large health centre but will offer a far wider range of services. In addition to GP services, there will be services such as district nursing, health visiting and physiotherapy. There will also be specialist services such as outpatient clinics and associated diagnostics services (like X-ray), and Emily Savin and Simon Hope from NHS Westminster with health and wellbeing services such as managing Westminster residents at a polysystem consultation. weight and how to stop smoking. 66% 83% 98% said they had seen the healthcare said they felt confident with had high satisfaction (‘excellent’ professional’s Id hygiene standards or ‘Good’) with a pilot community blood-clotting prevention service to bring care closer to home Contents
  14. 14. Contents
  15. 15. OUR STRATEgiC FivE-YEAR plAN Contents
  16. 16. NhS WeStmiNSter ANNuAl report 08/09 section Our STrATeGIC PLAN SeTS OuT two our ViSioN from NoW to 2013 In partnership with our practice-based commissioning clusters, over the next five years we will work with Westminster City Council, a range of healthcare providers and other local partners, to lead local healthcare improvements. Five years – five strategic objectives To achieve our vision, we have set five strategic goals: 1. 0 reducing health inequalities 2. 0 Adding years to life 3. 0 building a choice of quality healthcare 4. 0 Adding life to years 5. 0 Promoting healthy lifestyles 10 health outcomes NHS Westminster has put in place 10 health outcomes that will show if our strategy has succeeded. These are to: 1. 0 reduce overall health inequalities, including reducing the size of the gap in life expectancy between the most affluent and those on the lowest incomes. We intend to reduce this by 10% by 2012 measured according to the nationally recognised Index of Multiple deprivation (IMd) score. 2. 0 Increase the overall average number of years people in Westminster are expected to live. 3. 0 Achieve 98% coverage of children under five who complete both doses of the mumps, measles and rubella (MMr) vaccine by 2013. Westminster and London are below the national target of 95% (required for herd immunity which protects those unable to be vaccinated due to medical contraindications). The capital therefore is at risk of a measles epidemic. 4. 0 Increase the proportion of women aged 53 to 64 who are screened every three years for breast cancer. The proportion of Westminster women who take these regular tests is substantially below the national average. 5. 0 reduce the number of people who die from heart disease. This is the single biggest cause of premature death in Westminster and the main reason why people on lower incomes die younger than more affluent people. Contents
  17. 17. 17 6. 0 reduce the number of people who die from 10. Increase the numbers of people with mental diseases related to breathing and circulation, health problems who receive psychological such as bronchitis, emphysema and other therapies. The proportion of Westminster’s diseases of the lungs. This is the second population with mental health problems is biggest contributor to why people on lower relatively high and not everybody is getting incomes die younger. The biggest cause of the help and treatment they need. these diseases is smoking and we aim to reduce the level of smoking in young people Who we work with and adults to 10% of the population by 2013. Our key partners include Westminster City Council, Imperial College Healthcare NHS Trust, Chelsea and 7. 0 Cut the rate of Clostridium difficile (known as Westminster Hospitals NHS Foundation Trust, C-diff) in patients who go into hospital. C-diff university College London Hospital NHS Foundation is a healthcare acquired infection to which older Trust, Central and North West London NHS Foundation people are particularly susceptible. Hospital Trust, Central London Community Healthcare, infection control is a key priority both for us and neighbouring primary care trusts, i.e. Kensington and Westminster residents. Chelsea, Hammersmith and Fulham, brent and 8. 0 reduce the numbers of people who are Camden, NHS London, London Ambulance Service, admitted to hospital because of harm caused Metropolitan Police, Voluntary Action Westminster, by alcohol. There is growing concern about how black and Minority ethnic Health Forum, the Carers many people need hospital care because of the Network, Westminster Local Involvement Network effects of alcohol consumption. (LINk) and other organisations in the voluntary sector. 9.0 reduce the proportion of primary school-aged children who are recorded as being obese. There is growing concern about the rates of childhood obesity, which rises sharply between starting primary school and secondary school. Our local targets We set these four targets after consultation and within 31 days. by 2013 we want all patients who engagement with local residents: have a full diagnosis of cancer to have begun their treatment within nine days or less. • reduce the proportion of our population that smokes from around a quarter where it is now, to one adult in ten or less. • Measure the experience that patients and users actually have of the NHS, so we know how patients really feel about NHS services. We will involve patients and their families, who will help us make real and tangible improvements. • reduce the level of MrSA infection in hospital. • everyone who is diagnosed by their GP as A Westminster resident at the Westminster Health Debate. potentially having cancer beginning their treatment Contents
  18. 18. NhS WeStmiNSter ANNuAl report 08/09 Our STrATeGIC FIVe-YeAr PLAN 1. reDuciNg heAlth iNequAlitieS Overall the health of people living in Westminster is good. However, people on different incomes and from different backgrounds have very different levels of health. We are working to narrow these gaps, including gaps between the wealthiest and those on the lowest incomes, between men and women and between different ethnic groups. Above left: Lord Darzi and NHS Westminster, with City Partnership colleagues, has developed Dr Adrian Brown, Consultant a five-year strategy to address health inequalities. It includes tackling in Public Health at the launch of Healthy Hearts and Minds the causes, reducing the impact, and improving the health of all Westminster residents. Above right: Marina, who attended our Understanding Health Improvement course, Healthy Futures part of our Health Trainers This project takes an innovative approach to breaking the cycle of declining programme. health among residents who find it hard to access mainstream services and opportunities. The project includes: healthy people: Health MOTs are available at community centres. These support residents in choosing healthy lifestyles, including stopping smoking, increasing physical activity and healthy eating. DiFFeReNCeS iN HeAltH 12.7 yrs x2 x6 There are significant differences People living in the most deprived Type 2 diabetes is up to six times in life expectancy between areas of Westminster experience more common in people of South Westminster’s wards with a gap twice the rate of coronary heart Asian descent and up to three times of up to 12.7 years for men and disease and death from stroke, more common in those of African 12.6 years for women as those living in the least and Caribbean descent than in the deprived areas general population Contents
  19. 19. 19 healthy homes: environmental health officers Improving access to psychological therapies carry out home health improvement in people’s We have expanded our cognitive behavioural therapy homes. They identify people who can get help workers from 5 to 11 (funding we won through the with home adaptations, fuel poverty and winter department of Health). warmth payments. We will also support people with mental health health trainers: This is an accredited scheme that problems to return to work or stay in their jobs. trains local people to provide key health messages These new services will help reduce health within their community. This includes giving information inequalities and regenerate Westminster by: and advice on the services available locally. • ensuring that people who need access to primary care mental health services for anxiety and Healthy Hearts and Minds depression receive them rapidly In January 2009 Health Minister Lord darzi launched • helping people to stay in work or return to work an innovative community-based cardiovascular and supporting those who have recently been disease prevention programme in Westminster – made redundant Healthy Hearts and Minds. This is designed to tackle • creating jobs for local people in both the NHS the biggest killers and causes of premature death, and the voluntary sector, through investment in heart disease and stroke. the local economy Healthy Hearts and Minds identifies the residents with a more than one in five chance of developing cardiovascular disease. It will help them to make lifestyle changes to reduce their chances of having a heart attack or stroke. Patients recruited to the programme are offered BY 2013 WE Will one-to-one assessments and health advice from • educe overall health inequalities R a team of cardiologists, nurses, dieticians and • ncrease average number of years people in I physiotherapists. In regular sessions at community Westminster are expected to live venues they will be able take part in supervised • ncrease proportion of children under five who I exercise classes, workshops on healthy eating, get both doses of the MMr vaccine diabetes, blood pressure management and how to stop smoking. Measles, Mumps and Rubella (MMR) catch-up campaign Local GP practices and NHS Westminster took part We are nearing the 95% recommended by the in the national catch-up programme for all children World Health Organization (WHO) to ensure aged 13 months to 18 years. It was successful, with protection for the whole community (including those the number taking the first dose of the MMr unable to have the vaccine for medical reasons). vaccination increasing by 10% to 89%. The number of children getting the second dose of MMr more than doubled during the programme. 67% of children have now had the vaccine. Contents
  20. 20. NhS WeStmiNSter ANNuAl report 08/09 Our STrATeGIC FIVe-YeAr PLAN 2. ADDiNg yeArS to life Preventable ill health and disease is one of the major causes of premature death in Westminster. We will change this by working to prevent ill health, diagnosing disease much earlier and giving people more rapid access to specialist centres of excellence. This will give many more Westminster residents a better chance of living longer. Cancer In Westminster, cancer accounts for 33% of premature deaths in men and 41% of those in women. The main causes of premature cancer death in men are lung and bowel cancer. In women they are eARly CHeCk uP iS tHe MoSt breast, bowel and lung cancer. iMPoRtANt tHiNg, BeCAuSe We are working to ensure that people PReveNtioN iS BetteR tHAN CuRe! Mr Kasim, Harrow Road use cancer screening programmes (cervical, breast and bowel), promoting healthy lifestyles, and we are improving access to cancer treatment services. This means that people who develop cancer receive treatment as early as possible. After talking with local residents, we have set ourselves local cancer targets: • everyone who is diagnosed by their GP as potentially having cancer should begin their treatment within 31 days • by 2012 we want all patients who have cancer to have begun their treatment within nine days or less of their diagnosis 3 days 1 in 8 90% 170,000 One woman in Westminster For every eight women 90 per cent of care ”NHS Westminster sets is diagnosed with cancer diagnosed with breast currently delivered at a gold standard for the every three days. cancer, one will be spared hospital outpatient prevention of heart attack a mastectomy. departments will be and stroke, which kills delivered by the new 170,000 people every year community cardiac team. in the uK.” Health Minister Lord darzi Contents
  21. 21. 21 MyAction MyAction is a new and rapidly growing programme in heart disease prevention. It integrates the care of patients with cardiovascular disease (and their families) and those at high risk of developing atherosclerotic disease, within a convenient local community setting. In Westminster, we will provide the programme to around 1,500 families each year, in seven community centres. Community Cardiac Team This year we commissioned a new service to move the care of patients with cardiovascular disease into the community. We plan to integrate it with MyAction and our new polysystems. The services will be consultant-led with a range of new specialist nurse posts. It will be a one-stop shop for diagnostics and patient clinical management plans. It will also move patients out of hospitals and HeARt DiSeASe AND StRoke into the community. because they are run by clinical ARe tHe BiggeSt CoNtRiButiNg specialists, patients will have world class expertise FACtoRS to tHe HeAltH closer to home. iNeQuAlitieS tHAt exiSt BetweeN RiCH AND PooR, Not oNly iN weStMiNSteR witH itS DiveRSe PoPulAtioN, But ACRoSS tHe uk. BY 2013 WE Will • ncrease the proportion of 54- to 64-year- I old women who are screened every three years for breast cancer • educe the number of people who die R from heart disease – the single biggest cause of premature death in Westminster and the main reason poorer people die younger than wealthier people Contents
  22. 22. NhS WeStmiNSter ANNuAl report 08/09 Our STrATeGIC FIVe-YeAr PLAN 3. builDiNg A choice of quAlity heAlthcAre The NHS now allows all patients to be treated at any hospital of their choice. We’re working to ensure residents are aware of their right to choose the care that is best for them. Since december 2008, more than half the GP practices in Westminster gp-led offer patients longer opening times. This includes before 8.00am, after heath centres 6.30pm in the evening and on Saturday mornings. We are now planning • pen 8am to 8pm, o extra GP services which will open from 8.00am to 8.00pm, seven days 7 days a week a week. • GP appointments We’ve commissioned a GP-led health centre which should help patients • walk-in services see GPs and get primary care services when they need them – patients • or registered and f had told us that they found it difficult to see a GP at a convenient time. non-registered The launch of our practice nursing scheme funds more nursing hours – giving patients more appointment choices for patients wanting to see a practice nurse. Local residents also told us that more dental surgeries were needed to give them easy access to NHS dental care. We are making major improvements to dental care with two new practices opening in 2009. both new surgeries will be offering we StARteD oFFeRiNg A lAte longer opening hours and services for NigHt weDNeSDAy SuRgeRy patients with disabilities and phobias. uNtil 8PM AND A SAtuRDAy It is planned that the new surgeries MoRNiNg oPeNiNg. ouR FiRSt will cover 3,000 new patients by 2010 week wAS Fully BookeD! ouR and that this will increase to 5,000 by PAtieNtS HAve welCoMeD tHe March 2011. New, CoNveNieNt tiMeS. We have enough dentists for all Mandy Walsh, Practice Manager at Bayswater Westminster residents to register and Medical Centre in Craven Road, W2 receive NHS dental care. For a list of dentists accepting new patients and clear guidance on charges visit, call freephone 0800 587 8818 or email Contents
  23. 23. 23 Our STrATeGIC FIVe-YeAr PLAN 4. ADDiNg life to yeArS Many people live with illness for a significant part of their lives. We are working to improve the quality of their life, as well as their lifespan, by tailoring care to their particular needs, preferences and expectations. Where possible, we also aim to keep patients out of hospital. Care pathways In 2008/09, we redesigned care pathways for clinical areas including musculoskeletal services, dermatology, gynaecology and ear nose and throat. The new pathways mean more services will be available in the community, as most of these services are currently provided in hospital. We are working to have care closer to home wherever possible. A wide range of local clinicians have been involved in developing the new pathways, including GPs, hospital consultants, nurses and physiotherapists. Local people were also asked their opinions and provided ideas and feedback into the project. The new pathways will be commissioned during 2009 and patients will be able to have specialist care at a clinic close to their home. Closer to home More health services are being provided at or near the home than ever before and people in Westminster have better access to high quality care. This particularly helps people with long-term conditions such as asthma and diabetes to stay healthy and independent for as long as possible. NHS Westminster will also be funding more staff to work in the community with increased community nursing, therapists and services to support people with mental health problems. Audrey Lewis, Clinical Lead for Healthy Choices/Obesity Contents
  24. 24. NhS WeStmiNSter ANNuAl report 08/09 i HAve A HeAltH ACtioN PlAN. People with learning disabilities now get to see it’S ABout HeAltHy eAtiNg AND their GP at least once a year for a health check – which includes everything from diet to sexual health exeRCiSe. HeAltH ACtioN PlANS and foot care. They then develop an individual ARe veRy iMPoRtANt iF you HAve health action plan, with their GP. A HeAltH PRoBleM. Patricia, Learning Disability Partnership Since the new service started, blood pressure Board member recordings have doubled from 41% to 82.5%. A new team has been formed to help patients These health checks have also given us vital public who have suffered a stroke to leave hospital earlier. health information that we use to improve other When they return home, they are supported by an services such as dentistry, sexual health and weight expert team taking hospital level care into management for people with learning disabilities. the community. Since the health checks started, referrals have increased almost tenfold. Patients have welcomed a new community blood clotting prevention service which gives them the opportunity to be treated locally – or at home if they are unable to make it to the local clinics. Learning disabilities NHS Westminster was praised by a national independent inquiry for good practice in providing health services for people with learning disabilities. (The Independent Inquiry into Access to Healthcare Matthew Morris and Dr Tom Mtandabar at a Health Check for People with Learning disabilities cited the Trust’s work in their report released on 29 July 2008.) Expert patients programme NHS Westminster has developed a unique service in This is a free, six week course giving you the conjunction with local GPs. This was developed after confidence, skills and knowledge to manage listening to local people with learning disabilities and your condition better, and reduce its impact on their carers, who said that better access to health your daily life. Courses are led by tutors living services was needed. with long term conditions themselves. we HAve DouBleD tHe tAke-uP Call our Patient Advice and Liaison Service oF RoutiNe HeAltH teStS (PALS) Freephone 0800 587 8818 or check FoR PeoPle witH leARNiNg our website for DiSABilitieS. more information. £3.6m £260,000 £540,000 £3.6m will be spent over three years £260,000 in a new community- £540,000 in a community-based in community nursing services based assessment and treatment podiatry service which will start in service for elderly patients 2009. More than 2,000 Westminster residents told us what they wanted from their local podiatry service Contents
  25. 25. 25 Our STrATeGIC FIVe-YeAr PLAN 5. promotiNg heAlthy lifeStyleS London welcomes the world to its Olympic Games in three years time, and we see our preparations for the Olympics as a major opportunity to promote the need for us all to make lifestyle changes that will improve our health and wellbeing. Preventing illness is one of our major priorities. It includes raising awareness of, as well as supporting, healthy lifestyles. There are six lifestyle areas we are concentrating on: 1. Healthy eating 2. Physical activity 3. Smoking 4. Sexual health 5. Substance misuse 6. Mental health and wellbeing KickStart – from strength to strength kiCkStARt HAS BeeN Kickstart helps children and families in Westminster adopt a healthier gReAt Not juSt FoR lifestyle. It’s a free 12-week after-school programme for children My SoN, But FoR tHe above their ideal weight, who are aged 7-12, and their families. wHole FAMily. Family-focused and hands on, the sessions are interactive and packed Westminster Dad, Moifak Dib with exciting activities including street dance, football and cooking. The programme, which has been running since 2006, has helped over 60 children and their parents lead healthier lives. It uses behavioural change strategies, healthy eating education and physical activity to help children and families get healthier. Drop in to Weigh In In Westminster local schemes give support to residents to make healthy lifestyle and food choices. Over 500 people have joined our ‘drop in to Weigh In’ scheme and lost hundreds of kilos. Our dieticians set up the free weight management service, to help people lose weight and increase their knowledge and understanding of healthy eating principles and a healthy lifestyle. Supporting people to stop smoking kiDS ARe HeAltHieR wHeN tHeiR HoMeS The Westminster Stop Smoking Service has helped just over 10,000 people quit smoking from 1 April 2003 – 31 March 2009. ARe SMokeFRee. Contents
  26. 26. NhS WeStmiNSter ANNuAl report 08/09 This year we focussed on the areas with the heaviest it iS vAluABle to See tHe smokers: Westbourne Park, Queens Park, Church DietiCiANS eACH week AND i eNjoy Street, Harrow road, Warwick, Tachbrook, Churchill MeetiNg otHeR PeoPle At tHe and Vincent Square. Local pharmacies saw a SeSSioN FoR eNCouRAgeMeNt 60% increase in referrals where one-on-one help AND SuPPoRt AND AM FeeliNg was available. HeAltHieR AS A ReSult. Now i Feel We have also been working to keep Westminster gooD ABout MySelF AND AM homes “Smokefree”. We know second hand smoke lookiNg FoRwARD to loSiNg can cause cancer. So, we want to give families MoRe iN 2009. in Westminster a reason to stop smoking around David Fearn their children. Our Smokefree project includes a community-led programme of education, a social marketing campaign, health promotion and a referral to a stop smoking service if required. Promoting Sexual Health We aim to reduce the levels of HIV and other sexually transmitted diseases, particularly in those people under 25. We are adding to our sexual health services and commissioning more community projects to engage with young people around sexual health. A significant element of this programme is our chlamydia screening programme. BY 2013 WE Will • ave less primary school-aged children H recorded as being obese – obesity levels for children rise sharply between starting primary school and beginning secondary school • ave less people admitted to hospital H because of harm caused by alcohol. There is growing concern about how many people need hospital care because of the effects of alcohol consumption 4 24% 500 Smokers are four times more likely of under-25s would not tell their More than 500 people have joined to quit with NHS support previous sexual partners that they our drop in to Weigh in scheme had chlamydia Contents
  27. 27. 27 i HAve FouND it AN exCelleNt wAy oF loSiNg weigHt AS it iS RelAxiNg AND tHeRe iS No PReSSuRe. i tHiNk oF it AS HeAltHy eAtiNg, Not DietiNg. i MADe CHANgeS to My eAtiNg wHiCH HAS MADe A ReAl DiFFeReNCe AND i Now Feel BetteR, i go tHe gyM AND CAN RuN to tHe BuS. tHe FACt it’S FRee iS AN ADDeD iNCeNtive. Brenda Smith, Drop in to Weigh In participant A Queens Park resident signing up to Smokefree Homes. Contents
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  29. 29. DiRECTORATE REviEWS Contents
  30. 30. NhS WeStmiNSter ANNuAl report 08/09 section dIreCTOrATe reVIeWS three 1. SerVice DeVelopmeNt Key achievements in 2008/09 Strategic and Joint Commissioning • We invested £1 million to reduce waiting times for planned care – and since July 2008, 95% of patients are now seen within 18 weeks • We redesigned care pathways to move more clinical services away from hospitals into the community to give patients care closer to home • We helped GP Practices review the services they offer to make them more accessible and convenient – with quicker and more proactive care. • We developed an electrocardiogram reporting service, a falls prevention clinic and an anticoagulation service • based on an assessment of health needs in Westminster, we ARe CReAtiNg joBS we developed new, three year commissioning strategies, that FoR loCAl PeoPle By bear in mind the needs of users, carers and the wider community eNCouRAgiNg ouR ReSiDeNtS to tRAiN • We received “beacon” status for our joint strategic commissioning, which means we have been recognised as AS PSyCHologiCAl delivering best practice, from the IdeA programme on behalf tHeRAPy woRkeRS. of the department for Communities and Local Government. We plan to share our experiences in 2009/10 • We developed a procurement policy and a procurement competition dispute resolution procedure for dealing with issues raised around individual tenders • Major re-commissioning programmes have been implemented or are in progress and include: the integration of drug and alcohol services; access to psychological therapies; new supported housing for people with learning disabilities; improved access to wheelchair services; and an overhaul of the chlamydia screening programme Contents
  31. 31. 31 • We are reviewing our contract portfolio to make services more personalised and to give new guidance on community health service and mental health contracting Mental Health • We invested an extra £1.4 million to improve the quality of care at the mental health in-patient wards at Gordon Hospital and the St Charles’ Mental Health unit, including putting more staff on the wards • We secured additional investment to improve access to psychological therapies by employing 14 low and high intensity, locally based, cognitive behavioural therapy workers. This means that more people get help for depression and anxiety when they need it • We commissioned a user-led website, which was conceived, implemented, led and maintained by service users, employs a website manager and a trained volunteer team. More than 200 people have visited the site each month since April 2008 • Westminster Forum, our local mental health user group, organised three Open Forum events and a user-led conference Learning Disabilities • We increased investment in learning disability services to support young people moving from children’s to adult’s services, and the resettlement of people from NHS campuses tHe Big PlAN outliNeS tHe joiNt CoMMiSSioNiNg StRAtegy FoR PeoPle witH leARNiNg DiSABilitieS oveR tHe Next tHRee yeARS. it CAN Be DowNloADeD FRoM tHe weStMiNSteR City CouNCil weBSite At: www.weStMiNSteR. Contents
  32. 32. NhS WeStmiNSter ANNuAl report 08/09 • As part of the local housing strategy for people Older People and Physical Disabilities with learning disabilities, seven new flats with on • A pilot scheme to support early discharge of site support have been opened. We are working stroke patients from hospital has been set up. with Westminster City Council to develop more This involves providing specialist multidisciplinary • Our locally enhanced service, to ensure people stroke rehabilitation and care in the home setting. with learning disabilities receive an annual health The team includes home support, physiotherapy assessment and health action plan, has been and voluntary sector services, providing return to acknowledged by the department of Health work support, re-training, vocational rehabilitation as an example of best practice and so on • We have invested in oral hygiene, healthy living, • Two hub projects, strategically attached to older health and fitness projects – and a liaison post peoples’ housing units, provide drop-in centres for at St Mary’s Hospital patients over 50 years of age – allowing them access to a range of services that help them stay • The Learning disability Partnership board well and independent at home had elections for positions that included video campaign addresses on the website. Over 100 • A new memory assessment service has been people voted commissioned as part of the development of New sexual health centre at 56 Dean Street Chelsea and Westminster Hospital NHS provides a full range of HIV and sexual health Foundation Trust opened a new state-of-the-art services and is even open during the evenings and HIV and sexual health centre in the heart of Soho on Saturdays. It has proved popular with patients in March 2009. 56 dean Street, which replaced - 23% more people used services at 56 dean the Trust’s Victoria Clinic at the South Westminster Street in the 4 months from 2 March - 31 July Centre, has been designed to be welcoming and compared with the same period last year at the friendly, with a social, rather than clinical, feel. It Victoria Clinic. Contents
  33. 33. 33 a dementia strategy. This service will ensure good or have children; and continue to have services in quality diagnosis and intervention for all, with easy, place to meet people’s needs around housing, direct access to services welfare benefits and debt advice • A survey was introduced to obtain patient Substance Misuse feedback on their experience of using major home adaptations and community equipment. It is • We are on target to increase by 3% the numbers influencing the way local services are developed of drug users receiving treatment • At the Physical disabilities and Sensory Needs • An additional three hostels offering services were Strategy stakeholder event, the aims and priorities established in 2008/09 of the strategy for the next three years were agreed • We have commissioned two new services to by service users, carers and group members improve the general health and well being of substance misusers HIV and Sexual Health • A joint pilot project to develop a comprehensive • We commissioned a range of services to screen package of testing and support in Westminster to 15-24 year olds in Westminster for chlamydia offer dry blood spot testing was successful. It will which included screening in sexual health centres, be mainstreamed in 2009/2010 and focus on GP and pharmacy services, outreach in community improving pathways into secondary care for and social services, the substance mis-users who test positive for website and marketing campaigns hepatitis C and HIV 16 to 24-yeAR-olDS iN weSt • We increased the provision and availability of loNDoN CAN get A FRee alcohol services in Accident and emergency CHlAMyDiA teSt FRoM (A&e), which increased the number of referrals from 848 in 2007/08 to 956 in 2008/09 Blood Borne Viruses • We currently have the third largest HIV positive population in London. So, in partnership with • From just two testing sessions in 2007/08 the Westminster City Council, we carried out an HIV service has expanded to coverage across the city needs assessment to ensure we have the right five days a week in 2008/09. Over 500 patients services in place by April 2010. We’re aiming to have been tested for blood borne viruses make HIV testing more accessible – in primary • The project has been endorsed by the National care, out-patient services, and community and Treatment Agency as an example of best practice social venues; provide support to people at times in terms of harm reduction of need, such as when they are first diagnosed, start treatment, are entering a new relationship Contents
  34. 34. NhS WeStmiNSter ANNuAl report 08/09 Alcohol and Accident & Emergency Community Pharmacy • We commission two posts based in Accident With the Community Pharmacy Advisor, we have & emergency who offer brief interventions and commissioned a range of new services to be referrals into specialist alcohol services in their delivered through local pharmacies. These include: borough of residence. The service is embedded as • stop smoking services part of the core staff team which is part of the reason it has been successful • flu vaccinations • chlamydia screenings Dentistry • medicine usage reviews • We have designed a new, quality focused, service specification to procure two new dental practices • emergency hormonal contraception • Working with our current practices, we’ve • minor ailments increased provision and improved access to • supervised consumption and needle exchange already established practices Following the 2007/08 pilot, this year we • We have implemented a communication strategy implemented the flu vaccination service in pharmacies to give local people information about good oral and increased the numbers of patients vaccinated health and where to find services there from 412 to 946 – an increase of over 100%. • We’ve also funded digital signage in 11 local practices to inform patients about their entitlement to care, costs and to promote oral health. The digital screens will also display other healthcare messages and we aim to install the same equipment in further practices Contents