NHS Westminster Annual Report Highlights Health Improvements

NHS Westminster
Annual Report
www.westminster.nhs.uk

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

NhS WeStmiNSter ANNuAl report 08/09 www.westminster.nhs.uk

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.

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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

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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

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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.
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Westminster for the last six years and
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the north, Queens Park in the
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• 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 www.westminster.nhs.uk for
wellbeing of our local residents. So we upcoming events, or call freephone
listen closely to what you have to say. 0800 587 8818.

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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

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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%).

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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

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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


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

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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

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www.westminster.nhs.uk

Contents

OUR
STRATEgiC
FivE-YEAR
plAN

Contents


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.

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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

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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

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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.

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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

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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


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 www.westminster.nhs.uk, call freephone 0800 587 8818 or email
pals@westminster-pct.nhs.uk.

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23

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


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 www.westminster.nhs.uk 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

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25

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


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

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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

DiRECTORATE
REviEWS

Contents


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

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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,
Go4mentalhealth.com 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.
gov.uk/wlDP/tHeBigPlAN

Contents


• 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.

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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 www.check-kit.org.uk
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
www.CHeCk-kit.oRg.uk 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


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

NHS Westminster Annual Report Highlights Health Improvements

NHS Westminster Annual Report Highlights Health Improvements

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