Over time, this page will contain information about the range of services provided by the NHS in the community, including ambulances and GP surgeries.
Many community services were provided by Hillingdon Community Health until it merged with Central & North West London Foundation Trust on 1st February 2011.
As a result of that merger CNWL is now responsible for both its traditional role, provision of mental health services, and the provision of community services such as clinics and home nursing services. Its Board Meetings will be shown on our CNWL page, but occasionally community items wil also be noted here.
Other community items originate in Board Meetings of Hillingdon Clinical Commissioning Group, Hillingdon Health and Wellbeing Board and The Hillingdon Hospitals NHS Foundation Trust, where they may be reported more fully. All NHS bodies integrate their services where possible.
From Board Meeting of Hillingdon Clinical Commissioning Group 1st July 2016:
Central & North West London FT’s contract for community care: As part of the three year contract with CNWL savings of £1.25m have been agreed. Any changes must not cause excessive hardship to patients such as increased excessive increases in travel times or costs, but it is acceptable for waiting times to be increased for services where there is no safety risk or risk of breaching contractual or mandatory targets. Site consolidation is to be expected. Savings cannot be achieved without some disruption and the CCG will need to support decisions that may be unpopular.
Business case for Paediatric Services: Hillingdon’s child population is expected to increase from 76,000 to 88,000 by 2022 against a background of Hillingdon Hospital becoming a major acute hospital for most specialist services, closure of Ealing Hospital’s maternity services and both its in-patient and emergency paediatric services, and recruitment challenges for paediatric medical staff both nationally and locally. Extensive recruitment attempts by THH for paediatric staff have been unsuccessful. The CCG has agreed to fund a consultant led service to provide improved staff training, access for GPs to 24 hour seven day telephone advice and development of new models of care for Critical Care as well as Integrated Community Clinics, with sufficient capacity to provide 24 hour seven day services. These improvements will be delivered in three phases.
Hillingdon GPs work under one of three different contracts.
- General Medical Services (GMS): Most work under this nationally negotiated contract.
- Personal Medical Services (PMS): 10 work under this locally negotiated contract with premium funding to support specific service initiatives.
- Alternative Provider Medical Services (APMS): One such contract is held in Hillingdon. This is locally negotiated and can be held by a non-GP who employs salaried GPs.
- The high number of frontline vacancies in the Service
- Its low staff levels, exacerbated by inappropriate staff training
- Its demoralised and stressed staff, including bullying and harassment
- Its lack of senior staff supervision
- Its failure to meet response target times.
c. Support for GP Networks: The Business Case for GP Networks proposes £333k in 2015-16 for clinical, administrative and business manager support in 2015-16, shared between networks on a capitation basis.
d. Wheelchair service: The CCG is procuring a new Wheelchair Service which will hold agreed levels of stock with each acute trust and other key providers for short-term loan of wheelchairs
e. Community bed based provision for 2015-16: The proposal is to “block” book 5 nursing and nursing/dementia care beds from suitable care home providers for patients who need a bed based service
Hillingdon Carers' Fair is on Tuesday 9th June 2015 in the Pavilions Shopping Centre, Uxbridge, from 10am - 4pm.
This is part of the National Carers' Week, which is called "Building carer friendly communities", which runs from 8th to 14th June.
At the Hillingdon Fair there will be information and advice about carer-related support available in Hillingdon.
a. Dr Morgan started by affirming that it is possible to live well despite a diagnosis of dementia.
b. Dr Morgan then presented an overview of dementia, noting that it refers to disorders of cognition, including a decline in memory and orientation of time and space, as well as difficulties with planning, organisation, problem solving, and language. These symptoms are caused by loss of nerve cells due to disease, for which there may be more than 100 causes.
c. Dementia is very common and is experienced by 5% of those over 65 years and by 20% of people over 80 years. There are 812,000 cases in the UK, with several subtypes: Alzheimer's Disease - 62%, Vascular dementia - 18%, Mixed dementia – 10%, Dementia with Lewy Bodies - 5%, Other dementia including fronto-temporal dementia - 5%
d. Alzheimers disease has an insidious onset followed by progressive decline in cognition, which begins with short term memory problems and difficulty with language, recognition, and daily tasks. The brain changes, suffering atrophy and the development of plaques and tangles.
e. Vascular dementia has a variety of causes, an abrupt onset and stepwise deterioration, with a fluctuating course. Deficits may be patchy, with better insight, but more emotional symptoms.
f. Dementia with Lewy Bodies usually involves memory loss, problems with attention span, and Parkinsonian symptoms such as tremor, slowness, muscle stiffness, also visual hallucinations, fainting fits and “funny turns”.
g. Fronto-temporal dementia may start younger, with memory intact but with personality and behaviour changes, early loss of insight, loss of the capacity to empathise, and communication difficulties.
h. Some dementias can be treated, particularly those due to vitamin B1 or B12 deficiency, infections such as syphilis, endocrine abnormalities e.g. hypothyroidism, brain tumours e.g. meningiomas, normal pressure hydrocephalus, and injury with subdural haematoma (collection of blood).
i. The national agenda is led by NICE. There have been various national initiatives - Supporting people with dementia and their carers in health and social care. (2006); National dementia strategy (2009): National Dementia Declaration (2010) and the Dementia Action Alliance: Prime Minister's Challenge (2012): NICE quality standards – supporting people to live well with dementia (2013).
j. Dementia care in the community occurs in many settings, based on person centred care, targeted prevention programmes, early diagnosis and early treatment. Shared care practice involves supporting carers, supporting patient autonomy and independence, and managing crises. The cost of dementia care is very great, largely provided by families and friends. Two thirds of dementia sufferers live in their own homes and one third live alone, which brings the risk of isolation or abuse. Two thirds of people in care homes have dementia. Memory assessment services are increasingly community based and in some areas are moving more into primary care settings.
k. The NICE aim is for people to manage their own support as much as they wish, so that they are in control of what, how and when support is delivered to match their needs.
l. To prevent dementia, some risk factors can be controlled - high blood pressure, high cholesterol (hypercholesterolemia), diabetes, smoking, heavy alcohol use, physical inactivity. Other protective factors include educational attainment, improved workplace health in mid-life, supportive social interactions and lifelong learning and stimulation in later life, as well as care from services, carers and families. Action to tackle the social, economic, and environmental factors is important too.
m. Currently only 44% of dementia sufferers are diagnosed but diagnosis is important for patients, their families and carers, because it facilitates better understanding, improves access to medication, information and support, and allows better planning for future care. NHS England has prioritised dementia and aims to increase diagnosis to 60% of sufferers.
n. Basic dementia screening is completed in primary care with routine haematology, biochemistry tests (electrolytes, calcium, glucose, renal and liver function), thyroid function tests, serum vitamin B12 and folate level tests. Early referral to memory services is helpful. There are newly commissioned services in Hillingdon and Harrow. Medication is initiated by a specialist but most people then no longer require specialist input, so they are discharged back to primary care for community support.
o. In UK there are 670,000 carers of people with dementia. Families provide the majority of care, which is tiring and stressful, physically, emotionally and financially. This saves the UK over £8 billion a year. Carers should have early access to community based assessments, information and support groups and access to respite care to reduces the carer’s burden and distress.
p. Decisions must be taken about dementia patients continuing to drive, about arranging Power of Attorney and advanced directives to invoke later if needed, and about end of life care. Dr Morgan answered questions, assisted by Phil Bolland. Some audience concerns related to crisis support by CNWL but other concerns related to Social Services’ issues.
The speakers were thanked by Neville Hughes, who also praised the excellent CNWL carers’ course, from which he had benefitted, but then noted his long campaign to combat the lack of Admiral nurses in Harrow. His thanks to the speakers were endorsed by audience applause as the speakers left the hall.
The Hawthorn Intermediate Care Unit was opened on 29th January 2014 in the Woodlands Centre, on the Hillingdon Hospital site. It is administered by Central & North West London Foundation Trust (CNWL), which is responsible for the services of Hillingdon Community Health (HCH).
The Unit has an interesting history. In 2005 the last patients of the Northwood and Pinner Community Hospital were moved to the Northwood and Pinner Community Unit in Mount Vernon Hospital, for the patients' safety. The Mount Vernon accommodation was recognised as old fashioned, with limited space and facilities but the move there was expected to be only temporary. The Community Voice accepted the need to move the patients, but continually pressed for the Northwood and Pinner Hospital site to serve the local community, in accord with its original purpose as a war memorial to local citizens who died in the 1914-18 war - that fight is still ongoing.
At Mount Vernon the Unit was initially administered by Hillingdon Primary Care Trust, but that responsibility passed first to HCH and then to CNWL. Despite sterling effort by those organisations to improve the facilities - and huge fund raising by the Friends of Northwood and Pinner Unit to provide additional comforts - it was impossible to bring the Unit to modern standards. Now CNWL has moved the Unit into its Woodlands Centre on the Hillingdon Hospital site, where the accommodation is splendid! The Community Voice is saddened that the Northwood and Pinner link is broken - but it rejoices in the new facilities that are now available to the patients of today and tomorrow.Those gathered for the launch of the Hawthorn Intermediate Care Unit were addressed by the new CNWL Chair, Professor Dorothy Griffiths. She noted that this Unit is a model of integrated care - the nurse-led unit is run by HCH, medical care is provided by the Care of the Elderly team from the adjacent Hillingdon Hospital NHS FT, and mental health services are available from other units within the Woodlands Centre. The opening ceremony was performed by the Mayor of Hillingdon, Cllr. Allan Kauffman.
This Unit's 22 beds provide state of the art facilites for rehabilitation, including an onsite gym and an activity kitchen.