Ruislip Residents' Association

Hillingdon Clinical Commissioning Group

NHS Hillingdon was abolished on 1st April 2013, when Hillingdon Clinical Commissioning Group became responsible for commissioning NHS services for Hillingdon residents.  Hillingdon Health and Wellbeing Board also became responsible for setting the strategy for Hillingdon's NHS services and for integration of health and social services.


1. Mental Health Priority Setting:

The “Five Year Forward” view requires parity of esteem for mental and physical healthcare.  In 2015/16 Hillingdon CCG increased funding for mental health services by 7.8%.  To achieve parity with physical health services in 2016/17, this CCG will need to invest an additional £1m in mental health services.  Implementation of plans drawn up last year will be treated as a priority including projects that focus on dementia, urgent care, perinatal care, learning disabilities and the mental health needs of children and young people.


2. Accident and Emergency Remedial Action Plan for Hillingdon Hospital: Attendances have increased by 9% and blue-light ambulance attendances also by 9%, with other ambulance attendances up by 7.7%.  Difficulty in achieving the four hour waiting target has been addressed jointly by the hospital and the CCG with the following introductions:
  • Early senior consultant assessment
  • Two new triage rooms.
  • Additional Clinical Decision Unit beds are being considered
  • A longer term solution is proposed in the Shaping a Healthier Future business case, which would allow the department to see 220 patients per day.
3. North West London collaborative plans:
The focus is on:
  • New models of proactive and co-ordinated care, including out-of-hours care
  • Intensive support for self care
  • Social factors including housing, employment and isolation
  • Rapid response and intermediate care
  • Reductions in acute care and better hospital discharge arrangements.
4. London Ambulance Service  response times:
Targets are not yet being met, but a successful recruitment drive has brought staffing up to full numbers and improved funding from CCGs is allowing implementation of the CQC priorities.
5. Finance:
Overall at end of July, the CCG was achieving its year to date planned surplus of £1.2m and its £3.6m planned surplus by year end.  However, the CCG has fully deployed all its available reserves in both Programme and Running Costs, so it faces risks ahead without fall-back resources.
6. Sustainability and Transformation Plan (STP):
The STP describes the shared ambitions across health and local government for five years ahead.  The draft plan was submitted to NHS England as required on 30th June and the final plan, following local feedback, is expected to be submitted by  21st October.  This proposes a more proactive model of care which will reduce costs and be clinically and financially sustainable.  It has five themes:
  • upgrade prevention and wellbeing
  • eliminate unwarranted variation
  • achieve better experience for older people
  • improve outcomes for children and adults with mental health needs
  • ensure high quality sustainable acute services

Published on 05 September 2016


1.  Hillingdon Annual Health Conference:

This was held on 18th July at Brunel University.  After presentations from the CCG, hospital trusts and local services, residents and staff discussed local concerns, which the CCG will use to develop plans for 2017 -18, including:

  • Improving  access to GP surgeries.
  • Offer local services to avoid attendance at Urgent Care Centres and A&Es..
  • Improving care for older people to avoid hospital admittance.
  • Better care for children and parents to avoid use of urgent and emergency services.

2.  NHS England’s ratings of CCGs:

There were 5 assessments - well-led, delegated functions, finance, performance, planning.

Four ratings – outstanding, good, requires improvement and inadequate.

  • 10 CCGs were rated outstanding, 82 rated good and 91 required improvement
  • Hillingdon was rated good for “well-led”, “delegated functions” and “planning” but "require improvement" for "finance", "performance" and overall rating".
  • Hillingdon CCG is challenging these ratings with NHS England.

3.  Strategic Estates Development:

  • The outline business case for a “hub” in the north of the Borough is underway, with St Andrews Park development negotiations continuing.
  • Three bids have been submitted to NHS England for 2016 – 17:
  1. i.      Expansion of medical premises at Heathrow
  2. ii.     Expansion of premises for Yiewsley Family Practice
  3. iii.    Relocation of two other surgeries.

4. Health and Social Care in NW London:

The current pattern is not sustainable

  • Adults are not making healthy choices – 20% have a long term condition
  • Increased social isolation – 50% of people over 65 live alone
  • Poor children’s health – 1 in 5 children aged 4-5 are overweight
  • Unwarranted variation in clinical practice and outcomes – 30% of patients in acute hospitals should be treated elsewhere
  • Reduced life expectancy for mental health patients – 20 years below average
  • Lack of end of life care at home – 80% want this but only 22% die at home
  • Deficits in most NHS providers – 2021 expected gap in health and social care £1.3bn

5.  Mental Health Priority Setting 2016-17:

Achieving parity with physical health services, required in the Five Year Forward View, would need an additional £1m in Hillingdon on top of sums already agreed.  New models of care are being developed.  Work in 2015-16 with other NWL CCGs has increased collaboration and transparency across the crisis care system including the Single Point of Access implement by CNWL last November.


6.  Performance:

  • Many targets are met – diagnostic waits, cancer waits, referral to treatment times, etc.
  • Some targets are improving  - District Nursing referrals, NHS 111 waiting time, etc.
  • Some challenges remain – London Ambulance response times, A&E waits, etc.

7.  Finance:

At end of June the CCG  was on target to achieve its end of year planned surplus of £3.6m with an underlying exit position of break-even compared to its opening plan, £2.977m surplus


Published on 05 September 2016

Sustainability  & Transformation Plan (STP): This is the national and local NHS response to the Five Year Forward View.  Hillingdon CCG feeds into the North West London STP which sets out shared plans for the next five years. This sees 21% more activity leading to a requirement of net savings of £42.5m, based on a projected Hillingdon population in 2020 / 21 of 321,000 with about 20% of children (11,8000) living in poverty.  Excess weight is a growing threat to good health – currently 21% of 4 / 5 year olds are overweight as are 32.6% of those aged 10 to 11 years.

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 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.

Paediatric Services at Ealing Hospital: 25% of these services are moving off site to other local hospitals including THH, but 75% of services will remain on the Ealing site.

Better Care Fund: Progress continued.  In 2015/16 there were 10,406 emergency admissions to hospital of patients aged 65+years, 5% fewer than the previous year and better than target, but 763 falls related to emergency admissions slightly exceeded the target.  The 4,196 delayed transfers of care were better than the 4,790 target and the 145 permanent admissions to care homes was below the ceiling of 150.

NHS RightCare: This is a joint initiative between NHS England and Public Health England.  Harrow and Brent CCGs have been selected as Wave 1 of the programme and other CCGs, including Hllingdon, are part of Wave 2, which will start towards the end of 2016.  However Brent, Harrow and Hillingdon CCGs have agreed to work together with workshops on diabetes and muculo-skeletal problems in June and July 2016, followed by workshops on respiratory and cancer care in September 2016.

London Ambulance Service: Targets are still being missed with staff sickness levels high and staffing levels too low to meet demand.  Increased use of non-ambulance responses (Hear and Treat, taxis) for non-critical patients continues to improve..

NHS 111: The rate of call back is reported as above target due to higher than planned absence and on-going shortage of clinical staff.  Recruitment is underway.  Both call handling time and the number of staff on rotas have been increased.

Finance: Overall at end of May the CCG achieved its planned year to date surplus of £0.6m and it was on target to achieve its planned £3.6m planned surplus by year end.

Published on 27 July 2016

Sustainability  & Transformation Plan (STP): This is the national and local NHS response to the Five Year Forward View.  Hillingdon CCG feeds into the North West London STP which sets out shared plans for the next five years. This sees 21% more activity leading to a requirement of net savings of £42.5m, based on a projected Hillingdon population in 2020 / 21 of 321,000 with about 20% of children (11,8000) living in poverty.  Excess weight is a growing threat to good health – currently 21% of 4 / 5 year olds are overweight, as are 32.6% of those aged 10 to 11 years.

Paediatric Services at Ealing Hospital: 25% of these services are moving off site to other local hospitals including THH, but 75% of services will remain on the Ealing site.

Better Care Fund: Progress continued.  In 2015/16 there were 10,406 emergency admissions to hospital of patients aged 65+years, 5% fewer than the previous year and better than target, but 763 falls related to emergency admissions slightly exceeded the target. The 4,196 delayed transfers of care were better than the 4,790 target and the 145 permanent admissions to care homes was below the ceiling of 150.

NHS RightCare: This is a joint initiative between NHS England and Public Health England.  Harrow and Brent CCGs have been selected as Wave 1 of the programme and other CCGs including Hllingdon are part of Wave 2 which will start towards the end of 2016.  However Brent Harrow and Hillingdon CCGs have agreed to work together with workshops on diabetes and muculo-skeletal problems in June and July 2016 followed by workshops on respiratory and cancer care in September 2016.

London Ambulance Service: Targets are still being missed with staff sickness levels high and staffing levels too low to meet demand.  Increased use of non-ambulance responses (Hear and Treat, taxis) for non-critical patients continues to improve..

NHS 111: The rate of call back is reported as above target due to higher than planned absence and on-going shortage of clinical staff.  Recruitment is underway.  Both call handling time and the number of staff on rotas have been increased.

Finance: Overall at end of May the CCG achieved its planned year to date surplus of £0.6m and it was on target to achieve its planned £3.6m planned surplus by year end.

First published on 05 July 2016.  Last updated on 17 July 2016

1.  New Chief Operating Officer: Caroline Morison was present at her first Hillingdon CCG Board Meeting in public.  She formerly worked for the NW London Collaboration of CCGs.

2. Contract update: All thirteen key NW London in sector provider contracts have now been signed, including the Hillingdon Hospitals contract, CNWL mental health and community health contracts and Royal Brompton and Harefield contract.

3. Better Care Fund: Hillingdon CCG and the London Borough of Hillingdon have approved the 2016-17 Better Care Fund, valued at £20.15m.  The plan supports work to anticipate need rather than respond to crisis management. Specific initiatives include identification of people susceptible to falls, dementia, stroke, and social isolation, better care at end of life, reduced delays in hospital discharge and support for carers.

4. Hub development: The Mount Vernon Hospital master planning exercise has identified a potential site for the North Hillingdon Hub, which is expected to be presented on 21st June 2016.  NHS Property Services Ltd is negotiating commercial terms with the St Andrews Park developer to secure a site for the Uxbridge and West Drayton Hub towards the north of the development site, with the expectation of submitting a planning application in early 2017.

5. Kirk House: Following the move of the CCG from Kirk House in West Drayton to Boundary House in central Uxbridge, the CCG has carried the cost of its space in Kirk House.  CNWL, another tenant of Kirk House, has now indicated that it wishes to take over the full lease of that building.

6. Urgent and Emergency Care: The current model is still evolving but it appears that the NHS 111 service will be procured at NWL level and will provide a non-clinical telephone triage service, possibly from July 2017, but probably later.  GP Out of Hours Services will be provided by Care UK, located at Hillingdon Hospital, which will provide an Advice Line and Home Visiting Service.

7. London Ambulance Service: In March LAS again failed to meet its targets for responding to major calls.  Staffing has been the main issue plus higher demand than contract and high levels of vehicle downtime.  LAS has recruited to full establishment but some overseas staff have not yet arrived..

8. Joint A&E Recovery Plan: The CCG has provided Hillingdon Hospitals FT with £2.1m of Resilience Funding to support improvements in Hillingdon Hospital’s A&E Department and has also invested in additional schemes with the Urgent Care Centre and Central & North West London FT to support performance improvement around Unplanned Care in Hillingdon.
First published on 05 July 2016.  Last updated on 14 July 2016

1. Chief Operating Officer: Ceri Jacob has now left. Joan Vesey is covering this vacancy.
2. Hillingdon Better Care Fund:
  • Funding: The Council’s minimum capital contribution in 2016-17 for Disabled Facilities Grants is £3.457m, but the Council is proposing a further £1.152m, which was approved by the Health and Wellbeing Board in April. The minimum CCG contribution is £16.558m.
Integration of Health and Social Care: Full integration is planned by 2020. Hillingdon’s Accountable Care Partnership (ACP) was agreed in 2015-16. It will initially apply to older people with long term conditions, but will progress to cover all older people and other population groups with long term conditions. Shadow services will be provided in 2016. By 2019-20 the model of care is expected to include:
  1. Early identification of susceptibility to disease with a focus on prevention.
  2. Residents and carers actively involved in care planning.
  3. Hillingdon Hospital admission only when acutely ill, with shorter stays.
  4. Fewer people living in residential care.
  5. Initiatives to encourage older people to be mentally and physically active.
  6. 3. Out of Hospital Seven Day Working Standard Action Plan 2016-17: This includes:
  • Clinical community health support in place prior to discharge: Ensure District Nurse/Community Matron involvement pre-discharge for high risk patients 7–days per week.
  • Social care support at Hillingdon Hospital: Ensure this is available 7-days per week.
  • Nursing Home admissions: Ensure admissions are possible 7-days per week.
  • Sufficient transport: Ensure sufficient capacity to support discharges 7-days per week.
4. Delayed Transfers of Care Action Plan 2016-17: This includes:
  • Development of a joint discharge policy / procedure: Clarity about all roles involved.
  • Timely ordering of community equipment: So that it is available on discharge
    • Psychiatric Service involvement: Ensure mental health needs are met.
    • Develop palliative homecare and hospice provision: For patients who are dying.
5. Care plans for people with learning disabilities, autism or challenging behaviour: Transitional costs of developing community services and close inpatient provision over the next three years for these patient groups is to be supported nationally by NHS England with £15m capital funding plus other funding conditional on matched funding from local commissioners.
6. Seven Day Services: As one of the “early adopter” areas, NW London acute trusts have agreed to deliver four Clinical Standards by April 2017 for 100% of the population.
  • 24/7 access to specific interventions including: Critical care, emergency general surgery, thrombolysis, urgent radiotherapy, and other services
  • Radiology / diagnostics: Imaging in-patients within 24 hours and other services.
    • Discharge improvement: Use of a single NWL–wide discharge assessment form and other improvements.
    • Inpatient Model of Care: Development of evidenced based models of care including consultant  requirements.

NB Increased weekend access in Primary Care has previously proven to be of low value.

7. Community Learning Disability Service: The national drive to halve the number of inpatient beds for this group of patients goes in hand with expectation of increase community provisions, which is supported by national funding, but also requires considerable, probably matched, commissioner funding. Full details are awaited.
8. CCG Improvement and Assessment Framework 2016-17: These NHS England initial ratings on cancer, dementia, diabetes, mental health, learning disabilities and maternity care will be published on-line from June 2016 with an annual assessment in June 2017.
First published on 18 May 2016.  Last updated on 28 May 2016

1. Quality, Innovation, Productivity and Prevention programme (QIPP):

The current QIPP projections are that the CCG needs to realise around £50m over the next five years.  The challenge for 2016-17 is £10.5m.

Currently the CCG has schemes to realise £8.6m, but some schemes have high failure risk.  The biggest gaps are in long term conditions, mental health and out of hospital care.

To put this challenge in context, it is possible that within 5 years the CCG could be facing 20% more demand with a 20% gap in its funding.


2. Financial Plan 2016/17:

A plan has been submitted to NHS England for a surplus of 1% (around £3.6m).  This is despite expecting a reduction of £5.3m in its NWL Strategy funding and being expected to contribute its full 2.5% share to the other NWL Strategy and Saving a Healthier Future workstreams (£8.6m in 16/17 compared to £1.5m in 15/16).

In addition, in line with current NHSE guidance, the CCG is required to retain 1% of its funding as uncommitted at the planning stage in 16/17 (£3.4m) in addition to the usual 0.5% contingency (£1.8m).

3. Finance Report to end of February 2016:

The year to date surplus was £6.858m, £3.666m ahead of plan.  The revised year end forecast is a surplus of £7.482m.


4. Community Dermatology Service:

In 2015/16 the CCG appointed Concordia to run this service, but activity was below the expected level and there are now revisions for 2016/17 to reduce cost and waiting times and to introduce Patch Testing and support for Acne, which were not included originally.

5. Termination of Pregnancy Service:

The current service commissioned by Hammersmith and Fulham for NW London CCGs is to be extended by one year to allow time for review.

6. Children’s and Adolescents’ Mental Health Services: There is a risk of poor access to these services due to lack of investment and there are difficulties in recruiting and retaining staff.  CNWL CAMHS is able to meet the waiting time targets for urgent and emergency referrals, but not for routine.  The demand for these services has increased year on year, therefore any additional funding to reduce waiting times has not had a sustainable impact.

A significant increase in incidences of self harm adds pressure to the system.  There are long waiting lists for assessment and treatment, with poor educational and health outcomes as a result of lack of early intervention.



7. January 2016 Integrated Performance:

The four hour target for A&E patients to be admitted or discharged within 4 hours was not met, nor the 31 day treatment standard for radiotherapy, nor some mental health or community service targets.  London Ambulance Service again did not meet its targets for response to major calls within 8 minutes.

First published on 06 April 2016.  Last updated on 19 April 2016

  1. CCG Elections: Every year three GPs stand down from the Governing Body, one from each locality.  This year the three are Dr Goodman (North Locality), Dr Garsin (Uxbridge and West Drayton Locality) and Dr Gudi (South Locality) but  they are entitled to re-stand if nominated, for election to take effecto on 1st April 2016.

  1. Finance: At month 9, December 2015, the CCG achieved its year to date planned surplus of £2.611m  and it was forecasting a revised surplus of £7.482m by year end, which was £4m above plan - £0.457m surplus above plan on running costs and an anticipated £3.543m above plan on programme costs., which will be carried forward into 2016/17.

  1. 3. Mental Health Services November 2015:
  • Difficulties in finding placements for patients led to delayed transfers of care from acute beds.
  • Children and adolescent mental health services experienced an increase in referrals, which led to pressures on waiting times.  Capacity is being addressed through a recruitment plan, following agreement on additional funding.  An early / late appointment system is being implemented, with users  being made aware of appointments available outside 9am – 5pm.


  1. A&E Services: Neither Hillingdon nor Northwick Park hospitals achieved the target to admit or treat and discharge 95% of patients within four hours in November 2015.  Northwick Park Hospital opened 48 additional beds on 18th January, which were originally planned to open in November. At Hillingdon Hospital an additional medical consultant is now on site in A&E 12 hours a day over weekends, to help expedite discharge and free up bed capacity.  The discharge lounge assists wards to discharge patients earlier in the day.


  1. London Ambulance Service: Again in November LAS did not reach its targets for reaching even its most seriously ill patients. Commissioners have agreed additional funding for LAS to help it improve its standards, along with a number of action by LAS itself to improve its performance.


  1. Maternity Services at Hillingdon Hospital: The number of deliveries per month is expected to stabilise when the mothers who have transferred from Ealing Hospital have delivered their babies. The Trust will then be able to build a business case for the recruitment of more midwives, based on firm numbers, but this will take time.


  1. Caesarean births: The Trust has reduced its elective caesarean rate to 8.1%, which is the lowest rate in North West London, but its rate for emergency caesarean births has increased to 20.8%.


Published on 10 February 2016
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