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.
Hillingdon CCG Board Meeting in public, 26th June 2014
NB Main points of interest from the Board’s papers, read on-line – not a summary of the meeting. The time of the meeting had been changed and representatives of Te community Voice, of which RRA is a member, missed most of the discussion. Many papers offered options for discussion.
Prime Minister’s Challenge Fund: North West London won a national pilot for some of the PM Challenge Fund money to support GP practices in developing new ways of working together. It is particularly earmarked for improving the IT infrastructure to promote more care across primary care network practices and to allow patients to book appointments online and to access their healthcare records.
St Andrews Development, Uxbridge: This expects a population of 1700 people. It will include a 77 bedded supported living unit. The Section 106 agreement includes provision of a small, single handed GP size building on the site, which is not what the CCG wanted – it had hoped to locate a “Hub” to support its out of hospital strategy and to accommodate the health needs of the new population.
Hillingdon CCG has therefore alerted NHS England Primary Care Team that there is potential for unmet need for primary care services in the locality, so that they can decide how to use the small plot available. This information has been shared with Council officers. A land search to identify a new hub site in the Uxbridge and West Drayton locality has been initiated. Early indications are that this will not be identified close enough to the St Andrews site to meet the needs of the new population.
Mental Health Projects: Two CCG workshops brought together GPs, practice managers, service providers, voluntary sector providers, patients and carers, leading to the outlines of three potential projects - the living well group, a peer support café and the ‘wishful thinking' project. A third workshop is planned.
Finance: The CCG anticipates an underlying deficit by the end of 2014/15 of possibly £17.2m.
Care for diabetic patients: Hillingdon CCG is providing additional training for local GPs and their practice nurses to enable practices to better manage their diabetic patients, reduce secondary care activity and when necessary to redirect care to the most appropriate provider. Upskilling practices will support the development of a network model for diabetes service delivery.
In the last 3 years there have been many significant advances in drug therapies that the practices may not feel confident in managing. Practices also need to be kept informed about fast moving research and development programmes to ensure patients receive the most efficient and optimal treatment. It is hoped that quality of care in practices across Hillingdon will be standardised, with improved diagnosis rates, earlier effective interventions to delay the onset of complications and a higher percentage of patients receiving all the care processes recommended by NICE. .
All patients should have management plans to support self-care.
The subsequent letter was personalised for each of the three CCGs - the version to the Chairman of Harrow CCG is attached. It was copied to seven local MPs and the three Healthwatch in Harrow, Hillingdon and Hertfordshire
NB Main points of interest from the papers for this Board Meeting – not a summary of the meeting.
1. Finance: The CCG’s end of 2013-14 deficit was £5.007m, better than plan by £7.243m.
2. Performance: The CCG is meeting its year to date targets except for ENT at NWLHT, plastic surgery at Royal Free Hospital, and MRSA (10 cases in year, against a zero target) .
3. Hillingdon CCG’s Out of Hospital Strategy: The system suffers growing pressures from population growth, health challenges, health inequalities and financial pressures. Three Hubs are envisaged to support the provision of increasing amounts of care in community settings. The Hesa site in Hayes Town is already being developed to support Hayes and Harlington. The St Andrews site in Uxbridge is planned for development in 2015-16. A North Hillingdon Hub is envisaged in 2018-19, with several possible options for the site, which will be reviewed nearer to the time of development.
An estimated increase in demand of about one third is expected in out of hospital care, compared with 2012-13 levels. Initiatives already under way include the 111 service, the UCC and the Rapid Response service but to provide an effective scale GP networks must be developed, as well as locality hubs. Ten GP premises need to be re-built or re-housed, at an estimated cost of £6.9m, and others need refurbishment. Some consolidation will be necessary.
4. Urgent Care Centre at Hillingdon Hospital: This has got off well in its first six months, treating on average 213 patients per day without referral to the Emergency Department, 62% of all patients to the site – above Commissioner expectations - and patient surveys show patient satisfaction too.
5. Care Homes: Hillingdon has 64 care homes with 1,200 beds, plus nine supported living units with 318 beds – more are planned to open this year. The CCG proposes to recruit two Community Specialist Nurses to support care homes in caring for residents, to avoid admissions to hospital.
6. Hillingdon’s 2012 Integrated Care Pilot: This focused on diabetes and people aged over 75 years – funded by NHS England from monies denied to hospitals where non-elective admissions rose above a marginal threshold. 85% of local GP practices have participated in the pilot. The focus has been on reducing falls, using care navigators to help people access care, providing psychological support to people with long-term conditions and improving self-care and medication optimisation. The patient survey shows very positive responses from patients.
7. Integrated care by health and social services: Two localities in the north of Hillingdon are working with THH, CNWL and voluntary sector providers, called Hillingdon 4 All, to develop proposals by mid-May for integration of care services.
8. Networking of GP practices: NW London has been awarded £5m from the Prime Minister’s Challenge Fund which will be matched by £5m from NWL CCGs and Health Education North West London, totalling £10m, non-recurrent, for networking of GPs across 39 GP networks and development of lay contribution to NHS service redesign. 48 Hillingdon GP practices are networked in six networks, at a cost this year of £441,240 which will be met by the Shaping a Healthier Future enabling fund. The two Hillingdon GP practices not currently networked can still opt in.
9. Yiewsley Health Centre: The current building is not fit for use. In 2010 Hillingdon PCT approved a full business case for a new health centre in Yiewsley, to house community services and three GP practices, to be built with money from sale of the current site plus Section 106 funding by Hillingdon Council, for lease to the NHS. Changes to rules about funds from sale of NHS land prevent implementation of that intention, leaving a financial gap. The problem is therefore back for review.
10. New home for Hillingdon CCG: Kirk House in Yiewsley, inherited from Hillingdon PCT, is geographically isolated, not on a tube line, with very limited parking and inadequate space which it shares with CNWL’s community services team. After comparing options it hopes to move to Boundary House, Uxbridge, immediately behind the Civic Centre.
11. Next Meeting: Friday 23rd May in Committee Room 4, Civic Centre, Uxbridge 12.30pm – 2pm
NB Points of interest – not a summary. We were not represented as the meeting time was changed.
1. Finance: Hillingdon CCG is now forecasting an end of year deficit of £5,250k which is £7m better than plan. Having now reached agreement with The Hillingdon Hospitals FT about additional costs related to winter pressures the CCG’s underlying deficit within the balanced plan is around £7m.
PCT legacy items, both continuing care retrospectives and other balances are now confirmed as remaining with NHS England. In 2013 /14 the CCG inherited an underlying deficit from the PCT and had an agreed deficit plan of £10.2m as part of a three year recovery plan to restore underlying financial balance. In December NHS England confirmed that Hillingdon CCG was assessed as 9% under its target allocation and as a result it has therefore received a larger than average increase in allocation in 2014 /15 and 2015 /16 of 4.3% and 4.0% respectively.
The allocations published in December 2013 for 14/15 are shown below:
2015 / 16
Per head £
Tariff prices for 2014 /15 include a cost uplift of 2.5%, the efficiency requirement of 4%, giving an overall reduction of 1.5%. The CCG plan for 2014 /15 includes repayment to Brent CCG of £2m.
Without help the 14 /15 financial plan would be a deficit of £25.8m, but the agreement of the North West London financial strategy would enable a balanced plan to be produced including a deficit of around £7m for this CCG.
2. Shaping a Healthier Future: Hubs are being developed to support the provision of increasing amounts of care in community settings. The business case for Hillingdon hubs will be presented to the April Board Meeting.
3. Meetings with MP: The Chairman and Chief Operating Officer met Nick Hurd MP to discuss a range of issues including the future of the Northwood and Pinner Cottage Hospital site.
4. Out of Hospital Strategy: Care pathways are now being implemented, including Gynaecology ENT and Urology. A pilot is underway to assess the use of Health Champions to improve the ability of patients and carers to care for their own long term conditions, starting with Diabetes, Asthma, and Chronic Obstructive Pulmonary Disease. Investment has also been approved for a Psychiatric Liaison Service across Brent, Harrow and Hillingdon CCGs, which will support psychiatric liaison in A&E.
5. Month 10 Integrated Performance Report: The CCG was not meeting the following year-to-date targets:
- Referral to treatment: 52 wait target or speciality standards, largely due to NWLHT problems
- MRSA: 10 cases, versus zero tolerance target
- Cancer: 62 days to treatment, marginally missed at 84.8%
6. Integrated care from health and social services: NHS England requires 5 year plans across a wider footprint than individual boroughs in recognition of shared providers across London, which will be submitted to NHS England on 4th April. The two year element is at local level – Hillingdon’s quality premium proposal is to reduce the number of admissions to acute care for people over 65 years as a result of a fall. It is estimated that a 15% reduction in fractured neck of femur cases would save over £126k in acute healthcare, £119k in social care and £220k in community healthcare.
7. Next Meeting: Friday 25th April in Committee Room 4, Civic Centre, Uxbridge 12.30pm – 2pm
1. Question on access for Hillingdon residents to the Paul Strickland Scanner Centre: This question was submitted by The community Voice too late for an answer to be available at the Board’s February meeting but a response will be given by the March meeting.
2. Shaping a Healthier Future: The first 'advertorial' has been published in the Hillingdon Gazette. It is planned that these articles will be published bi-monthly, with half the space devoted to updates on implementation of SaHF and the rest used by the CCG to provide updates on the Out of Hospital Strategy.
Julian Maw, of Harrow Healthwatch, and a delegate member of The Community Voice, has been selected as the new Chair of the Patient and Public Representative Group.
3. Finance: Overall, at month 10, the CCG is reporting a deficit of £5.2m, which is better than the planned deficit of £10.2m. The end of year forecast is now a deficit of £6.75m which is £5.5m better than plan.
4. Better Care Fund Draft Hillingdon Plan: By April 2014, Local Authorities and CCGs must jointly submit a plan to integrate health and social care services over the next five years, and for Hillingdon this will provide £17.99m from the Better Care Fund for 2015/16. However this is not new funding but comes from existing budgets of Hillingdon CCG and London Borough of Hillingdon.
The local focus will be on frail elderly people including dementia, 7-day services to support discharge from hospital and to prevent unnecessary admissions at weekends, better data sharing and joint assessments of care planning. Work will be aligned with other local work streams.
5. London Ambulance Service: In Month 9 There were 112 breaches of the waiting over 30 minutes standard at Hillingdon Hospital and 142 breaches at Northwick Park Hospital. Hillingdon also had six hand-overs waiting over an hour. The contract includes penalties of £200 per 30 minute breach and £1000 per 60 minute breach.
6. Dementia numbers: Hillingdon CCG has adopted a proxy indicator - the number of new patients referred to the Memory Assessment Service, instead of the numbers actually diagnosed with dementia. In year the target for newly diagnosed case has risen from 25 in April to 202 in November, but new referrals to the Memory Clinic have increased from 79 in April to 848 in November, giving a cumulative total of 1,278 for those diagnosed ( which is estimated to be 47% of the local prevalence).
Hillingdon Community Health, the responsibility of Central North West London FT, has a target for dementia assessment of 75% of its patients over 65 years, but it had achieved only 13.6% by December 2013.
7. 111 Services: Harmoni’s services in Brent, Ealing, Harrow and Hillingdon continued to perform above the contracted standards and national average for call handling and abandonment of calls. Call back rates fluctuated in December and Harmoni therefore reviewed its rota patterns for clinical staff.
Next Meeting: Friday 28th March in Committee Room 4, Civic Centre, Uxbridge
NB Points of particular interest – not a summary.
Finance: At month 9 the CCG is reporting a favourable variance of £5m actual deficit against £9.2m planned deficit. It is now forecasting an end of year deficit of £8.25m in 2013/14 which is £4m better than plan.
Appointment of Associate Lay Members: In its eight months of operation the CCG has had a high level of lay member engagement in various working groups and committees. It is now proposed that Hillingdon, Brent and Harrow CCGs share two associate lay members. As such associate members would not have statutory responsibilities it is proposed to reimburse them at 75% of the lay members’ rate - £7,500 pa rather than £10,000pa - which, anticipating 2.5 days per month on an annualised basis, amounts to a day rate of £250. This amounts to £15,000 pa shared between the three CCGs.
Hillingdon Urgent Care Centre: The new UCC at Hillingdon Hospital has been operational since 1st October 2013. In December it saw an average of 180 patients per day, which represents over 60% of the overall patient activity in the UCC and Hillingdon Emergency Department.
Now that the transitional phase is complete, the CCG will be working with the Urgent Care Centre to enhance referral pathways into community services such as Rapid Response and also to start redirecting routine primary care patients back to their own GP practices – helping patients to register with a GP when necessary.
Shaping a healthier future: The document “Better Care, Closer to Home” outlined the case for change in Hillingdon – that longer life expectancy, chronic disease and variability in patient experience make the current model of healthcare unsustainable.
There are growing health challenges. Hillingdon performs well on many health indicators but some of its rates are worse that the England average, notably diabetes, alcohol related harm, and tuberculosis. The number of residents over 75 years is expected to grow, with an increase in rates of dementia. There are also financial constraints, including a requirement for £55m savings by 2017/18, together with increased demands for 24/7 services. Variability in access and quality of care also needs to be addressed and it is recognised that increased demand with limited resources will increase this variability unless models of care are changed.
Various initiatives are being developed to meet these challenges including the Urgent Care Centre at Hillingdon Hospital, redesigned care pathways, a peer review programme for a consistent approach to referrals, case management by community nurses, a broader remit for the Rapid Response Team and an improved supported discharge service across Hillingdon.
Creation of a Hub at Hesa Health Centre: The CCG has identified the Hesa Health Centre in Hayes Town as a Hub to support the delivery of its out of hospital strategy. A lease for the former post office adjacent to the health centre was secured some years ago together with capital funding from NHS London but a number of delays have occurred. The project has passed to NHS Property Services, which is now in a position to enter into a contract to proceed with the necessary work to extend the health centre. The work is expected to take ten months, but the health centre will remain operational while the work is underway.
The Hesa Health Centre currently accommodates two GP practices and community services. The planned extension will provide additional accommodation for community services and out of hospital services. The work will cost £990,477 plus VAT and will create an additional revenue cost of between £85k and £95k per annum.
1. Withdrawal of Ealing CCG from the Outer NW London Group of CCGs:
Ealing CCG will move to the Inner NW London Cluster on 1st December. The withdrawal negotiations have protected the remaining CCGs in the Outer Cluster – Brent, Harrow and Hillingdon – from the adverse effects that were feared.
2. Hillingdon CCG finances:
- At month 7, the CCG achieved a positive variance of £2,704k for year to date against the agreed deficit plan.
- The 2013-14 forecast deficit is now £8,250k, which is better than plan by £4m.
- In view of the improved financial situation, the CCG has developed proposals to invest around £1m in respect of winter pressures and other forward plans.
2. Performance in September 2013:
- 18 Weeks Referral to Treatment (RTT), targets: This target was missed due to poor waiting list management at North West London Hospitals, and two patients waited over a year at University College London, but they have now been treated.
- London Ambulance Service: There were breaches to the 30 minute handover targets, 45 at Northwick Park and 46 at Hillingdon Hospital.
3. Communication with the public: Members of the public are encouraged to provide appropriate comments and recommendations on the Trust’s performance by writing to the Chief Operating Officer. Documents will be published on the CCG’s website as a matter of public record and to enable patients, carers and partners to comment
4. Hillingdon Urgent Care Centre:
- The UCC saw and discharged a total of 5155 patients in October, its first month of operation, an average of 166 patients a day. This compares well with the previous service that saw and discharged an average of 74 patients a day in September. On four days in October the UCC achieved or exceeded the target performance of 188 patients a day – which was not expected to achieve until January 2014.
- Only 7 of the 5155 patients breached the four hour target waiting time – 99.88% met the target.
- An average of 21 patients a day were transferred to the Emergency Department, some of these within 2- 3 minutes of arrival, some following triage and assessment within one hour, and some with two hours. The UCC is on target to achieve the planning assumptions and targets for transfers to the Emergency Department.
- In October a total of 480 patients were referred onwards to a specialty department for specialty care, which is broadly in line with planning assumptions and will change as specific pathways between services are developed and implemented.
- In the first month of operation,150 patients were redirected into primary care services.
- The UCC does not yet see children aged below six months, but will do so after the transition phase.
- Monthly performance meetings have been established between the UCC and Hillingdon CCG. The UCC provider will submit the first detailed performance report in November.
NB Points of particular interest – not a summary
1. Hillingdon CCG finances:
- At month 6 the CCG achieved a positive variance for year to date against the agreed deficit plan.
- The 2013-14 forecast deficit is now £10.25m, which is better than plan by £2m.
2. Performance in August 2013:
- 18 Weeks Referral to Treatment (RTT), targets missed: Problems have arisen due to poor waiting list management at North West London Hospitals and backlog in Plastic Surgery at the Royal Free Hospital
- London Ambulance Service: There were breaches to the 30 minute handover targets, 24 at Northwick Park and 89 at Hillingdon Hospital.
- Hillingdon CCG’s response to target breaches: Contract penalties will be applied eg £5k for each RTT breach, £0.2k for a 30 minutes handover breach and £1k for a 60 minutes breach. Root cause analysis, exception reports and action plans are required where breaches occur.
- 3. Hillingdon Urgent Care Centre:
- The new service went live on 1st October and has been performing well.
- The UCC has seen around 192 patients per day (compared to an average of 74 in September)
- An average of 24 patients a day have been transferred to the Emergency Department
- The UCC does not yet see children aged below six months, but will do so after transition phase.
- A formal progress and performance report will be presented to the CCG in January 2014