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.
Background information: Hillingdon Clinical Commissioning Group (HCCG) held a public meeting on 31st July 2013 about the services it has commissioned at the Urgent Care Centre Hillingdon Hospital (UCC). These services, selected by an independent Procurement Panel on behalf of HCCG, will be provided by Greenbrook Healthcare, a consortium which works with Ealing Hospital NHS Trust, and already provides services in the UCCs in Northwick Park Hospital and West Middlesex Hospital.
The UCC is expected to take pressure off A&E and to save money. It will be staffed by GPs and experienced nurses who will deal with urgent infections, rashes, fractures, stomach upsets, burns and sprains.
Previously the Hillingdon UCC has had a restricted service, 9am to midnight, provided by Harmoni, with no diagnostics. The new UCC will be open 24/7 and will have diagnostic facilities.
All patients arriving at Hillingdon A&E, other than those coming by 999 ambulance, will be triaged in the UCC, leading to three options - referral to their own GPs, treatment in the UCC by a GP or nurse, or transfer to A&E.
HCCG has set up an UCC Project Board to oversee the UCC for three months after it opens in Autumn 2013.
A number of members of The Community Voice attended the meeting. In subsequent discussions it was agreed that a letter would be sent to the CCG Chairman, Dr Ian Goodman, listing a large number of queries. The reply to that letter, which posted a response after each query, is shown below.
NB points of particular interest only - not at summary. The meeting was brief – under an hour.
Participants: Council Leader and two other Cabinet Members - Cllr Corthorne and Cllr Mills, Directors of Residential Services, Adult Services, Children’s Services, Public Health, Public Safety & Environment, Chair and COO Hillingdon CCG, CEO Hillingdon Hospital, senior representatives of CNWL, Royal Brompton & Harefield Hospital, Chairman Hillingdon Healthwatch (No other public representation). Three members of the public – no opportunity for them to participate, but Board papers were available.
Joint Health & Wellbeing Strategy Action Plan 2013/14: Achievements to date include:
- Schemes to combat obesity and improve health are on target to achieve 7,000 additional residents participating in regular exercise eg free swimming for older people; new led cycle rides and Healthy Walks programmes; Tea Dances; sports activities for teenagers, primary age children, and disabled adults; exercise schemes for cardiac and stroke patients.
- Action to tackle fuel poverty via home insulations and essential repairs for older residents.
- Integrated care programme has been extended from frail elderly. diabetics, and those with mental health needs to now include chronic obstructive pulmonary disease and cardiac difficulties. Work is underway to develop services for those with dementia. 80% of GPs are participating.
- The Child and Adolescent Mental Health Service is being developed.
- Issues of low birth weight babies and uptake of childhood immunisations are being addressed.
- So are the problems of teenage pregnancies and sexually transmitted infections in young people.
- Pathways are being developed to respond to mental health needs, and drug or alcohol problems.
- End of life care is being improved.
- TeleCareLine is on track towards target of 750 new installations per year for three years to help people live safely and independently at home, to reduce reliance on care homes and hospital care.
- As at 30th June 78% of social care clients had personal care budgets.
Public Health Action Plan 2013/14: The Public Health budget is ring-fenced. A Memorandum of Understanding is being developed between Hillingdon Borough Council and Hillingdon Clinical Commissioning Group, to be jointly agreed by them both.
Hillingdon CCG’s Recovery Plan 2013/2016: This plan aligns closely with the Hillingdon CCG Out of Hospital Strategy. A deficit budget of £12.15m has been set for 2013/14, The savings target for this year is £11m, rising to £14.5m in each of the next two years, a total of £40m. Savings plans for this year are £3m from unscheduled care; £3.7m from planned care; £0.4m from Long Term Conditions; £2.4m from Prescribing; £1.7m from Mental Health & Community Care.
Several of the schemes are already delivering the expected level of savings, for example the Hillingdon Urgent Care Centre, negotiation of a new musculo-skeletal care pathway with Hillingdon Hospital and continuation of the successful Rapid Response and Admissions Avoidance care-pathways.
Allocation of S106 Health Facilities contributions: Three strategic hubs for out of hospital services have been agreed for development in the Borough, at the Hesa Health Centre in Hayes, Mount Vernon Hospital in Northwood, and a new health centre at St Andrews Park in Uxbridge. Where possible any 106 contributions taken from new developments will be allocated towards one of these hubs, where none of those hubs is eligible (too far from the new development?) GP practices in the area can express an interest in spending these contributions on eligible schemes.
The proposed new Yiewsley Health Centre on the former Yiewsley Pool site has £61.7k earmarked. However there are no plans to use £185.9k from the RAF Eastcote site and if the money is not used by September 2014 it will be returned to the developer. The Hesa Health Centre must spend £53.5k by January 2014 out of the £264.8k waiting to be used there.Funding Transfer from NHS to London Borough of Hillingdon: £3.7m of funding in 2013/14 has been transferred to support social care where it benefits health. Much of this is to be used to supplement the TeleCareLine Service, some will be used to help children transferring to adult services and some to prevent unnecessary admissions to hospital. Men over 65 years have a 7 in 10 chance of needing some care before they die and women nearly a 9 in 10 chance. The 2011 census showed 25,905 unpaid carers in Hillingdon. Stroke is one of the main causes of disability. Dementia is expected to increase by 17% in the eight years to 2020.
As announced to the Hillingdon Voluntary Sector Health and Social Care Forum on 21st August 2013, Hillingdon CCG’s commissioning intentions for 2014/15, include:.
- 1. Changes to commissioning intentions: In order to initiate changes in April 2014, Hillingdon CCG proposes to give local Trusts six months notice by publishing its intentions in October 2013. There will then be an opportunity for dialogue with Hillingdon Health and Wellbeing Board, the relevant Trusts and other stakeholders.
- 2. Development of the CCG’s “Operating Plan”: This plan will be developed over the autumn – it is likely that there will have to be a £14m savings programme.
- 3. CCG funding: The NHS England Operating Framework and financial allocations for 2014-15 are expected in the New Year. ( Community Voice urged local CCGs to protest at their repeatedly poor funding)
- 4. Proposed five themes for 2014/15:
a. Reducing health inequalities: Improving life expectancy, tackling obesity, targeted services for people over 75 years old. (Community Voice urged that this is not primarily a NHS responsibility)
b. Delivering an “Out of Hospital Strategy”: Via community hubs / primary care networks (Community Voice urged careful costing of all proposals before any changes are agreed )
c. Responsive to patients views
d. Integrated care: Both integration across community and secondary health care, and integration between health and social care.
e. Commissioning for Quality
- 5. The Recovery Plan needs to deliver:
- a. Savings via user engagement / prevention of future ill-health
- b. Shift of planned and non-elective care : Better long-term-conditions management via transfer to community settings, Urgent Care Centre interventions, Rapid Response etc
- c. Tackling waste and duplication
- d. Savings via improved productivity and integrated delivery
- e. Quality services - “doing it once, doing it right”
- 6. What this means in practice:
- a. Active prevention programmes e.g. Weight reduction / exercise, led by Public Health
- b. Development of planned care pathways:
- c. Community Services support: Including self-care management of long-term-conditions.
- d. Development of services: The Urgent Care Centre, Rapid Response, Admissions Avoidance programme, Acute Emergency Care
- 7. Feedback from patients: Patients’ views should influence decisions e.g.:
a. Attitudes of clinical staff: In Quarter 1 this year 55% of complaints received by Hillingdon Hospital related to staff attitudes and nearly 20% related to poor communication.
b. Management of long-term-conditions: 92% of local patients feel confident to manage themselves – 22% say support not needed and 60% feel they already have enough support.
c. GP decisions on care: 69% of patients say their GP is good or very good at involving them in decisions on their care
- 8. Feedback from GPs: GPs views should influence decisions e.g.:
- a. Decommission Community Matrons: Replace them with Nurse Practitioners
- b. Decommission Pain Services: Widen use of alternative services, e.g. physio
- c. Improve services for over 75s: Longer home visits, better NHS / social care liaison
- d. Improve discharge planning
- 9. CCG Proposals to date include:
- a. Work with Hillingdon Hospital on ambulatory emergency care pathways
- b. Targeted work for patients over 90 years
- c. Practical improvements to integration of health and social care
- d. Tele-monitoring
- e. Decommissioning some services?
- 10. Next steps include:
a. Opportunities to comment via website in August and September
b. Further dialogue in October and November
Meeting called by: Hillingdon Clinical Commissioning Group
Time: Scheduled for 6.45pm – 9 pm and all present but started 20 minutes late
Audience: Estimated at 50+ including ten members of Community Voice
Chairman – Dr Ian Goodman, Chairman Hillingdon CCG
Michael Steel, Chief Executive, Greenbrook Healthcare
Trevor Begg, Lay Member Hillingdon CCG
- Purpose of an UCC – to take pressure off A&E and save money
- It deals with - urgent infections, rashes, fractures, stomach upsets, burns, sprains
- Staffing – GPs and experienced nurses
- Hillingdon location – entrance to Hillingdon Hospital A&E
- Hillingdon UCC management – Greenbrook Healthcare – works with Ealing Hospital staff
- Greenbrook experience - runs Northwick Park UCC and West Middlesex UCC and others
- How selected – Procurement Panel / HCCG accepted its recommendation
- Current UCC - restricted service 9am to midnight by Harmoni, no diagnostics
- New UCC hours – 24/7 with diagnostics
- New UCC process – triage leading to referral to own GP / UCC GP or nurse / transfer to A&E
- Monitoring – HCCG has set up and UCC Project Board to oversee for three months then CSU
- Public involvement – Tel: 01895 488 188 or www.hillingdonccg.nhs.uk
- Impact on Hillingdon Hospital – shared goals, close working with Greenbrook and HCCG
Introduction: All top table members spoke covering points above, with a slide presentation
Questions: A wide ranging session, with a number of people commenting or asking questions – a generally hostile audience raising the following concerns:
- Involvement of a private provider takes profit out of NHS
- Hillingdon Hospital could have integrated UCC and Emergency Department
- The NHS is trusted – private healthcare is not
- The public had no opportunity to influence the decision
- No evidence provided to justify the selection of Greenbrook
- HCCG no curiosity about the funding formula that determines its income / or its fairness
- Minutes for the meeting? - Dr Goodman said the meeting was being recorded and suggested that The Community Voice would put minutes on its website – Joan Davis responded – no minutes, but a short report for members would be provided - members would be looking for evidence to justify the appointment. Response from top table, evidence for appointment is subject to legal considerations and commercial sensitivity, advice would be sought.
Filming: Donald Edward filmed the event. His video will be on The Community Voice website within a few days.
Feedback forms: Asked personal details e.g sexual orientation; possible gender change. Also whether the meeting was worth attending and had it changed views held prior to the meeting.
Next public meeting: September Josn Davis
NB Points of particular interest – not a summary
1. Hillingdon PCT finances: The 2013-14 forecast and agreed deficit is £12.2m.
2. Performance: Across all providers, Hillingdon CCG has achieved most national targets within current year but a total of four MRSA cases breaches the zero target – one case each in three hospitals and one case in the community; it is unclear whether this will incur a financial penalty from the Department of Health. The 31 day target for treatment after a cancer referral is also not being met.
Contract penalties will be applied to all trusts breaching national standards for example £5k for each 18 week wait breach, £1k for each 60 minutes handover of ambulance to hospital breach - £0.2k for each 30 minute breach. Root cause analysis and action plans are required for breaches. The Commissioning Support Unit (CSU) monitors most action plans weekly or monthly and A&E pressures daily.
3. Proposed transfer of Ealing CCG from federation with CCGs in Brent, Harrow and Hillingdon: Ealing CCG wishes to leave this federation and to join the federation of inner North West London CCGs, Westminster, Kensington and Chelsea, Hammersmith and Fulham, Hounslow. Hillingdon CCG discussions showed much reluctance for this split, which requires NHS England approval.
4. Commissioning priorities for children and young people: Within its strategic priorities for the whole population, HCCG has reviewed a range of potential priorities for those aged 0 – 19 years to improve health outcomes and particularly primary and community services. This work will inform its children’s commissioning plans for both this year and next year, including children with disabilities and long term health conditions.
NB: Selected items only - not a summary
Finances: All Governing Bodies in the Brent, Ealing, Harrow, and Hillingdon CCGs consortium have agreed in principle to develop an in-year financial risk share, and work is underway to develop this.
The split of the Hillingdon CCG budget is still subject to finalisation but the draft split is 65% managed at Practice level (197m), and 45% at CCG level £107m. The CCG component includes an £11m risk pool budget for high cost patients (£10k spells).
A forecast end of year deficit of £12.25m has been approved.
Performance Report: Hillingdon Hospitals Trust did not meet the four hour maximum wait In A&E in April for inpatients or outpatients but remedial action has led to near target improvements in early June.
NHS England has required all Local Area Teams to work on improvement plans in three phases:
(i) An urgent recovery programme to recover standards (ii) A programme for next winter (iii) A long-term urgent care strategy so that the A&E four hour wait targets are reached every quarter.
Hospital handover for patients arriving there by London ambulance in April also failed target times, partially due to a 6.1% increase in ambulances arriving. The 99 breaches dropped by 17% in May.
Shaping a healthier future programme: Decisions were agreed in February 2013 with subsequent preparations for implementation, in a programme covering the years 2013 to 2018.
NB Points of particular interest – not a summary
1. Hillingdon PCT finances 2012 – 13: The PCT’s final draft accounts have been sent for audit, showing a surplus of £1,979,000, in line with revised expectations - achieved with in-year support of £21.8m and the return of Hillingdon’s share of the 2% top slice (£2.6m). The year end position includes provision for retrospective Continuing Care Claims of £10.6m. The 2012-13 accounts indicate a recurrent deficit of £11.3m.
2. Performance of Central & North West London FT:
a. Hillingdon Community Health targets 2012-13: The target for discharge summaries from Northwood and Pinner Unit at Mount Vernon and the Rapid Response Team was for 95% to be sent to GPs within two working days of discharge. Only 92% was achieved, some 20 cases below target. The contract forfeited all payment if the target was not achieved, so HCH lost considerable income.
The Diabetes Service target was to see 95% of patients within six weeks – but in March it reached only 66%, partially due to staff sickness. Remedial action is now in place.
b. Mental Health: Patients’ do not attend rates (DNA) are causing concern. Rates for first appointments are rated amber and follow up appointments have moved from amber to red.
3. The Hillingdon Hospitals FT: Pressures on A&E have eased but demand frequently exceeds capacity. New facilities and the Urgent Care Centre are expected to come into effect in late 2013 to expand capacity.
Choose and Book performance is not meeting targets but is expected to improve.
4. Royal Brompton & Harefield FT: The Trust had 18 cases of clostridium difficile in 21012-13, six more than its target. It also failed to achieve its targets for 90% of patients to start treatment within 18 weeks of referral, for smoking cessation and for treatment of cancer within 62 days of GP referral. Remedial actions are underway.
5. Health checks for people aged 40 – 74 years: Only 9.3% were offered health checks versus target of 20% and only 6.2% actually had health checks, against a target of 10%.
6. Teenage conception, girls 15- 17 years: There were 36 conceptions per 1000 girls, 6 higher than the target of 30
7. Mental Health Strategy: Hillingdon CCG and London Borough of Hillingdon have worked together on the Mental Health Strategy for adults aged 18-64 years with mental health problems. Key features include:
- Services provided on the basis of need not age
- Improved support for carers
- Improved support in crises
- A shift from bed and secondary care services to community and primary care treatment / support
- A co-ordinated approach to treatment and support for both physical and mental health needs
- The waiting times for memory assessment and diagnosis is up to 6 months, which leads to delays in provision of support and treatment; this is being addressed.
- Older patients with functional mental health problems and/or dementia will be supported in their own homes for as long as possible.
8. CCG Operating Plan 2013-14: This is based on three strategic programmes – Shaping a Healthier Future / Out of Hospital Strategy / Financial Recovery Plan
9. End of Life Care Strategy 2013-16: This has a six step pathway:
- Identifying people approaching the end of life
- Advance care planning, assessing needs and preferences
- Co-ordination of care, including across sectors and out of hours services
- Delivery of high quality care in all locations
- Management of the last days of life, to provide “a good death”.
- Care after death and access to bereavement services
NB Points of particular interest – not a summarySubmitted questions from the public:
This was the first item on the agenda, but there were no questions. Future enquiries could possibly be submitted through this channel.
CNWL performance for month 11:
A routine report was received for mental health services and community services in Hillingdon. Do Not Attend rates for Hillingdon Adult Services first appointments have been in the red range since April 2012 but are improving – follow up appointments are also in the red range, with a spike in month nineBusiness Case and project Practice Commissioning Improvement Plan:
This was the major item on the agenda. The aim is to develop a programme to enable Hillingdon practices to manage their commissioning budgets effectively. Various options were considered. The intended outcome is to provide all practices with a robust clinically led referral management system and commissioning guidance and support to reduce current overspends and over-utilisation of services and commissioning budgets for both planned and unscheduled care.Interventions include:
- Clinically led peer support and coaching programme
- Peer referral review
- An education programme for practices
- A coaching programme for practices currently overspending
- CCG championed referral pathways
- Non co-operation of practice leaders
- Need for community service teams to provide responsive capacity
- Ineffective coaching
- Referrals within provider organisations
- High patient expectations
- Financial factors with respect to monitoring and analysis of progress
There has been a drop in immunisation rates which is being closely monitoredFinance:
A special meeting to consider finance is being held on Wednesday 8th May, 2.30pm – 3.30pm in Committee Rom 5 at the Civic Centre.
Next General Meeting:
12.20pm Friday 17th May at the Civic Centre