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.
This meeting, on 29th June 2011, was a joint meeting for the Boards of three PCTs - NHS Ealing, NHS Hillingdon and NHS Hounslow
Change of Chief Executive:
Robert Creighton is to be seconded to NHS London as Director of Transition from 1stJuly. His role as CEO to this Group of PCTs is to be taken by Nick Relph, formerly CEO NHS Hounslow.
Finances of NHS Hillingdon
The unidentified savings gap in NHS Hillingdon’s accounts prevented budgets being signed off earlier in the year. NHS Hillingdon has now received £10m non-recurrent income support from the 2% non-recurrent fund subject to various conditions. NHS Hillingdon will be designated a challenged organisation and placed in the North West London Challenged Trust Board process.
When NHS Hillingdon’s community services were transferred to Central & North West London NHS FT the PCT retained all assets and liabilities relating to the provider arm.
NHS Hillingdon’s redundancies
In the Annual Accounts for 2010/11 the PCT provided for £1,832k of redundancies relating to 46 employees.
NHS Ealing, NHS Hillingdon, NHS Hounslow are now administered jointly as the Outer North West London Sub-Cluster. The Sub-Cluster's first Board Meeting was held on Wednesday 18th May 2011. The three PCT Boards were all represented and the affairs of the three PCTs were all reported in parallel. Only points of particular interest to Hillingdon viewers are noted below.
Pattern of Meetings: Meetings are to be held in public every two months, at various venues within the areas covered by the three PCTs. At this first meeting there were insufficient papers for the public – this will be remedied in future and regular attenders will receive papers by post in advance. The Minutes will show the role of those with seats at the table as this was not evident to those in the public gallery.
This meeting: There were 22 people at the table. Apart from the Chairman and Chief Executive, those listed below were representing the interests and concerns of Hillingdon:
Chairman: Jeff Zitron Chairman, who also chairs the N. W. London Cluster (former Chairman Hammersmith & Fulham PCT)
Robert Creighton CEO
Martin Roberts Chairman NHS Hillingdon
Ellis Friedman Director of Public Health, Hillingdon
Keith Bullen Director, NHS Hillingdon
Dr Ian Goodman Hillingdon GP Consortia
Trevor Begg Hillingdon LINk
The acoustics were poor and much of the discussion could not be heard from the seats reserved for the public
Minutes of previous meetings: These were agreed for the three PCT Boards
Finances:Details of the three PCTs were presented separately. Acute costs in Hillingdon were cited as a particular pressure, but all three Boards met their key statutory financial duties for 2010-11 – even NHS Hillingdon reporting a £5k surplus although it did not meet its target surplus.
Performance: Again details were provided for each PCT, with Hillingdon achieving generally better outcomes than Hounslow or Ealing.
Public Forum: Joan Davis, representing The Community Voice, of which Ruislip Residents' Association is a member, expressed pleasure that the meeting was in public and that members of the public were allowed to ask questions. However, she noted the shortcomings mentioned above. She was promised more papers for the public in future, also maps of venues, details of who was present in the Minutes, and consideration of provision of microphones at future meetings.
Next meeting: This will be on Wednesday 29thJune, but the time and venue are still to be confirmed. The date conflicts with other Board meetings in public - NHS London, The Hillingdon Hospitals NHS FT, North West London NHS Hospitals Trust, and East & North Herts NHS Trust.
As guest speaker at the April meeting of The Community Voice, of which our Association is a member, Dr Ian Goodman, Mountwood Surgery, Northwood summarised the Health and Social Care Bill currently progressing through parliament. He noted that NHS budgets are protected, but the growing elderly population and growth in technology require a 5% –7% growth in expenditure, so a frozen budget equates in practice with a cut in resources.
The impact at local level is already considerable. The formation of Clusters and Sub-Clusters in London, has removed many decisions from NHS Hillingdon and has cost it most of its staff. With only 18 people left, there is a loss of corporate memory with which to administer its £300m budget. Also, the shadow Hillingdon GP Consortium will gradually take over commissioning responsibility from NHS Hillingdon, prior to full transfer of responsibility in 2013.
The new Consortium Board comprises three members with voting rights from each of Hillingdon’s three localities, North Hillingdon, Uxbridge and West Drayton, Hayes and Harlington, with at least two elected GPs from each locality. The Board also has a number of Associate Members, currently without voting rights – Keith Bullen and a Non-Executive Director from NHS Hillingdon; Ellis Friedman, the Director of Public Health; representatives from Hillingdon Council, Hillingdon Hospital, Community Services and the Voluntary Sector.
The speaker queried whether GPs have the expertise and time for this responsibility, particularly with their increased workload as clinical services move from hospitals into the community. Most GPs will have conflicts of interest - for instance, he is a director of Harmoni, the parent body providing out of hours services – so it is essential that Board activities and decisions are transparent.
Few changes will be immediately apparent, as NHS Hillingdon signed many contracts last year, but the Hillingdon Hospital contract is outstanding as the hospital’s estimate is greater than the PCT’s resources.
Something has to give. Fewer authorised procedures and tougher criteria will apply to all services. A cut in budget cannot be achieved without cuts in services and longer waiting lists.
Mayur Nanavati Reva Gudi Brett ThomasNorth Hillingdon:
Steven Shapiro Kuldhir JohalIan Ian GoodmanUxbridge & West Drayton:
Mitch Garsin Stephen Mort Tom Davies
Having had a gap of three months between its November Board Meeting in public and its meeting on 1st March, NHS Hillingdon then had only three weeks before this meeting, so there was little to report. Also its powers are greatly reduced since the majority of decisions now rest with either the North West London Cluster or the Outer North West London Sub-Cluster (comprising NHS Ealing, NHS Hillingdon and NHS Hounslow).
At month 11 of its financial year, NHS Hillingdon reported a deficit if £1.2m mainly due to heavy emergency activity at three hospitals – Hillingdon, Harefield and Northwick Park. Primary Care also contributed to the deficit, due to increased prescribing costs. However, the PCT was still predicting breakeven at year end on 31st March, but that will only be possible if it achieves its £4m recovery plan. (Subsequent rumours suggest that the deficit is MUCH higher!)
Individual Funding Requests:
When the eight PCTs have formally approved the plan, a single panel will deal with these requests for the whole North West London sector.
This produced some interesting statistics. NHS Hillingdon is failing to achieve the following targets:
Bowel cancer screening (age 60-69) – achieving 49.1% v. target 60%
Immunisation for girls aged 12- 13 years – human papillomavirus vaccine – achieving 76.6% v. target 90.1%
Immunisation for children aged 13- 18 years – tetanus, diphtheria and polio – achieving 72% v. target 75%However life expectancy is increasing and is currently 78.1 years for men and 83.2 years for women
BUPA involvement in the monitoring of NHS Hillingdon Commissioning:
At the November Board meeting I commented that the review of the BUPA project had not been made public and our representative asked what had been achieved. At the 1st March meeting it was noted that the three year contract ended in January 2011 and cost £29k per month. At this meeting the issue was referred to again, in a very bland statement, that revealed nothing. After further pressing, it was admitted that the project had not been a success.
There should be a public report on this project, both as a matter of public interest and because GP consortia should be made fully aware that involving BUPA in monitoring the PCT’s commissioning costs proved to be an expensive experiment. Further consideration of the issue was promised.
NHS Hillingdon has had no Board Meeting in public since 30th November 2010. During those three months there have been structural changes in the NHS locally. NHS Hillingdon is now part of the Outer North West London Sub Cluster of the North West London Cluster. Some functions are now undertaken by the Cluster, including much of the commissioning of NHS services, and other functions are undertaken by the Sub Cluster.
NHS HILLINGDON - A SHADOW OF ITS OLD SELF!
NHS Hillingdon exists in name, but for most functions it is administered as part of Ealing, Hillingdon and Hounslow. On 1st February Hillingdon Community Health, the provider arm of NHS Hillingdon, was merged with Central & North West London Foundation Trust, so NHS Hillingdon now provides no services directly. Local NHS services are no longer controlled locally.
At the March Board meeting there were many reference to how things are done in Hounslow, as the relevant Director originated from that PCT. There have been massive staff losses from NHS Hillingdon and with the exception of Ellis Friedman and Keith Bullen, both newcomers in recent months, no familiar Executives remain on the NHS Hillingdon Board. At the March meeting, the Non-Executive Directors appeared more than previously critical of Executive reports and decisions. It is recognised that the latest NHS reforms are expected to abolish both NHS London and all its Primary Care Trusts. That factor contributed to a feeling within the Board Meeting of living on borrowed time.
Snippets of news from the March meeting and its papers:
Acute hospital over-performance: North West London Hospitals, the Hillingdon Hospital and Imperial College are all treating many more patients than planned. The Royal Brompton is 22.5% over plan. A cap is in place between NHS Hillingdon and The Hillingdon Hospital NHS Trust . Based on historical trends it is expected that acute activity will increase by a further 2% in 2011-2012.
Finance: NHS Hillingdon is now predicting breakeven at year end on 31st March, against a planned surplus of £4m but to achieve this the PCT will have to find savings of £4m in a very short time.
Complaints and PALS (Patient Advice and Liaison Service): These services are now based in Hounslow.
BUPA involvement in the monitoring of NHS Hillingdon Commissioning: The BUPA contract cost £29k per month and in 2010/11 £290k was paid for the contract, which ended in January. The use of BUPA to check the Hillingdon Hospital’s bills was set up with Department of Health approval, so it is a matter of public interest to know whether BUPA reduced NHS Hillingdon’s costs, particularly as previous Audit Committee Reports suggested that the project was a costly failure. The new Chief Executive, Robert Creighton, agreed to look into this with the possibility of making the report public, but subject to commercial sensitivities – so I am not hopeful that we shall ever know the truth!
NOTES FROM NHS LONDON'S BOARD MEETING IN PUBLIC JANUARY 2011
The year to date position of Trusts and PCTs across London is dominated by activity levels significantly in excess of plan and they also have difficulties in delivering the unprecedented level of cost improvements that they are required to make. This affects virtually all organisations across London, but it is particularly evident in those whose underlying financial position is already relatively weak.
DEMANDS FOR NHS EFFICIENCY SAVINGS, YEAR AFTER YEAR, TAKE THEIR TOLL
Three trusts and two PCTs are now expected to finish the year in deficit, but a further four trusts and 7 PCTs reported cumulative deficits to month 8 and are at risk of failing to achieve breakeven. These organisations are said to be receiving the highest level of scrutiny, challenge and support from the SHA and Sector teams.
Royal National Orthopaedic Hospital is listed amongst the eight trusts falling substantially behind planned position at month 8 – the financial year ends in March 2011. The Hillingdon Hospital had a small deficit below plan at that time. However both these hospital are forecasted to end the year broadly in line with their plans.
SO NHS HILLINGDON IS NOT THE ONLY ONE IN TROUBLE!
NHS Hillingdon, reporting its finances as £4.3m below plan due to acute over-performance, is among the 12 PCTS with problems at month 8, and it is now forecasting a year end deficit of about the same sum. This should be seen against the background of its neighbouring PCT, NHS Harrow, which was reported in the Health Service Journal of 10 February 2011 as having a bailout of £22.6m from its NW London Sector PCTs.
JOINT COMMITTEE OF PRIMARY CARE TRUSTS FOR NORTH WEST LONDON (JCPCT)
This Committee is already in operation and is responsible for joint commissioning for the 8 PCTs in the NW London Sector - now called the North West London Cluster.
NW LONDON SUB-CLUSTERS
The JCPCT has set up a single executive management team for each of the three clusters of PCTs within the Sector – one cluster comprises Brent and Harrow, with Chief Executive Mark Easton – another comprises Ealing, Hillingdon and Hounslow with Chief Executive Robert Creighton; Yi Mien Koh simply disappeared from NHS Hillingdon before the November Board meeting. For legal reasons the individual PCTs retain responsibility within their own areas, so they must hold individual Board Meetings. The prime purpose of the clusters is to save management costs.