NHS Hillingdon is facing abolition, date uncertain, in expectation that the Health and Social Services Bill will become law. It retains legal responsibility for NHS services in Hillingdon, but it has very limited powers since NHS London initiated first five London clusters of Primary Care Trusts (PCTs), one cluster for each of its five sectors, which later developed sub-clusters. NHS Hillingdon is now in the Outer North West London Sub-Cluster - with NHS Ealing and NHS Hounslow - within the North West London Cluster which consists of the eight PCTs in North West London.
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
Handover and Closure:
In readiness for the abolition of Primary Care Trusts on 1st April 2013, much effort is being expended towards a smooth handover of responsibilities from Hillingdon PCT to Hillingdon CCG.
Special meeting to transfer responsibilities from the PCT to the CCG:
This significant meeting, which members of the public are invited to attend, will take place on Wednesday 20th March 2013 from 12.30-14.30pm in the Lecture Centre 004/006 in Brunel University. It will replace the meeting on Friday 15th March 2013. Parking will be obtainable at the University by obtaining a parking permit from the main reception, Eastern Gateway Building quoting “HCCG Board Meeting”. Meeting papers will be available to download on the HCCG website: www.hillingdonccg.nhs.uk from Thursday 14th March 2013
The PCT is still forecasting a deficit of £21.2 m at year end, offset by various awards made as gifts and a loan of £15m from Brent PCT, which is repayable over three years. The year to date overspend on CCG budgets was £8.8m
Transfer of responsibilities: Hillingdon CCG is in the process of taking over responsibilities from NHS Hillingdon, which will be abolished on 1st April 2013. This CCG will inherit repayment of a loan for £15m, borrowed from NHS Brent to balance NHS Hillingdon's books in 2012-13. Repayment of this loan over the next three financial years will be a huge burden for the new CCG - and this will impact on the level of NHS services that can be provided for local people.
The Community Voice, of which Ruislip Residents' Association is a member, is protesting loudly that Hillingdon residents should not be penalised as a result of a debt over which they had no control.
Musculoskeletal services: HCCG gave Hillingdon Hospital until 18th January to match practices in other London hospitals, which provide a cheaper service with fewer patient appointments. If Hillingdon Hospital does not provide quality with value for money, then the contract will be lost.
Financial report: NHS Hillingdon’s financial problems are mainly due to the volume of activity with the main local hospital trusts – Hillingdon, Royal Brompton and North West London. The projected deficit at end of year in March 2013 is £21.1m. £15m of this will be offset by a repayable loan from NHS Brent – the rest will be offset by other NHS NW London sources and will not have to be repaid.
Hillingdon Urgent Care Centre: London has the highest rates of A&E attendance and admissions in the country and Hillingdon’s rates are above the London average. To combat this, a larger UCC is planned, next to the Hillingdon Hospital’s Emergency Department, to treat minor illness and minor injuries and to reduce activity in the A&E Department, with a total net saving of £1.35m by 2014/15.
All non-ambulance emergency patients will enter Hillingdon Hospital via the UCC and be triaged there. Subject to urgency of patient condition, those referred by the telephone 111 service will be seen ahead of patients who just walk-in, so it will be wise to ‘phone first. GP heralded admissions will go direct to the Emergency Assessment Unit, by-passing the UCC and the A&E Department..
Diabetes service: The service has a target of seeing 95% of patients within six weeks but in November it saw only 60%, down from 82% in October due to staff sickness.
Mental Health performance Report, month 8: The CNWL service Increasing Access to Psychological Therapies (IAPT) is now fully staffed, but staff need additional training so it will only be fully operational from July 2013. The Memory Assessment Service has reduced waiting time from referral to assessment from nine months at start of 2012 to the current 8 weeks wait.
Two snippets of news from NHS North West London
1. Community Ophthalmology Services in Hillingdon: The Hillingdon Hospitals FT has been contracted to provide this service.2. Northwood and Pinner Community Hospital: The future of this site is being considered within two related strategies, NHS North West London’s plans for “Shaping a Healthier Future” and the Hillingdon Out of Hospital Strategy. It appears increasingly unlikely that the fate of this site will be resolved before 1st April 2013, when NHS Hillingdon will be abolished and all its estate - including this important site - will pass to a national organisation.
This meeting was concerned mainly with proposals for meeting the large financial deficit facing the Hillingdon health economy. There were extensive papers. Only points of particular interest are noted here.
Finance report: The projected forecast for the end of year in March 2013 is a deficit of £21.2m. Additional support equivalent to this sum is expected, so that breakeven can be said to be achieved; £15m is expected to be repayable over the following three years, but this still has to be confirmed.
Northwood and Pinner Hospital site: The site was not mentioned by name but it was implied by the report that an expected sale of property for £1.4m was not now expected to take place in this financial year.
Transfer of workload from Hillingdon Hospital A&E to Hillingdon Urgent Care Centre: Work is expected to transfer to the UCC from both A&E and the Hesa Walk In Centre, in Hayes Town Centre. The expected split between the A&E and the 24/7 UCC was suggested as 60% / 40%. The transfer from the WIC was expected to save £340k. It was also suggested that 15% of the current UCC activity could be seen in primary care.
NHS North West London commissioned Sylvie Pierce in July 2012 to explore options for this important site. She reported at the end of August, but her report was not released to the public until 5th November 2012 – and then only with all financial factors and commercial submissions omitted.
By that date no decisions had been reached on the future of the site and NHS North West London pointed to a Hillingdon Clinical Commissioning Group report expected in January 2013, suggesting that this issue rests primarily with that CCG – despite knowing that on 1st April 2013 the site will pass to a national NHS body, with minimal local input, so it is highly desirable that the future of the Northwood & Pinner Hospital site is settled by that date.
The most significant points from the Executive Summary in Sylvie Pierce’s report are:1. Her brief was to find a solution that would meet the objectives of all the stakeholders (NHS Hillingdon, local NHS service providers, local people and commercial partners developing the site)
2. Essentially the service proposal envisaged a Health & Wellbeing Centre, providing more than GP services, but encouraging better life style choices by offering dietary advice, housing support, access to social welfare, exercise and group support for long-term conditions, along with day clinics and other NHS and social care services.
3. The next step was to discuss this … with all those who would need to contribute to the scheme particularly the broader NHS family; and to test the commercial viability …
4. The GPs from the Health Centre (Northwood Health Centre, adjacent site, to rear of hospital) ... expressed interest in moving to the hospital site … this would release the Health Centre site for further housing development.
5. Meetings and ’phone calls were held with CNWL (providing local community health services / mental health services), the 3rd sector, Hillingdon Hospital Trust (Positive support was received).
6. The proposal was then soft-market tested with 6 organisations … they were asked to respond to provision of a new 12,000 ft2 Health & Wellbeing Centre, possibly a new renal dialysis unit, and their suggestions for a supporting development, which would generate a receipt and meet planning constraints of the site.
7. Five of the six organisations responded; the majority appointed architects and carried out a full site capacity study.
8. There is considerable interest … from housing associations and others.
9. Site values for the (hospital) site alone are in the region of £1.5m - £2.5m … possibly around £3m and the Health Centre site around £0.5m.
10. A new 12,000 ft2 Health and Wellbeing Centre will cost in the region of £2.5m to build.
11. The GPs … would be interested in raising a mortgage and paying for their share of a new building.
12. At least one of the offers has suggested the possibility of a Joint Venture with the GPs.
13. Soft market testing has generated proposals for additional health facilities or mixed tenure housing.
14. Another option … would be to leave the Health Centre as it is and develop a complementary building on the front of the site.
15. Another option would be to expand the building on the current Health Centre site. No capacity study has been done on this ... but there is potential for a two-storey building, which would be a viable solution.
Future of Northwood and Pinner Hospital: Sylvie Pierce’s report on options for the site was submitted to NHS NW London in August. As nothing further had been heard, the Community Voice – of which Ruislip Residents’ Association is a member - wrote to the Chairman ahead of the meeting on 5th November asking for assurance that the issue would be on the agenda at that meeting, and asking that the report be released to the public in its entirety. At the meeting there was a one side A4 report, an addition to the main papers, giving a brief history of the site and noting that the options report had been shared with the team leading Hillingdon CCG’s out of hospital estate planning, which would report in January 2013.
The future of the site was on the agenda as an item for the public forum. Both Joan Davis, as Community Voice Chairman, and Tony Ellis, Chairman Northwood Residents’ Association, addressed the Board. They stressed that five commercial organisations had submitted proposals, the majority having employed architects to draw up costed plans for mixed use of the site, providing a centre for health and local services together with some housing. They had not been allowed to see financial factors, but understood that viable options had been received, satisfying the requirements of both NHS and local people. They urged an early decision on these options, as all PCT estates will pass to a national body on 1st April, when PCTs are abolished, and local input will be lost.
Little was achieved – bland assurances that Hillingdon CCG will have a voice in the national estates body and that this is really a CCG issue. Permission was given for the public to see the truncated version of Sylvie Pierce’s report, which has no details of bids and no financial information. It was apparent that the options report had not been circulated to the whole Board and that only a couple of Board Members knew anything about this issue. Earlier in the meeting the Chief Executive noted that decisions on which properties will transfer to the new Property Services will be made in a couple of months’ time.
No one mentioned a factor buried in the Board papers, that because NHS Hillingdon is seriously in debt all capital spending has ceased. Although the Northwood and Pinner Hospital options would NOT require financial input from the NHS, there would have to be a full business case to consider any of the options, which may be technically difficult during a suspension of capital spending.
Non-payment for patients readmitted to hospital within 30 days: There is national guidance restricting payments for these patients – even if there is neither blame on the hospital for their readmission nor services in the community to avoid readmission. The guidance requires commissioners to account for the money saved and to demonstrate that they have reinvested this sum in local services to prevent future readmissions. Hillingdon Hospital reports that it loses £2m per year in these non-payments. However, there is no evidence of corresponding reinvestment in community health services. Community Voice therefore submitted a written question to NHS NW London, which acts as commissioner for NHS Hillingdon, asking when national guidance, which was quoted with references, will be met.
Again, nothing was achieved. The response was simply that NHS Hillingdon does not have the money – which made our representatives very angry, as this denial hides the fact that NHS Hillingdon is £2m more in debt than it admits and that local people are the losers, as well as Hillingdon Hospital.
Finance: The Cluster reports a year to date surplus of £2.9m but Hillingdon has a £6.1m deficit at month 6 with an outturn of around £22m deficit predicted. It was agreed that NHS Brent can loan NHS Hillingdon £15m repayable by Hillingdon CCG over 3 years – but only if a viable plan for repayment can be produced.
At month 6, NHS provider trusts and the LAS report a surplus of £2.4m, but North West London Hospitals has a deficit plan for £20.6m and NW London PCTs have provided it with £10m non-recurrent funding.
2013-14 allocations to CCGs will be announced on 19th December. Definitions of what constitutes specialised commissioning changed recently, which will impact on CCG allocations. Hillingdon CCG’s year to date deficit is £5.7m, Harrow CCG’s deficit is £0.4m, Ealing’s is £1.5m but Brent CCG has £3m surplus.
Hillingdon Clinical Commissioning Group is gradually taking over the responsibilities of NHS Hillingdon as Primary Care Trusts will be abolished on 1st April 2012. Hillingdon CCG holds Board Meetings in public each month. The notes below are not a summary of the meeting on 12th October – only items of particular interest are recorded here.
Public attendance: The public gallery was full, which was encouraging, with representation from a number of organisations.
Collaboration agreement: In April 2012 Brent, Ealing, Harrow and Hillingdon CCGs established a collaborative arrangement to share a leadership team and to work together on areas that would enable them to commission high quality care for their residents. A collaboration document was brought to the Board for its approval. It aims to achieve economies of scale and to enable members to attract highly qualified staff – Director of Delivery and Performance, Director of Quality and Safety, Chief Financial Officer and Head of Governance - and to manage more effectively the performance of the Commissioning Support Service.
Hillingdon CCG’s Commissioning Intentions 201/14: A document was presented and approved, clarifying its intentions, related to the changing needs of the population served. Priorities include maternity care, musculoskeletal services, obesity, diabetes, mental health including dementia, alcohol and risk taking behaviour (children), older people, and exercise and physical activity.
Finance: At Month 5 QIPP schemes a 34% behind plan (£2.2m) and overall a £5m deficit against plan is reported for the year to date largely due to overspends in acute care (£6.2m). The overspend to date on CCG delegated budgets is £4.8m. After recovery measures, the forecast for the end of year deficit is £17.7m.
Safeguarding of Children: A paper was presented and approved
Continuing care beds at Franklyn House: The Board Papers noted that these beds have been decommissioned. In response to questioning it was clarified that patients now have choice over where continuing care is provided, instead of the former arrangement in which the PCT allocated the patient to particular care provision. Patients who wish to be cared for at Franklyn House are free to do so, providing there is a vacant bed.
North West London Carers Strategy: The strategy aims to improve support for carers. Funding in each of the Boroughs is different and in Hillingdon the Local Authority component is very high and the NHS component low. In answer to questioning it appeared that the low NHS input is related to that PCT being under very great financial pressure, but further consideration of the data provided may raise other issues.
However, Hillingdon typifies good practice with its carers' cafes for carers of people with dementia and it performs well in the number of short breaks taken by carers from their caring role.
Capping of payment for re-admission of patients to acute care: National guidelines restrict payment to a maximum number of re-admissions, substantially lower than last year’s re-admissions, but require the cost of unfunded re-admissions to be applied to additional provision of care in the community. This is not happening in Hillingdon. The Hillingdon Hospital FT is providing some £2m in unfunded care. When questioned the CCG response on behalf of Hillingdon PCT was that community services in the Borough are being improved, but there is no additional money available to increase services further because of underfunding of re-admissions. A suggestion that this be reflected as an increase in the PCT’s debt was dismissed.
Leaflet about Rapid Response Team’s avoidance of hospital admissions: This new leaflet is to be available to all patients aged over 65 years and their carers. It explains the role or the Rapid Response Team and urges all patients to register with a GP in order to enable them to access Rapid Response when appropriate.