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.
New structures within NHS North West London: From 1st April 2012 the former Sub Clusters within North West London have ceased to exist. All previous committees have been disbanded and new committees were to be created to replace them on 10th April, in Part II of the North West London Board Meeting. In May, new accountable officers for the shadow Clinical Commissioning Groups will be appointed and reporting lines will be amended.
The primary care trusts within the North West London Sector have re-grouped in the same pattern as their corresponding clinical commissioning groups. The Inner Cluster of PCTs now comprises Hammersmith and Fulham, Hounslow, Kensington & Chelsea, and Westminster. The Inner Cluster covers Brent, Ealing, Harrow and Hillingdon. These Clusters do not expect to hold meetings in public.
However, the Board of NHS North West London, comprising all eight PCTs, will meet in public on the following dates in 2012: 9th May in Wembley; 4th July in Victoria; 12th September in Victoria; and 7th November in Hounslow. An additional meeting may take place on 27th June in connection with the launch of public consultation on expected proposals for changes to services in the sector.
Shadow CCGs will be set up as committees of the Cluster Board. They will be expected to meet in public and the minutes of their meetings will go to the Cluster Board.
Delegation of budgets to CCGs: Early in 2011-12 NW London ran an exercise with CCGs to assess their readiness to take on responsibility for a variety of low complexity commissioning budgets. In October 2011 guidance was issued concerning delegation of medium and high complexity budgets. And assessments took place as a foundation for taking on full delegation and subsequent authorisation later in the year. Four CCGs were rated green and recommended for full delegation without conditions, but the remaining four CCGs, including Ealing, Harrow and Hillingdon were rated red for financial delegation and were recommended for full delegation with conditions. and they will be required to produce a financial recovery plan by 30th June 2012.
The pilot NHS 111 Service in Hillingdon was launched on Tuesday 13th March 2012. It is a free, fast and easy way to get the right medical help at any time, day or night. Even the 'phone call is free, whether it is from a landline or a mobile. Because this is a pilot, it is only available to Hillingdon residents.
Of course, in a life-threatening emergency always dial 999. For routine advice that can wait until your doctor can see you, contact your GP's surgery, in the usual way. However, if you do not know who to call, or you need immediate advice, dial 111. If the 111 team assesses your call as an emergency, it will call for an ambulance straight away.
NHS 111 is staffed by trained advisers supported by experienced nurses. You will be asked questions so that you can be given the right healthcare advice and directed to the appropriate local service as quickly as possible - this could be a doctor, an urgent care centre, community nurses, an emergency dentist or a late-opening pharmacist.
The NHS 111 service was first piloted in four areas in England in 2010. The whole of London will have access to the 111 service by April 2013.
- The agreed priorities:·
Enhancing quality of life for people with long term conditions.
Helping people recover from episodes of ill health or injury
Ensuring that people have a positive experience of care.
- It is a NHS requirement that no Primary Care Trust or Strategic Health Authority will plan for a deficit in 2012/13.
- PCTs with a legacy debt, (including all the above), must clear such debt in 2012/13 and CCGs will not be responsible for resolving PCT legacy debt that arose prior to 2011/12.
PCT clusters must support all CCGs in making progress to full authorisation by the NHS Commissioning Board and help the CCGs to build a track record for managing both the budgets for which they have delegated accountability and for delivery of their share of the Quality, Innovation, Productivity and Prevention program (QIPP).
Financial allocations will grow by 2.5% in 2012/13. Transfer of social care monies will continue into 2014 and 2015. The running costs allowance for CCGs is expected to be £25 per head of population per annum.
Health and Wellbeing Boards will be in shadow form from April 2012 and statutorily operational from April 2013.
Finance: In 2010-11 NHS Hillingdon’s budget was £1.4bn. It achieved a surplus of £100k and met all its financial targets. However its in-year difficulties led to it being re-entered in the Challenged Trust process, where it joined NHS Ealing and NHS Hounslow who are also regarded as financially challenged.
Commissioning: Hillingdon’s Clinical Commissioning Group is expected to take full commissioning responsibility from NHS Hillingdon in April 2013. All Hillingdon GP practices are participating in this pathfinder CCG, which is already engaged in acute contracting and pathway redesign and has delegated budgets for community services, prescribing, outpatients and diagnostics. Subgroups of GP practices provide peer review in the three Hillingdon localities, with three further subgroups in each locality.
Ahead: In 2011-12 NHS Hillingdon will focus on strengthening its work with the local authority, the voluntary sector and the public as well as developing the infrastructure for the CCG, and implementation of plans for its pilot 111 telephone advice service and the Urgent Care Centre at Hillingdon Hospital.
The October 2011 meeting took place in the Civic Centre Hillingdon, with representatives present from NHS Ealing, NHS Hillingdon and NHS Hounslow..
Finance: The Sub Custer is forecasting that its three PCTs will meet their targets by end of financial year but key risks are acute over-performance and the delivery of the Quality, Innovation, Productivity and Prevention target (QIPP), where 75% of planned savings are expected to be delivered during the second half of the year and £10.5m of the plans are risk-rated as red. Hillingdon ‘s target is to break even.
Performance: Hillingdon has a good record of achievement for dental access, cervical screening, breast screening and childhood immunisations, but its smoking cessation programme lags way behind target. On 4 hour A&E target Hillingdon Hospital does well, achieving 98.4%, but Northwick Park fails with only 94.5%. At both these trusts London Ambulance Service handover times fail to meet targets.
Hillingdon versus London and England: Male life expectancy at birth is 78.6 years (England’s best is 84.4 years / worst is 73.7 years) but in south 6.6 years less years than in the north and 9.1 less disability–free years; females life expectancy is 83.4 years with slightly smaller inequality figures than for males. Hillingdon is significantly worse than both the regional and England average for statutory homelessness, physically active adults and new cases of tuberculosis. It also has higher levels of violent crime than the England average, more stays in hospital for alcohol related harm, and more cases of diabetes.
These Primary Care Trusts are now grouped together in the Outer North West London Sub-Cluster. Papers from their joint Board meeting in July 2011 produced the following snippets of news:
Pattern of Meetings: Meetings are held in public every two months, at various venues within the area covered by the three PCTs.
New Chief Executive: Nick Relph, previously Chief Executive of NHS Hounslow, became Chief Executive of this Group on 1st July 2011.
Delegated authority for Primary Care functions: Minutes of the previous meeting confirmed that proposals for delegation by the eight North West London PCT Boards of their decision making responsibilities for the management of Primary Care Contracts had been agreed by this Board together with delegation of authority to the Cluster Chief Executive.
Finances: The position at month three is that each PCT is meeting its year to date control target (surplus for Ealing and Hounslow, breakeven for Hillingdon). Cost pressures are emerging at all three PCTs, particularly on acute contracts.
A&E four hour waits: The 98% target was not met by Ealing, Hillingdon or North West London in May, but only North West London also failed the 95% target.
London Ambulance Service Hospital Turnaround (Arrival to Patient Handover): The target for handover of patients within 15 minutes 85% of the time remains challenging for all Trusts in the sector. The target to handover 95% within 30 minutes was achieved by Chelsea & Westminster and Imperial College and narrowly missed by Ealing, North West London and Hillingdon hospitals. Failure to handover in 60mins arose 25 times year-to-date at North West London Trust and 9 times at Ealing Trust – only twice at Hillingdon.
Are you confused about all the local changes in the NHS? This extract from Outer North West London Board paper may fill some gaps - it is slightly truncated but copied directly from the July 2011 Board paper:
“The Joint Committee of PCTs which operates as the North West London Cluster Board has seen its roles and responsibilities developed significantly as a result of local decisions and national policy. … The key elements of the arrangements are an integrated management structure at Cluster level with a Chief Executive, as Accountable Officer, and Director of Finance.
As the legal requirements for membership of individual PCT Boards remain the same, for example in terms of Executive Committee representation and Director of Public Health, there are established arrangements for three Sub-Clusters each with their own integrated management structure. The PCT Boards comprising the Sub-Clusters meet at the same time to conduct business in a way which ensures that each Board is acting legally.
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.
Merger Accounting
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.
