Ruislip Residents' Association

The Joint Primary Care Trusts took their decision today on the outcome of “Shaping a Healthier Future”, their proposal for changed health services in NW London, which had been subject to months of preparation and consultation in 2012.

The JPCTs  billed their meeting as an all day event, and such it was, from 9.30am to 5.50pm, almost an hour longer than planned, and with only two short comfort breaks in the whole of the day.

Every aspect was looked at in detail with a pause after each section for Board Members to ask questions and discuss options. They looked at clinical issues, financial issues, value for money, public transport, public consultation, equality issues.  The Business Case ran to two full volumes.  All eight Chairmen of the CCGs were present in the afternoon and each gave a summary of their own CCG’s views.

The outcome was largely as planned but with some concessions.  The preferred  Option “A” was agreed, so there will be five major hospitals with 24/7 A&Es, urgent care centres, trauma, emergency surgery, intensive care, paediatric in-patients and maternity services – Chelsea & Westminster, Hillingdon, Northwick Park, St Mary’s, West Middlesex.  They all require major investment to meet their roles.

Transfer of responsibilities: NHS London is in the process of handing over its functions to the NHS Commissioning Board London Region, in preparation for its abolition on 1^st April 2013.   Planning is well underway..  A legacy document is being prepared, as is required from all NHS organisations that are handing over their functions to new organisations..

Clinical Commissioning Groups: CCGs take over from PCTs on 1^st April 2013. Authorisation of the London CCGs is at different stages.  Some were authorised in December 2012.  (Later in January the CCGs in Brent, Ealing and Harrow became authorised but Hillingdon CCG  must wait until 7^th March 2013). All 32 London CCGs have appointed clinical Chairs.  Of their Chief Accountable Officers, only one is a GP and two are public health doctors. Other Board Members are being appointed.

Finances:  At month 8 the forecast outturn position for London was a surplus of £147m which was £31m above plan.  However four provider trusts were not meeting their planned position for that month and four PCTs too, including Hillingdon PCT.  PCTs were still assessing retrospective claims for NHS Continuing Care - the estimated additional cost not already included in PCT forecasts was £14m.

An event was held on 28th November to announce the responses to the public consultation on proposals to install Urgent Care Centres (able to deal with the majority of emergencies) at all eight hospitals in the area but to reduce those with A&E Departments (for multiple injuries and trauma) to five.

A very vocal group from Ealing made clear its rejection of the preferred option, which would close Ealing Hospital’s A&E Department.

However the preferred option was clearly endorsed by the majority of respondents. That option proposes enhanced facilities, including 24/7 consultant-led teams, at Hillingdon, Northwick Park, St Mary’s, Chelsea and Westminster, and West Middlesex hospitals.

A second strand to the proposals is to move services out of hospitals into the community, which may actually have more impact on patients than the change to emergency services.

Decisions will rest with the joint Primary Care Trusts at a meeting in the New Year.

NB:  Notes only from the Board papers: The meeting time was changed so we were not represented.

Transition to new structures:

From 1^st October 2012 the NHS Commissioning Board and the NHS Trust Development Authority will take on management responsibility for managing operational delivery of NHS services for 2012/13 and planning for 2013/14.  London PCT Clusters, Clinical Commissioning Groups, Health Education England, Local Education and Training Boards, and Public Health England  will take on their new responsibilities when they are ready to do so, which will happen incrementally from 1^st October 2012 to 1^st April 2013.  Statutory accountability will remain unchanged until April 2013.

London is not developing Local Are Teams in the same way as the rest of the country.  Cluster Chief Executives throughout the transition will report to the CEO NHS London.

When they are appointed the three NHS Commissioning Board Delivery Directors for London will be appointed as Associate Directors of the relevant PCT Cluster Boards.

A new Handover and Closure Committee will be established to oversee the way NHS London and PCTs are closed down and their function and assets transferred.

Clinical Commissioning Groups

There are 32 emerging CCGs in London, the majority coterminous with their local authority boundaries.

Harrow CCG is in Wave 2 for authorisation and expects a site visit in October and a decision on authorisation in November.  Hillingdon CCG is in Wave 4, with a site visit in December and a decision in January 2013.

NHS London’s Legacy Document and Library of Knowledge:

In common with other SHAs, NHS London is required to produce these documents to hand over to the organisations that will take over its functions or the functions of PCT clusters.  The documents are in the process of compilation.

Here are some snippets from the Board Meeting on 7^th September

Transition: There will be no formal transfer of statutory functions ahead of new organisations becoming operational in April 2013.  New bodies will only be accountable for responsibilities consistent with their preparatory powers and planning for 2013/14.

CCG Authorisation: Harrow is on track for authorisation in Wave 2 with the formal authorisation visit on 23^rd October 2012.  Hillingdon has delayed its application to Wave 4, to review its financial position.

Olympics: The Cluster performed well during the Games with business as usual.  The London Ambulance Service  exceeded its targets throughout the period.

London Specialised Commissioning Group: This is a joint committee of the 31 London PCTs, commissioning a portfolio of specialised services on their behalf, in line with national arrangements.

Finance: NHS NW London ended 2011-12 with £60m surplus against the planned control total of £45m.  All eight PCTs in the sector broke even and met their statutory financial duties for 2011/12, but this was achieved by Hillingdon and some others only by receiving financial support within the cluster.

As at 31^st July 2012 the Cluster was reporting break-even position, but NHS Hillingdon has significant financial pressures.  Hillingdon’s position deteriorated in Month 4 to a deficit of £4.4m.

Performance: Over-performance is being experienced across all provider trust in the Cluster, mainly due to increases in demand.  Royal Brompton and Harefield FT has a variance of 12% above planned demand.  The Bowel Cancer awareness programme has resulted in increased activity in several trusts.

Imperial College presents the highest level of risk with respect to delivery of national standards.  It resumed national reporting in April after a break to deal with its problems, but has subsequently failed a number of cancer targets and its 18 weeks admitted target.

Hillingdon:

The borough has 48 GP practices, with a population of 264,000 which is projected to grow over the next five years and to become more diverse, with greater diversity in the younger age groups.  In 2008 ethnic minorities accounted for 30% of population, which is expected to increase to 50% by 2016.  Hillingdon is relatively affluent, being ranked 24^th most deprived of the 32 London boroughs.

A quarter of Hillingdon children are living in poverty and 21% of Year 6 children are classified as obese.  23% of the adult population is obese.  Major causes of death are tumours, circulatory disease and respiratory disease,

NHS North West London's consultation on its proposals for reconfiguration of health services include two local events in Hillingdon in September 2012.

On Wednesday 5th September there will be an event, open to everyone, at the Great Barn, Manor Farm, Ruislip  from 1pm - 9pm.  Consultation documents will be available, together with displays.  This will provide an opportunity to ask questions and clarify uncertainties.

A more in depth event featuring impacts within Hillingdon is being held on 26th September in the Middlesex Suite at the Civic Centre, Uxbridge.  Registration begins at 9.30am, for a 10am start. The meeting is scheduled to end at 1pm. followed by a light buffet.  Those wishing to attend are asked to telepone 01895 556251 to register  their attendance.    

1.  The reconfiguration of NW London NHS services started a 14 week public consultation on 2nd July 2012 

A public consultation meeting is being held in Hayes on Saturday 14^th July in the Methodist Church Station Road Hayes from 10am - 4pm. Other meeting dates will follow.

• As expected, it is proposed that the present eight A&Es are reduced to five. All proposed options keep A&Es at Hillingdon, Northwick Park and St Mary’s as major hospitals, with Hammersmith as a specialist hospital and Central Middlesex as a local hospital, both without A&Es. The preferred option also keeps A&Es at Chelsea & Westminster Hospital and West Middlesex Hospital.

o A second option keeps an A&E at Charring Cross instead of Chelsea and Westminster

o A third option keeps an A&E at Ealing Hospital instead of West Middlesex.

All options allow hospitals losing A&Es to have Urgent Care Centres instead and the hospitals with A&Es will be strengthened to offer improved 24/7 services.

2.  Royal Brompton Hospital ‘s paediatric heart surgery:  

Joint Primary Care Trusts decided on 4^th July that London needs only two sites to provide children’s heart surgery - Great Ormond Street and Evelina hospitals – and that the Royal Brompton will provide only diagnoses and non-surgical procedures. A subsequent message on the Royal Brompton’s website reassured parents that services would continue as normal in the near future and that any changes would not be implemented for some years.

• 3.  Online comparison of GP practices in London is now possible:
• If "myhealthlondon" is entered into the Google search engine, it will provide access to a comparison site provided by NHS London:

i. This site identifies participating GP practices within 1 mile, 2 miles, 5 miles of any London postcode

ii. Any five can then be compared for a range of factors – health outcomes, opening hours etc

iii. If one’s own GP practice is not taking part, then it is reasonable to complain to the senior GP!

NHS North West London’s Reconfiguration Programme: The proposals include:

• All nine acute hospitals in NW London (including Central Middlesex) will provide local services and an Urgent Care Centre, but the eight currently with A&E Departments will be reduced to five.
• The five major hospitals will have 24/7 A&Es, consultant-led obstetric units, inpatient paediatrics and associated complex care.  Three of these major hospitals will be Hillingdon, Northwick Park and St Mary’s hospitals.  The other two will be either:

1. Chelsea & Westminster Hospital (the preferred option) or Charring Cross Hospital
2. West Middlesex Hospital (the preferred option) or Ealing Hospital

• In all options:

1. Hammersmith Hospital is proposed as a specialist hospital
2. The Western Eye Hospital is proposed to move to St Mary’s Hospital

• If the preferred option is accepted, the hyper acute stroke unit at Charring Cross Hospital will move to St Mary’s Hospital.

Public consultation will start on 2^nd June and continue for 14 weeks.  There will be wide publicity with a flyer to all households, road shows, focus groups, GP events, staff events and public meetings. After consultation assessment, in January 2013 a Joint Committee of PCTs, comprising all eight NW London PCTs, will consider the programme board’s recommendations.   Final decisions will rest with the JCPCT.

London’s specialised stroke and trauma services: These services have resulted in significant improvements in patient outcomes.   London continued to perform significantly better than the rest of England on key measures and stroke mortality is lower in London than the rest of the UK, saving up to 400 lives in the last year.  Major trauma data shows similar improvements.  London is the only region with 24/7 consultant-delivered major trauma services, saving 58 lives in the first year.

London Health Improvement Board: The NHS in co-operation with the Mayor and local government aims to reduce smoking by 20% in the next six years, and to increase bowel cancer screening by 33% and earlier cancer diagnosis by 10% within three years, and to tackle child obesity and alcohol abuse.

myhealthlondon -  a website that compares GP practices in London: Asking Google to search for myhealthlondon leads to a website that identifies all signed up GP practices within 1 mile, 2 miles, or 5 miles of any London postcode.  Any five selected practices can then be compared for a wide range of criteria, including outcomes for various health conditions, opening hours, patient satisfaction and other factors, as well as comparison with London and national averages.