November 2016 Health Update

National Issues

1. Nursing Home beds: Profit margins have reduced, compounded by the impact of the national living wage – the number of beds has reduced and no longer meets demand, the whole health and care system suffers – more emergency admissions to A&E, more delays in hospital discharge etc.
2. Training places for doctors: The number of medical training places is to be expanded from September 2018 with the government funding an additional 1,500 student places each year, but there may be a requirement to work a minimum period in the NHS following graduation.

Royal Brompton & Harefield FT

1. Congenital Heart Disease (CHD) Proposals: Decommissioning of the Trust’s CHD services is not expected in 2017.  The national consultation process on the decommissioning proposals is expected to run from December 2016 to March 2017.  The Trust will respond.  So will The Community Voice.
2. Research Funding: Redistribution of Cardiovascular / Respiratory  Biomedical Research Centre funds from the capital to the regions will cost this Trust around £4m per year from April 2017.  The Trust’s Charity is considering bridging the funding gap until new research funding can be identified.
3. Finance: Despite NHS England activity being £1m below plan in September there was a surplus for the month partly due to the sale of 151 Sydney Street, which provided £4.3m more than plan.  Year to date the Harefield Heart Division contributed £7.6m to the Trust’s finances, in line with plan.

The Hillingdon Hospitals NHS FT

1. Third Heathrow Runway: The Trust’s Board will cite this decision as additional justification for rebuilding Hillingdon Hospital, on top of age and estate inadequacies. Implementation of the decision would lead to a bigger local workforce both during and after the runway’s
2. Peter Pan Ward Extension: The official opening of the paediatric ward extension on 22nd October was performed by Boris Johnson MP, who then toured the new Pharmacy and new Paediatric A&E.
3. A&E: Despite a supernumerary band 7 clinician on every A&E shift and two new triage rooms, the 95% four hour standard could not be met in September due to the increase in A&E activity.  
4. Proposed new role for Edmunds Ward: This step-down project, if agreed, will be run by GPs and Social Services, providing the equivalent of nursing home care for patients on discharge.
5. Finance: Despite the year to date surplus being £84k behind plan in September the Finance Director noted that if everything went well The Trust might still break even at year end in March 2017 but a deficit of over £6m was possible – some funding depends on achieving very challenging targets.

Hillingdon Clinical Commissioning Group

1. Financial performance: A letter from Dr Anne Rainsberry, Regional Director London, states that despite the CQC rating of “Requires improvement”, the Hillingdon CCG has achieved a significant financial turnaround  in the years from its inception, which is a major achievement. NHS England considers the CCG’s 2015-16 financial performance was sound.
2. Combatting the risk of stroke: Atrial fibrillation is a heart condition causing irregular heart beats, with a high risk of having a stroke – new medication can reduce the stroke risk dramatically, but few who would benefit are being treated.  So, this CCG has applied for a £50k grant so it can audit GPs’ lists to find patients whose medication should be changed.
3. Key performance challenges: These include London Ambulance Service response times, A&E four hour and longer waits, infection control, discharge from hospital problems, Child and Adolescent Mental Health waiting times, dementia screening and 111 Service problems.
4. Better Care Fund: This is the pooled budget of NHS and local Council, hosted by the Council.  Its concerns include discharge from hospital problems, and home placements for people with complex needs, particularly those with challenging behaviours.
5. Disabled Facilities Grants: In Quarter One 2016/17, 26 people aged over 60 years were enabled to stay in their own homes through these grants.
6. Carers’ respite: Also in the first Quarter, 130 carers were provided with respite or another carer, at a cost of £230.7k.  This underestimates the total care provided as carers were also supported by other means.