Transforming health services in Hillingdon

Transcription

1 Transforming health services in Hillingdon NHS Hillingdon Clinical Commissioning Group Annual Report 2013/14 1

2 Contents Annual Report 2013/ Foreword from the Chair and Chief Officer of NHS Hillingdon Clinical Commissioning Group... 5 Member Practices Introduction... 6 Strategic Report... 8 Hillingdon Clinical Commissioning Group... 8 Authorisation of Hillingdon Clinical Commissioning Group... 8 The London Borough of Hillingdon... 9 Hillingdon CCG s strategic objectives Supporting environmental, social and community issues in Hillingdon Progress against agreed targets Progress against financial targets Improving clinical standards in Hillingdon Tackling inequalities in Hillingdon Working with public and patients Transforming care in Hillingdon Key highlights from 2013/ Working with our partners in Hillingdon Hillingdon Clinical Commissioning Group s performance against national indicators Key challenges and pressures Sustainability report Equality report Members Report List of member practices of Hillingdon CCG Hillingdon CCG Governing Body and committee members Collaborative working between the clinical commissioning groups in North West London Sickness absence data External audit Disclosure of serious incidents Cost allocation and setting of charges for information Principles for remedy Employee consultation Disabled employees Emergency preparedness, resilience and response Remuneration report Statement of the Accountable Officer s responsibilities

3 Annual Governance Statement 2013/ Financial Accounts Statement 2013/

4 Annual Report 2013/14 4

5 Foreword from the Chair and Chief Officer of NHS Hillingdon Clinical Commissioning Group Transforming health services in Hillingdon is Hillingdon Clinical Commissioning Group s first annual report for 2013/14. As a GP-led organisation, we are in the unique position of being able to draw upon the first-hand experience of our patients who use the health services we commission. We have developed an outcome based approach to commissioning, which takes into account the views of patients and the public, as well as the relevant health issues, so we are clear what outcomes we want services to deliver. This report sets out the progress we have made in our first year, from the reconfiguration of hospital services, providing more services in a community setting, and redesigning individual care pathways to better meet the needs of patients. These achievements have not been without challenges, and in particular the need to meet the growing health needs of the borough while at the same time ensuring we work within the budgets we have been set. Reflecting on our work to date, a number of clear themes emerge: Joined up NHS services deliver better care, because they improve the experience and outcomes of care and enables resources to be used more effectively to treat patients, especially those with multiple needs; Improving care involves not just the NHS it needs to involve the public and patients, local authorities and community representatives, all with a shared commitment to providing excellent patient care; Clinicians are effective champions of change because of our daily contact with patients and the insights this gives us; and Patient empowerment is not an afterthought it has to be the starting point for together creating the services that patients require. What we have achieved in 2013/14 has only been possible through working closely with NHS providers, the local authority, voluntary and community organisations, and of course the public and patients. We therefore give our thanks to everyone we have worked with in Hillingdon, and look forward to continuing to work with you in the coming year ahead as together we transform health services in Hillingdon through clinically led commissioning. Dr Ian Goodman Chair and local GP NHS Hillingdon Clinical Commissioning Group Rob Larkman Chief Officer NHS Brent, Harrow and Hillingdon Clinical Commissioning Groups 5

6 Member Practices Introduction The member practices of Hillingdon Clinical Commissioning Group have worked closely with our Governing Body over the course of the year to improve the services provided to our patients in the borough. There are 48 GP practices in Hillingdon, and we are organised into a network of six peer groups which are arranged on a geographical basis across the borough. We meet as GP commissioners in network groups to collectively feed into the commissioning process and decision making and share best practice. This has been particularly important as new care pathways for patients have been introduced, and for sharing ideas on how best we can manage our budgets. Hillingdon CCG also holds regular GP forums which are attended by all practice members across the borough, where we discuss issues of common concern. Throughout 2013/14, we have been working hard to transform the health system itself how the different parts of the NHS in North West London work together, and integrate these services better with the social care services provide by our partner organisations. In addition, we have worked with patients and providers to transform a number of individual care pathways, so that more services are provided in a community setting, making it easier for patients to access them and receive the care they need. In particular, Hillingdon GPs have worked with the Hillingdon CCG governing body to implement new planned care pathways, and integration of health services through new integrated care pathways. Using an outcome based approach to commissioning ensures that the services we commission for the residents of Hillingdon better meet their needs, and provide support and care at an earlier stage to avoid them getting seriously ill. Another important driver for us is to ensure that services are provided as efficiently as possible, so that we make best use of our financial resources. This is particularly important for Hillingdon, given we inherited a deficit budget from the former Hillingdon Primary Care Trust, and our annual budget makes it challenging to commission the services required to meet the needs of the borough. Evaluation of how we work together is very important, so that collectively we make decisions that result in better health outcomes for our patients. For example, the 360 degree stakeholder survey commissioned by NHS England will provide us with useful insights into how we can work better both as an organisation, and with our provider organisations to commission and manage services for our patients. We also have introduced a unique management development programme for training and coaching GPs who want to have a greater role in the running of the CCG. All aspects of Hillingdon CCG s work are regularly evaluated by NHS England to ensure we are meeting the local needs of our patients. There are monthly and quarterly meetings where performance and outcomes are discussed, and recommendations for further action agreed. This work is grouped into six specific domains which includes one which looks at whether the CCG has strong and robust leadership, where Hillingdon CCG is evaluated as NHS England assured. This assurance process provides us with the opportunity to review our work in a supportive and developmental environment, and enables Hillingdon CCG to become the best commissioning organisations we can be building on what CCGs are already doing to hold themselves accountable to their communities, members and stakeholders. 6

7 This has been our first year of operation as the body responsible for commissioning health services for residents in Hillingdon. Having GPs working together with patients, providers and our neighbouring CCGs in North West London has enabled us to make significant progress towards our vision for the borough. This is that through clinically focused commissioning, Hillingdon CCG will be recognised for delivering a high performing, good quality collaborative and cost effective acute and community based health system for the residents for Hillingdon, within available resources in an environment that delivers quality care, supports clinicians and is satisfying for all staff and members. We look forward to continuing this important work with our patients and providers in 2014/15. 7

8 Strategic Report Hillingdon Clinical Commissioning Group Hillingdon Clinical Commissioning Group (CCG) is made up of all 48 GP practices in Hillingdon, and is responsible for the planning and design of many of the health services needed by people who live in Hillingdon. We have a governing body, comprising of local GPs, a hospital doctor, nurse, lay members and officers which meets in public each month. We are very much focused on the needs of patients, carers and residents, making sure they are at the forefront of everything we do. Working together with our patients, we have an outcome based approach to commissioning, which provides coordinated and effective services that meet their needs. Our most important priorities are to provide more health services in a community setting and provide more tailored mental health services that will better support people who are ill. Although we do not directly commission primary care services (GPs, dentists, pharmacists and optometrists) we recognise our role in helping to develop primary care and improving access to these services. Achieving this will take time, and we are committed to delivering clear improvements to the quality, access and co-ordination of local health services and at the same time, ensuring we demonstrate best value for money. In carrying out this work, Hillingdon CCG will not compromise health standards and patient safety when making changes to services. The Hillingdon Hospital is the main hospital in the borough, and many patients are referred there for treatment by their GP. Community and mental health services for the borough are commissioned from Central and North West London NHS Foundation Trust. We work closely with our partners to ensure that patients receive a single seamless service across all providers. Hillingdon CCG works in a federation with Brent and Harrow CCGs which are adjacent to our borough. Working in a federation means we can share senior posts, which saves on management costs. The CCGs work closely together on issues that affect all three CCGs, as well as sharing knowledge and experience on specific projects. The federation also works with the five other CCGs in inner North West London on issues of common interest, such as the Shaping a healthier future programme to reconfigure hospital services across North West London. Authorisation of Hillingdon Clinical Commissioning Group All CCGs in England have to be authorised by NHS England under section 14B of the National Health Service Act 2006 (as amended). Hillingdon CCG was authorised by the NHS Commissioning Board in March 2013, with five conditions placed upon it, which meant NHS England required additional work from the CCG to meet these conditions. These conditions were that the CCG must: Have a clear and credible integrated plan that meets authorisation requirements; 8

9 Have a detailed financial plan that delivers financial balance, sets out how it will manage within its management allowance, and is integrated with the commissioning plan; Demonstrate that QIPP is integrated within all plans and clearly explain any changes to existing QIPP plans; Provide evidence that the likely inheritance from the PCT is quantified, identified, understood and that robust transition arrangements are in place; and Provide a clear and time limited path to resolution, where the area covered by the CCG is not on track to deliver its plan. Following the submission of further evidence by the CCG, four of the conditions were removed in June The remaining condition The CCG must have a clear and credible integrated plan that meets authorisation requirements relates to the CCG s financial deficit. Hillingdon PCT has been in deficit for much of the last 10 years which has undermined investment in innovation, puts at risk the delivery of high quality services to meet the changing health needs of our population and risks failure of the CCG to meet its statutory obligation to deliver a balanced budget. We have a financial recovery programme in place to address this deficit and which reflects priorities set out in the borough s Joint Strategic Needs Assessment (JSNA), Health and Wellbeing Strategy and supports implementation of the Shaping a healthier future and out of hospital strategies. Whilst the deficit is reducing and the fact that Hillingdon CCG is underfunded against national criteria is recognised, this condition is expected to remain in place until the deficit is removed. The London Borough of Hillingdon Hillingdon is the second largest of London s 32 boroughs covering an area of 42 square miles. Hillingdon s population for 2011 was estimated at 273,900 (13 th largest in London), an increase of 2.93 per cent over midyear estimates for Hillingdon has significantly higher population of young people (aged 5-19) compared with England and London. The population of older age groups (50+) is also larger than London but smaller than England. Both groups are expected to increase ahead of average population growth rates. Hillingdon is a relatively affluent borough, but with large differences existing between the north and south. The north of the borough is semi-rural, with large sections protected by green-belt regulation. The south of the borough is more urban and densely populated. It also has areas falling in the 20 per cent most deprived quartile nationally, and a significant number of areas have children living in poverty. Hillingdon is an ethnically diverse borough with around 32 per cent of the population from black and minority ethnic communities, which is lower than London s 35 per cent. The largest ethnic community is Asian, with Indian community forming 13 per cent of the total population followed by Black at 3.7 per cent Hillingdon has 48 GP practices, 42 dental practices with 150 GDPs, 62 Pharmacies and 47 ophthalmic practices in the borough. 9

10 The borough s key health trends are: Although population growth as a whole is low (around 0.6 per cent a year) the majority of growth will be in the elderly population, implying a greater need for health and social care services; The number of older people with dementia is expected to increase by seven per cent over five years to 2015; A higher burden of households (3.8 per cent) will need support for physical disabilities, frail elderly etc. and 29 per cent of households with frail elderly members living in housing unsuitable for their needs; Childhood obesity is rising, with 20 per cent of year 6 students classified as obese, and likely to suffer from cardiovascular diseases in time; and Significantly higher numbers of alcohol related hospital admissions compared to England (19 per cent higher for men, nine per cent for women). Hillingdon CCG s strategic objectives Our vision is that through clinically focused commissioning, Hillingdon CCG will be recognised for delivering a high performing, good quality and cost effective acute and community based health system for the residents for Hillingdon, within available resources in an environment that delivers quality care, supports clinicians and is satisfying for all staff and members. We have three key strategic programmes in place to help us to achieve our vision which are the reconfiguration of hospital services through Shaping a healthier future ; our out of hospital strategy; and our financial recovery and savings programme. The success of these programmes will be measured through the delivery of a range of services outside of acute hospitals, an expanded primary and community care offer which will lead to a reduction in acute activity and spend, and better integrated hospital and community care, including social care. Working closely with our providers, the local authority and community and voluntary sector groups is essential in for us to achieve this. Our financial recovery and savings plan is vital to help us achieve a sustainable health economy in Hillingdon, given the historical levels of deficit in the borough. The financial plan has a number of work streams where we plan to make efficiency savings: Unscheduled care and integrated care Planned care Community services Mental health and continuing care Prescribing Acute commissioning Practice commissioning improvement Each year we publish our commissioning intentions which set out our priorities and outcomes for the year, and the services we intend to commission in order to achieve them. We are also working hard to improve the performance of primary care in 10

11 Hillingdon generally, and have been supporting our GPs to work in networks in order to share resources and expertise that will deliver better care to their patients. Information about much of our work to improve health services in Hillingdon is set out in this report. Supporting environmental, social and community issues in Hillingdon Hillingdon CCG is committed to improving the health and wellbeing of all residents of Hillingdon, and in particular those groups of people who are disadvantaged, are hard to reach, or are vulnerable whether young or old. We work closely with a wide range of partner organisations to achieve this, as we all have a part to play in helping people to lead the best possible healthy and happy lives. Hillingdon s Health and Wellbeing Board is the principle forum for the main organisations in Hillingdon to oversee work to improve health and social outcomes in the borough, and Hillingdon CCG is a major partner on the board. The priorities of the board are to: Give every child the best start in life Help vulnerable families Empower communities to take better care of themselves Improve mental wellbeing throughout life We are also members of the adult and children s safeguarding boards, where decisions are made on how we collectively support vulnerable and at risk persons in these age groups. Hillingdon CCG is working more closely with Hillingdon Council to commission health and social services together, so that people who require both health and social care can receive it as an integrated service. This means services are more tailored to their individual needs, and services can be delivered more efficiently and effectively. Progress against agreed targets Hillingdon CCG worked hard throughout the year to achieve our targets, and performance against the key ones are set out in this annual report. Key overall priorities have been to provide more services in a community setting, improve the performance in primary care, and work with our public and patients to improve health services in Hillingdon. Our work has also involved working closely with our partner organisations in Hillingdon, to ensure that together we can provide patient-focused services that meet their needs. Progress against financial targets The Accounts in Section 3 have been prepared under a direction issued by the NHS Commissioning Board under the National Health Service Act 2006 (as amended). These accounts have been prepared on the going concern basis, despite the issue of a report to the Secretary of State for Health under Section 19 of the Audit Commission Act 1998 for the anticipated breach of financial duties. 11

12 Public sector bodies are assumed to be going concerns where the continuation of the provision of a service in the future is anticipated, as evidenced by the inclusion of a financial provision for that service in published documents. Statutory financial duties All clinical commissioning groups have a number of financial duties under the National Health Service Act 2006 (as amended) regarding the use of it resources. NHS Hillingdon CCG s performance against each is summarised below: expenditure not to exceed its income. For 2013/14 the CCG had a deficit of 5.0m; capital resource use not to exceed the amount specified in Directions. For 2013/14 the CCG did not have a capital allocation; and revenue resource use not to exceed the amount specified in directions. For 2013/14 Hillingdon CCG s net revenue expenditure totalled 306m, against a revenue resource limit of 301m. In addition the NHS Commissioning Board has placed the following additional controls on clinical commissioning groups use of resources: capital resource use on specified matters not to exceed the amount specified in directions. For 2013/14 the CCG did not have a capital allocation; revenue resource use on specified matters not to exceed the amount specified in directions. For 2013/14 the CCG had a deficit of 5.1m (programme cost); and revenue administration resource use not to exceed the amount specified in directions. For 2013/14 the CCG had a surplus of 0.1m (running cost). Programme and running costs together equal the CCG s outturn deficit ( 5.0m). The CCG set an opening deficit budget with the agreement of NHS England of 12.2m. The actual outturn deficit is 5.0m. Background to Hillingdon CCG s finances From April 2013 Hillingdon Clinical Commissioning Group (CCG) has been responsible for commissioning (planning and purchasing) local health services (excluding primary care and specialised services, which are commissioned by NHS England. Examples of specialised services include services for patients with cystic fibrosis and services for some cardiology treatments). Previously primary care trusts (PCTs) had responsibility for the full range of services. Hillingdon CCG inherited from the PCT an on-going shortfall of 23.7m (this is the on-going difference between the CCG s income the money the CCG receives - and expenditure the money the CCG is spending on healthcare for its residents needs). To address this shortfall, Hillingdon CCG agreed a three year recovery plan to restore the CCG to an overall balanced financial position (money CCG receives equalling spend on local health services) and as part of this a deficit plan was agreed with NHS England of 12.2m for 2013/14. At the end of the financial year, this figure had reduced to 5.0m. 12

13 Clinical commissioning group funding allocations The 2012 NHS Act requires NHS England to look at reducing inequalities in access to, and outcomes from, healthcare. The new funding calculations for the CCG allocations (the money the CCG receives from NHS England for its local health services) includes population growth, based on 2011 census information and GP patient list sizes, the effect of relative deprivation and poverty on health need, the impact of an ageing population and geographical cost differences across England. For 2014/15, all CCGs have received an increase of 2.14 per cent on their 2013/14 funding. CCGs judged to be under their target allocation funding received more funding than the national average increase in recognition of the additional health need of their populations. For 2014/15 Hillingdon is currently assessed as receiving 26.8m (8.8 per cent) less funding than its target share. Hillingdon CCG therefore received one of the highest increases in the country for 2014/15, amounting to 4.36 per cent on the 2013/14 funding baseline of 278.8m. This means the CCG receives c 12.1m growth funding in 2014/15. Hillingdon CCG s 2014/15 financial plan After CCGs have received their confirmed funding allocations, each CCG prepares a financial plan for the next year. For 2014/15, Hillingdon CCG has prepared a balanced budget. This plan however assumes agreement to additional funding from other North West London CCGs to cover: Funding for the non-repayment of forecast 13/14 deficit Funding to support 14/15 planned budget shortfall Retain 2.5% funding from joint CCG fund Funding to support Out of Hospital investment 5.2m 7.7m 7.6m 5.3m NB. All aspects of the North West London financial strategy are dependent on NHS England agreement as part of their review and sign-off of 2014/15 operating plans for all CCGs, and as part of this, ensuring consistency to statutory and other requirements on CCGs. Impact of Ealing CCG leaving the Brent, Harrow and Hillingdon federation An impact assessment on running costs was completed in August as part of the submission to NHS England for Ealing CCG s transfer from the BEHH Federation to the CWHH Collaboration. The conclusion of this impact was as follows: The overall impact on the running costs of the eight CCGs in North West London is an increase in costs of 485,000. All CCGs are able to remain within their running cost allowance for the year. However there will be an increase in costs for BHH as a result of BEHH shared team costs being spread over three CCGs rather than four. 13

14 To recognise this, the following has been agreed: In 2013/14 BEHH will not make a financial contribution to the non-recurrent element of the Imperial contract For 2014/15 onwards, following a preliminary review of running costs across BHH, a compensating programme allocation will be made to BHH to offset the increased running costs. This will be funded from the NWL financial strategy or from CWHHE if the financial strategy arrangements have been discontinued. Improving clinical standards in Hillingdon The Francis report into Mid Staffordshire Foundation NHS Trust calls for a rebalance and refocus on commissioning to ensure the procurement of enhanced quality standards that drive improvements in the NHS. Since the release of the Francis Report in February 2013, Hillingdon CCG s Director of Quality and Safety and the Director of Delivery and Performance have been working with the North West London Commissioning Support Unit, to identify specific quality measures that will form part of a new early warning system. The Director of Quality and Safety has also agreed a reporting format for NHS Trusts to demonstrate how organisations are implementing the Francis recommendations. The three CCGs in the federation will also work with NHS England to devise and agree these new enhanced quality standards. The intention is that we will be able to identify at an early stage when things are going wrong within a provider organisation from which they commission services. Francis calls for tighter supervision of providers by CCGs and a watertight corporate memory to ensure candid information about them is passed on and for CCGs to have powers of intervention where substandard or unsafe services are being provided. The Director of Quality and Safety led three workshops attended by managers, clinicians and service users from across Brent, Harrow and Hillingdon CCGs to consider in more detail how to take forward key concerns raised by the Francis report. Three working groups were established to look at collection and use of soft information; use of performance and quality monitoring data; and assessing culture. Francis also recommends commissioners be entitled to intervene in the management of individual patient complaints if it is felt they are not being dealt with satisfactorily. The three CCGs have reviewed the complaints process in line with Francis and to take account of those recommendations from NHS England as a result of the Clywd review of the national complaints procedure. The Director of Quality and Safety is also leading on a system review to uniformly consider safeguarding issues for both adults and children during the investigations of serious incidents and complaints. One of the report s recommendations was that GPs undertake a monitoring role on behalf of their patients who receive acute hospital and other specialist services, and this will be monitored by specific quality measures agreed during the contract negotiations. 14

15 Tackling inequalities in Hillingdon All CCGs have to publish equality objectives which ensure we are promoting and meeting the rights of protected groups of patients and their carers, as well as those who work in the CCG. We are committed to having our objectives embedded in our day to day work, so that we address inequalities and that health services can be positively accessed by all people, patients and carers who need them. We published our equality objectives in October 2013, having worked closely with the voluntary and community sector to draw them up, and will monitor their implementation throughout the course of the year. Working with public and patients Hillingdon CCG is committed to working with the public and patients in order to get their views and feedback on health services, so that they can be taken into account when designing new care pathways. We hold quarterly Meet the CCG public meetings in different parts of the borough, and which are well attended. Issues discussed include improving access to primary care, mental health services and the Shaping a healthier future programme. The CCG also holds other meetings to look at specific issues, such as our plans with Hillingdon Council to provide better integrated care across health and social services, starting with services for older people. We have a public and patient engagement committee which is made up of representatives from the voluntary sector, as well as a number of members of the public from across the borough. In recognition of the importance of their role, in 2013/14 we set up a new carers impact assessment group made up of carers in Hillingdon, to advise us on the impact proposed changes to services could have on patients and carers. The first issue they looked at was services for people who are mentally ill, and the group provided helpful ideas on how we can improve these services. We carried out consultations on changes to specific pathways including musculoskeletal services and at the end of 2013/14, started a consultation on new dermatology services. We certify that NHS Hillingdon CCG has complied with the statutory duties laid down in the National Health Service Act 2006 (as amended). Transforming care in Hillingdon Hillingdon CCG has ambitious plans to transform the way care is provided in the borough so that patients receive the best possible treatment through high quality integrated care. The following diagram shows how our GP networks, primary care transformation, whole system integration and the Shaping a healthier future reconfiguration of hospital serivces will work together to transform health care in Hillingdon. Each element is described in greater detail below. 15

16 Transforming primary care We are developing greater capacity in primary care services in Hillingdon through a range of measures including providing more bookable GP appointments; greater cooperation between practices through forming networks to provide additional services and support improved primary care; and commissioning additional services in primary care. Whole systems integrated care Hillingdon CCG is working with Hillingdon Council and key voluntary and community sector organisations to provide more services that cover both health and social care. We have applied for funding from the Government s new Better Care Fund to support specific services that are provided to patients using health and social care, in the first instances, targeted at services for the over 65s. Shaping a healthier future Shaping a healthier future is our major programme of improvements which the NHS is implementing across the eight boroughs in North West London (Brent, Ealing, Hammersmith and Fulham, Harrow, Hillingdon, Hounslow, Kensington and Chelsea and Westminster). North West London has a growing and ageing population and at present specialist hospital services are too thinly spread over too many sites and some facilities are inadequate for today s requirements. The key principle that underpins the reconfiguration programme is the centralisation of most specialist services (such as A&E, maternity, paediatrics, emergency and non- 16

17 elective care). Having highly skilled clinicians, supported by excellent facilities, will lead to better clinical outcomes and safer services for patients. In order to achieve this, five of the existing nine hospitals in North West London will become major acute hospitals. These are The Hillingdon Hospital in Hillingdon, Northwick Park Hospital in Brent, St Mary s Hospital in Westminster, Chelsea & Westminster in Kensington & Chelsea and West Middlesex Hospital in Hounslow. Three other hospitals will become local hospitals Ealing Hospital in Ealing, Charing Cross Hospital and Hammersmith Hospital in Hammersmith and Fulham. And Central Middlesex Hospital in Brent will become an elective hospital. Outline business cases for the hospital sites are currently being developed. These describe the detailed service changes at each site, how they will be delivered and the capital required to make these changes. They also explain how the changes will improve quality, the workforce implications and the plans for making these changes over the coming years. The Department of Health is expecting to review these cases during the second half of In 2014/15 the CCGs, working closely with these hospitals, will begin the implementation of their reconfiguration plans. This will include the transition of A&E services from Hammersmith Hospital and Central Middlesex Hospital to alternative sites, and the opening of a new A&E department at Northwick Park Hospital. Detailed transition plans are currently being developed, with the changes being led locally by provider organisations. Key highlights from 2013/14 As well as transforming the way health services work together in Hillingdon, in 2013/14 we undertook a number of projects to improve specific services, using our outcome based approach to commissioning to commission services that deliver the outcomes we want to achieve. Improving urgent care in Hillingdon NHS urgent care services provide care to patients who need medical help quickly and unexpectedly. Because of the unusually cold and prolonged winter of 2012/13, there was significant pressure on urgent and emergency care services nationally, including in Hillingdon. As a result, NHS England launched a review of urgent and emergency care. All CCGs which had an A&E service in their area were required to set up an urgent care working group, to consider how emergency and urgent care services could be improved for the following winter in 2031/14. Hillingdon CCG had already implemented a working group during spring 2013, which went on to oversee the production of the recovery and improvement plan with nearly 100 actions to improve the service. The plan was one of the first in London to be approved by NHS England, and nearly all the actions have now been implemented. This enabled Hillingdon Hospital to maintain the national standard during the first three quarters of 2013/14 for seeing, treating and discharging 95 per cent or more patients from the A&E department within four hours. In 2013/14 Hillingdon CCG commissioned a new and enlarged urgent care centre at The Hillingdon Hospital, in order to relieve pressure on the hospital s A&E department and ensure patients receive the right care. The CCG appointed a 17

18 partnership of The Ealing Hospital NHS Trust, Greenbrook Healthcare, North West London Hospitals NHS Trust and LCW - Unscheduled Care Collaborative, to provide the urgent care service in a new purpose built location at the hospital 24 hours a day seven days a week. The urgent care centre opened on 1 October 2013 and to-date has regularly reached its target of seeing 60 per cent of patients who turn up at the hospital seeking urgent or emergency treatment. This has meant that patients are seen quicker, relieving pressure on the A&E department which can concentrate on treating people who are seriously ill. The new NHS 111 telephone service continues to operate in Hillingdon, following its introduction in March Since then, the service has been launched across the capital, which has meant we have been able to take into account feedback and performance of the service in other areas in London. This information will be taken into account when we retender the contract for the service in 2014/15. Improving performance at The Hillingdon Hospital We worked closely with The Hillingdon Hospital throughout 2013/14 to ensure services we commissioned from them met patients needs. We were therefore delighted when the hospital was highly commended the hospital for an improvement in its performance for weekend emergency hospital standardised mortality ratios as part of the 2013 Dr Foster hospital guide awards, published in January The Trust was one of twelve in the country to have seen an improvement in performance at weekends on either weekend emergency HSMR, weekend readmission rates or weekend repair of broken hips - and whose performance on the four main mortality metrics used in the Hospital Guide: HSMR, SHMI, deaths in lowrisk conditions and deaths after surgery is at least in line with expected. Intermediate care services in Hillingdon Intermediate care services are provided to patients for up to six weeks following a serious medical event to help them regain as much independence as possible. This means the patient avoids inappropriate admission to hospital or residential care or unnecessarily prolonged stays in hospital. Care is provided both in a community and bed based hospital setting. The community based service is made up of the community rehabilitation service, the re-ablement service, Age UK Home from Hospital service, Telecare interventions, home care and any necessary equipment. In October 2013 the bed based intermediate care service was relocated to a newly refurbished site at The Hillingdon Hospital. This has improved the environment in which patients are supported to regain their independence and also means that the provider can support people with more complex needs to return to independence. A re-design of intermediate care services has been on-going in Hillingdon since May The existing community based rapid response service was expanded into the emergency department at Hillingdon Hospital in order to prevent patients who attend the department being admitted into acute care if their care needs could be met in the community. In October 2013 there was a further enhancement to the service with the introduction of night carers linked to the rapid response service. This means that in clinically 18

19 suitable cases, a patient who falls ill and needs support can be cared for at home rather than being admitted to The Hillingdon Hospital. The rapid response team will also refer suitable patients to the night carer service from the community. From October 2013, the Age UK emergency department support service was also made available during the afternoon as well as in the evening. Specific funding was also provided for a taxi service so that the Age UK workers could accompany patients home from the A&E. In January 2014, capacity in community rehabilitation was increased in order to reduce referral times from the rapid response service. Occupational therapists were also brought into the service in order to provide additional services to the team. A new community based crisis management and home treatment service for older adults with mental health conditions will be provided from April The service will work closely with the rapid response team, social care and the existing community mental health teams. Friends and Family Test pilot scheme In February 2014 Hillingdon CCG was awarded funding from NHS England to pilot a new friends and family test for community based services. The services we used the test for were musculoskeletal services and mental health services. Questionnaires were distributed widely across the borough in GP surgeries, and we also encouraged the voluntary sector to distribute the surveys to users of these services. The new test is a unique opportunity to gain feedback from current users of the services which we can use to make the services more suitable for their needs. Improving planned care in Hillingdon One of our five strategic goals is to develop clearly understood planned care pathways that ensure out of hospital care is delivered in a community setting, with GPs strengthening the process we use to refer patients. This will ensure patients are placed in the most appropriate healthcare setting and, where possible, patients will be able to access more services, such as outpatients and X-ray, closer to their home. In order to achieve this, Hillingdon CCG established clinical working groups, with representation from primary and secondary care clinicians and managers to develop care pathways for dermatology; ENT; gastroenterology; gynaecology; musculoskeletal; ophthalmology and urology. The guiding principles behind each pathway are to: ensure the patient is seen by the right professional, at the right time and place, to achieve the best health outcome; structure pathways around best evidence-based clinical practice; enable practices to monitor their referral rates against peers, with appropriate thresholds for referral, and comparable standards of care; offer integrated services via a single responsible provider, while enabling patient choice as to geographical location where necessary. This will require availability of the new service on Choose & Book; and deliver cost-effective treatment to ensure equity of spend and access to all patient groups. 19

20 To facilitate the delivery of this agenda, service specifications were developed and approved by the Quality, Safety, and Clinical Risk Committee and Governing Body for the development of community based multi-disciplinary clinical assessment and triage services (CATS), for musculoskeletal, Ophthalmology, Gynaecology, ENT, and Urology services in 2013/14. These services offer rapid access and streamlined care, including timely diagnostic tests and effective treatments and access via CATS for outpatients, day cases and elective admissions. The musculoskeletal CATS which offers services for lower limb, upper limb, upper spine, lower spine, hand, foot and ankle was the first service to go live in April To date 95 per cent of responders to the patient satisfaction survey have responded that they are extremely satisfied with the service. End of life services Hillingdon CCG believes that all patients in Hillingdon who are approaching the end of their life should have fast and equitable access to appropriate care, regardless of their age, ethnicity, religious belief, social status or diagnosis. Services to support people need to be flexible and responsive and delivered in the patients preferred place of care, as far as is practical. In order to receive the services they want, patients need to receive a continuity of care across the primary, secondary and tertiary boundaries that exist within the health service and between the NHS and voluntary sector. The quality of the service is to a considerable extent dependent on the skill of health and other professionals and the infrastructure for access and delivery. We have implemented the use of co-ordinate my care, a web based care record that can be viewed by the patient and all health practitioners who are providing care. This record is accessed by the clinician if a 111 call is made for urgent care and also by the London Ambulance Service who will then know the individual patients preference for care in the end of life period. Audits of this service demonstrate that those patients who have a documented care plan, 80 per cent receive care in their preferred setting. Working with our partners in Hillingdon Throughout 2013/14, Hillingdon CCG has sought to further develop effective relationships with all partners and stakeholders. In particular Hillingdon CCG has, through the local Health and Wellbeing Board, sought to strengthen its relationship with Hillingdon Council in recognition of the interdependencies between health and social care. This has included development and delivery of a planned programme of schemes to support implementation of the Hillingdon health and wellbeing strategy and more recently the development of a range of schemes to improve integration between health and social care as part of the Better Care Fund. Hillingdon CCG also actively participated in key council-led boards such as children and adult safeguarding. Through our whole system recovery programme board, we have strengthened relationships with our main providers to ensure a system-wide approach to managing financial and activity pressures in the local environment. 20

21 We consider patients and their carers to be key partners in development, delivery and management of local health services. A full programme of work to support patient engagement has been delivered, as set out in the section on working with public and patients. A shared team to support the federation of CCGs in key areas including quality, performance and finance, works alongside the local management team to ensure our strategic objectives are met. During the past year a programme of joint initiatives has been developed, including a clinical leadership development programme to ensure there are enough clinicians locally to ensure a legacy for CCG leadership roles in future years. Hillingdon CCG also works with the seven CCGs in North West London to deliver the acute reconfiguration programme Shaping a healthier future. In the coming year we will continue to increase levels of collaboration with local partners with the new national policy on integration acting as a key driver for this work. Our whole system Recovery Programme Board will oversee health transformation programmes at a local level such as seven day working and the national whole system integrated care (WSIC) programme. Hillingdon Clinical Commissioning Group s performance against national indicators Hillingdon CCG has a statutory duty to report on the performance of a number of services defined nationally within the NHS Constitution, Everyone Counts Guidance for 2013/14 (Operating Framework) and the NHS Mandated Outcomes Framework. In 2013/14 Hillingdon CCG met the following NHS performance standards: NHS Performance standards 18 weeks referral to treatment admitted performance within 18 weeks 18 weeks referral to treatment - non-admitted performance within 18 weeks 18 weeks referral to treatment - incomplete pathways performance within 18 weeks Patients waiting more than 6 weeks for a diagnostic test Clostridium difficile: reducing the number of outbreaks(improvement from 2012/13) Total time spent in A&E (all types) over 4 hours(improvement from 2012/13) Cancer two week wait percentage seen within two weeks of an urgent GP referral for suspected cancer Cancer 31 day wait - percentage of patients receiving first definitive treatment within one month of a cancer(improvement from 2012/13) Cancer 62 day wait - percentage treated in 62 days from urgent GP referral for suspected cancer(improvement from 2012/13) Mental Health IAPT proportion of people with depression and/or anxiety disorders referred for and receiving psychological therapies(improvement from 2012/13) Mental Health CPA proportion of patients on Care Programme Approach (CPA) discharged from inpatient care who are followed up within 7 days 21

22 Local measures Enabling people to die at their preferred place of death Reduction in average length of stay for people aged 65+ admitted as a result of falls Hillingdon CCG did not fully meet the following performance standards: NHS performance standards Number of 52 week referral to treatment pathways (admitted and nonadmitted) MRSA: reducing the number of outbreaks Mental Health IAPT proportion of people with depression and/or anxiety disorders receiving psychological therapies who are moving to recovery LAS handover times greater than 30mins LAS handover times greater than 60mins Local measures Reduce emergency admissions from care homes Key challenges and pressures There are a number of key issues that could have an impact on the work of Hillingdon CCG for the future. These are set out below, with an outline of the actions the CCG is taking to mitigate the associated risks. The financial risks are set out in section on progress against financial targets. Quality, innovation, prevention and productivity savings Because of our financial pressures, we have a challenging quality, innovation, productivity and prevention (QIPP) savings programme in place for 2014/15. We will need to achieve similar savings in 2015/16, which will bring us back into financial balance. We are also investing in services that will deliver early diagnosis and treatment, to prevent people becoming seriously ill and requiring more extensive treatment. We are also providing services to help people with long term conditions to manage themselves better, to prevent them getting seriously ill and requiring hospital treatment. Service transformation programmes Hillingdon CCG has ambitious plans to transform how health services are provided in Hillingdon so that they are better for patients and are delivered more efficiently. We are part of North West London s Shaping a healthier future programme to create more specialist centres of care. The Hillingdon Hospital will be one of the five major hospitals in North West London and will receive significant investment in new services. We also have our out of hospital strategy to move more hospital services into a community setting which will make them easier to access, support earlier intervention, and help hospitals to focus on specialist care. 22

23 Working with partner organisations Delivering the major changes we are planning will require working closely with a range of organisations in Hillingdon including the council, NHS providers, the voluntary sector and our neighbouring CCGs. Working together to achieve our shared goals will be vital if we are to succeed. Hillingdon CCG will continue to be an active partner in the Hillingdon Health and Wellbeing Board where joint strategies and plans to support the health and wellbeing needs of the community are agreed. We will also continue to develop our plans for whole system integrated commissioning with Hillingdon Council to deliver patient centred joined up health and social care services, utilising the Government s new Better Care Fund. Working with public and patients Given the scale and pace of change necessary in Hillingdon to create an effective and sustainable local health service, the way health services are provided and accessed is changing. It will be important to reassure the public and patients that clinical efficiency remains our top priority, that people understand the reasons for the change, and are able to navigate through this new healthcare system. We also want the public to take greater responsibility for their own care, which will include educating people on how to adopt a healthier life style. Hillingdon CCG has a board assurance framework which sets out the principal risks the CCG faces, the measures in place to manage these risks, and an overall risk rating. The assurance framework is regularly presented to the governing body so members can review the risks and mitigations, and record any actions or events which mean the risk rating for each issue may need to be amended. Sustainability report Hillingdon CCG s properties are owned and managed by NHS Property Services, which would normally provide information on the management of these properties for inclusion in this annual report. However, they are unable to do so for this year, and the intention is that they will provide the necessary data in 2014/15. Equality report Hillingdon CCGs is committed to equality of opportunity for all employees and is committed to employment practices, policies and procedures which ensure that no employee, or potential employee, receives less favourable treatment on the grounds of gender, race, colour, ethnic or national origin, sexual orientation, marital status, religion or belief, age, trade union membership, disability, offending background, domestic circumstances, social and employment status, HIV status, gender reassignment, political affiliation or any other personal characteristic. The promotion of equality and diversity is actively pursued through policies and ensures that employees receive fair, equitable and consistent treatment. It also ensures that employees, and potential employees, are not subject to direct or indirect discrimination. It is a condition of employment that all employees respect and act in accordance with our Equality and Diversity Policy. Failure to do so will result in the disciplinary procedure being instigated, which could result in dismissal. 23