Community Voice Health

Finance

NHS Hillingdon has improved its position since its last Board meeting, reducing its in year deficit from £1.4million to £1.0million, which allows it to forecast break even by year end in March 2010.

Key recommendations of KPMG report for the Challenged Trust Board

·          Appointment to senior vacant posts to provide leaderships across the PCT - a Director of Public Health, a Medical Director, and a            strong Professional Executive Committee (PEC) Chairman.

·                Improved GP engagement – to manage demand and ensure best use of resources.

·               Stronger roles for the PEC and for Practice Based Commissioning.

               Applications are being received for a Director of Public Health and a Chief Medical Officer. 

Overspend analysis

A root cause analysis of Quarter1’s overspend on hospital activity identified a number of causes, including:

·         More elective referrals by GPs, particularly in trauma and orthopaedics.

·         Suspension of Dermatology Clinical Assessment and Treatment Service (CATS).

·         Weak performance of the Urgent Care Centre (UCC), the Referral Management Centre (RMC) and the Clinical                         Assessment Service.

·         Increased attendances at A&E.

·         A number of costly high dependency and intensive care patients

The KPMG report identified rising activity levels and below inflation tariffs as the biggest threats to the PCT in the medium term.  The PCT needs to work in partnership with PBC and providers to redesign care pathways and to develop cost effective models of care.

Hillingdon GP referrals to outpatients are processed by a referral management centre based in Southampton, operated by Hillingdon Health Limited (HHL), a joint venture between Hillingdon GP principals and Harmoni.  The RMC processes around 80% of GP referrals.  It aims to manage hospital utilisation and to streamline referral patterns, but it has not led to improved patient experience or better use of resources – and the hospital reports high error and “did not attend” rates.  The Audit Committee concluded that the RMC is not value for money.  A contract termination notice has been issued to HHL.

From April 2007 to September 2009, use of the UCC rose by 25% whilst overall A&E attendances rose  by 10%.   This upward trend is worrying and unaffordable. The PCT must tackle the root problem of why patients use these and other walk-in services rather than booking appointments  with their GPs.

Forecast growth in activity, combined with inflation and predicted nil growth in funding suggests savings of around 35% will be needed in local healthcare by 2015/16 – even if the £19m historic debt is written off!  To survive the recession and avoid indiscriminate cuts, all NHS organisations need to work in partnership.

Daniel Ward, Mount Vernon Hospital

Slow progress is being made towards the ward closure. Sensitive investigation of options is being explored with the families of the eight patients.  Closure is not expected until the New Year.

London Ambulance Service response times

Following our request, response times for Hillingdon were produced, as well as for the whole service.

Capital Investment Program for 2009 to 2010 – this includes:

Yiewsley Health Centre – Borough of Hillingdon is now looking for possible premises.

Physiotherapy Suite in a West Drayton converted shop – for completion by early 2010

Eastcote Health Centre – a major extension and internal upgrade is proposed, to start May 2010

HESA Health Centre -  major extension to rear of building is proposed, for completion by April 2010

Ickenham Clinic – proposed extension for a dental decontamination suite, for completion by April 2010

Annual Health Check Ratings for 2008-2009

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