Agenda item

Mr Gary Collier, the Council's Health and Social Care Integration Manager, advised that a lot of work had been undertaken with regard to shaping the future health and care system but that the publication of the planning requirements for the Better Care Fund were still awaited. 

Insofar as the system wide winter key performance indicators in respect of Hillingdon Hospital activity were concerned, the Board was advised that 74% of patients attending Hillingdon A&E each day were individuals registered with a GP in the Borough.  As the majority of people in all age groups who attended A&E were not admitted (63% in 2021 and 2022), it was queried how these patients could be educated to understand that A&E was not the most appropriate place for them to present.  It was also queried why over one third of patients presenting at A&E were admitted.  Ms Patricia Wright, Chief Executive at The Hillingdon Hospitals NHS Foundation Trust (THH), advised that the Urgent Treatment Centre (UTC) sat at the front end of A&E and only passed on patients that had had an accident or emergency.  As such the percentage of patients who were admitted from A&E was likely to be high as these were the patients that were most in need and were therefore in the right place. 

Professor Ian Goodman, North West London Integrated Care System (NWL ICS), advised that the running of the UTC had recently been changed.  The UTC had been commissioned by the Urgent Care Board and had been transferred back to THH to maintain at short notice. 

With regard to the Discharge to Assess pathway, it was requested that data be provided at a future meeting on the delays to hospital discharge, perhaps grouped by type of blockage.  Whilst Hillingdon had one of the best track records with regard to discharge, there were still patients that were staying in hospital longer than necessary and further work was needed on Emergency Department avoidance.  Ms Wright advised that there was lots of data available but that this varied on a day-to-day basis so a conversation was needed to determine what would be useful and achievable.  

Mr Keith Spencer, Co-Chairman and Managing Director at Hillingdon Health and Care Partners (HHCP), stated that the report had been useful but that it needed to include information about what partners were going to do about each of the issues.  He would be happy to take this action forward. 

With regard to addressing the budget deficit, Mr Tony Zaman, the Council's Interim Chief Executive, queried whether there was a tolerance level.  Ms Wright advised that there had been some discussion about whether the deficit sat at a place level or with the hospital and noted that THH was unable to control factors such as demand.  The NWL Integrated Care Board (ICB) held the budget and would be the body that set any tolerance levels (if they were to exist) but that it would need to set a balanced plan for 2023/2024.  The acute trusts in NWL were required to submit a collective balanced plan and the mental health trusts were being required to do something similar.  It was queried whether the plans being put in place addressed the historical deficit that had been caused by the funding formula and whether it would even balance.  Ms Wright advised that negotiations had been undertaken with the ICB at a Trust and place level.

Mr Spencer advised that, at a place level, the root cause of the deficit had been investigated.  Work had been commissioned to look at how a balanced plan could be put in place for the next five years that would unlock discussions with NWL ICB.  In addition, the hospital would need to identify and achieve efficiencies and action would need to be taken at a place level to reduce the demand on the hospital.  It was hoped that this plan would be shared with the Health and Wellbeing Board once developed. 

Professor Goodman noted that there was a focus on the money when the focus should actually be on the impact on patients.  Patients expected much more from the NHS now than they had before the pandemic which had created a backlog in primary and secondary care.  In local government too, the money to provide residents with support around Covid had gone but the expectation to deliver had remained. 

There was a large number of GPs aged 65+ who would be retiring in the next few years and this loss would need to be mitigated.  It was noted that only around half of those training as GPs went into practice (they were instead working as a locum, etc).  It was clear that the status quo was not an option.

RESOLVED:  That the discussion be noted.