Agenda item

Ms Maria O’Brien, the Managing Director of Hillingdon Community Health (HCH), advised that there were 32 different community services delivered by HCH which were split between adult services and children’s services.  For 2010/2011, an additional £600k had been secured from the PCT commissioning arm to develop services.  Service developments that had already been established included the expansion of the community physiotherapy services, provision of ‘home’ phlebotomy service for housebound patients and the introduction of a new wound care service for ambulant patients.  Further work was being undertaken regarding the expansion of community rehabilitation services for Parkinson’s, dementia and stroke.

Other work included:

• The commencement of a new walk-in TB clinic in Hayes
• Expansion of the paediatric community nursing service
• Appointment of an additional 4 school nurses
• Appointment of a breast feeding co-ordinator

Ms O’Brien acknowledged that there was still room for improvement but that HCH’s performance was tracked monthly.  It was noted that the performance was now in the top quartile of community arms across London.  HCH had not performed well with regard to capturing ethnicity data and district nurse response times.  It was believed that, in reality, the district nurse response times were not a problem as it was actually a recording issue. 

In 2006, the policy direction was to separate the commissioning and provider arms of the PCT.  This strategy did not appear to have changed with the new coalition Government.  Monthly staff side meetings had been held with the unions and Ms O’Brien had four-weekly talks with the teams.  From this consultation with the staff, it was clear that an NHS solution was the preferred option.  It was noted that the GPs had also been involved in the process at all stages and concerns that they had raised had been resolved. 

It was noted that the internal separation of the commissioning and provider functions had taken place 18 months ago and was working well.  The external separation would need to be managed carefully to ensure that Residents were aware that there would not be a reduction in services or a change in access points (unless the commissioners decommissioned the service).

There had been a number of options considered with regard to how the PCT would externally separate the commissioning and provider functions which included:

• Joining with one or more existing provider arms to form a Community Foundation Trust – this was not a viable option
• Integrate with an Acute Trust
• Integrate with a Mental Health Trust
• Integrate with a local authority – this was explored in detail
• Form a social enterprise

A high level options appraisal was conducted in January 2010 including an appraisal of potential partners against the following criteria:

• Strategic fit
• Quality and innovation
• Leadership
• Financial viability

Hillingdon PCT reviewed all of the options in line with the above criteria and concluded that only two options were viable for short listing to the next stage of the process: Community Services Assessment Panel or Central & North West London NHS Foundation Trust (CNWL).  The perceived benefits of selecting CNWL centred around improving outcomes and quality, the ease of service integration, clinical sustainability, financial stability and whole system fit. 

The Joint Integration Commission (JIC) was in place to oversee the integration and ensure that patients received the best quality and outcomes and that tax payers received the best value for money.  Membership of the JIC included NHS Hillingdon, HCH, CNWL, HCH Staff Side, LINks, GPs (Practice-based Commissioning (PbC)) and the Council. 

The proposals would now be the subject of a communications and engagement plan which would be considered by the staff and would be the subject of weekly written briefings, face-to-face meetings and posted on the Intranet.  In addition, engagement was being undertaken with PbC/GPs, the LINk (and other patient/public groups) as well as the Council. 

The next steps of the process would be to produce a due diligence report and an integrated business plan.  These would then need to be approved by the Cooperation and Competition Panel (CCP), Monitor, Hillingdon PCT and CNWL’s Board.   Full approval would then be given by the NHS London Board.  It was anticipated that the transfer would taken place on 1 April 2011 at the latest (although January 2011 was preferred).  Following the completion of the transfer, Hillingdon PCT would take on a contract management role with regard to the provider services in Hillingdon. 

Mr John Vaughan, Director of Strategic Planning and Partnership at CNWL, advised that CNWL had been talking to staff and consulted widely before the process had gone too far.  CNWL would ensure that it made improvements around access to services and would make sure that any staff efficiencies implemented would not have a negative impact on front line staff.  Ms Sandra Brookes, CNWL’s Service Director for Hillingdon, added that there were many areas where synergies could be realised. 

Members were advised that, if the proposal was successful, CNWL would be looking to establish financial efficiencies.  It was noted that the majority of savings were likely to come from the PCT as it would no longer be supporting HCH.  Mr Vaughan advised that one of the advantages of CNWL being a Foundation Trust was that it could use any surplus funding generated for the provision of services such as the Wellbeing Centre at Boots the Chemist.  Any savings made by the PCT could be reinvested into commissioning more services.

Hillingdon PCTs Director of Communications was in the process of developing a communications plan which would be an important tool to update staff and service users.  A press release had been issued but it was recognised that this was not enough.  More work would need to be undertaken to ensure that Residents were aware that there would not be a significant change to the services that they received.  The timing and wording of this communication would be essential. 

The due diligence process required that key criteria be met, such as improved pathways to the community.  These criteria had been borne in mind throughout the whole process to date.  The due diligence process would culminate in the production of one report which would include background information (reports on accounts, estates, clinical service, etc) and would illustrate that the proposal to appoint CNWL was appropriate.  This information would be checked by Monitor. 

CNWL advised that it had been rated mid-table in London in the patient survey.  Significant improvements had been implemented and CNWL had performed markedly better in the Community Survey this year than it had two years ago.  Members agreed that this was a positive step forward.   

In response to a Member’s question, it was noted that any complaints received about the service provided would either go to CNWL or the PCT in the first instance.  

Members requested that representatives from CNWL and Hillingdon PCT attend the External Services Scrutiny Committee meeting being held on 24 November 2010 to update them on progress. 

RESOLVED:  That:

1. representatives from Hillingdon PCT and CNWL be invited to attend the External Services Scrutiny Committee meeting on 24 November 2010; and
2. the report be noted.