Ealing

Ealing is London's third largest borough, which is located in the heart of west London. Ealing is a culturally and ethnically diverse borough.

  • London North West Healthcare NHS Trust and Imperial College Healthcare NHS Trust are the main providers of acute and specialist care.
  • Ealing ICO (part of the London North West Healthcare NHS Trust) provides the majority of community services.
  • West London Mental Health NHS Trust provides mental health service.

Ealing CCG 2015/16 annual report.

Find out more information on how to maintain your health and wellbeing in Ealing.

The chair of Ealing CCG:

Dr Mohini Parmar

Population demographics

  • 342,000*
  • It is estimated that by 2020, Ealing’s population will reach 369,000, which includes a 19.5% rise in the number of people over 65 years of age, and the number of people over 85 is expected to rise by 48%.
  • Ealing is an ethnically diverse borough. Black and minority ethnic (BME) communities, including individuals of mixed ethnicity, made up 46% of the Ealing’s total population in 2012. This compares to approximately 35% of Greater London’s population.

*based on 2013 ONS figures

Health challenges

  • The main causes of death are cardiovascular disease e.g. heart disease and stroke accounting for 31% of all deaths. This is followed by cancers or Neoplasms (30%) and respiratory disease (14%).
  • Diabetes is most prevalent in the south west of the Borough in the networks of South Southall and Southall.
  • Dementia and mental health problems are most prevalent in the central and east of the borough within the networks of Central Ealing, South Central Ealing and Acton.

Service improvements

Integrated care

All CCGs across North West London including Ealing are committed to more integrated health and social care:

  • Better Care Fund (BFC) supports integrated health and social care, with care provided in the most appropriate setting and with the funding resources fully aligned to need. Examples of initiatives funded by the BCF are:
  • Healthy at Home – to create a wholly integrated pathway of services and care for the older persons in Ealing, and help individuals remain at home and receive any care required in a home or community setting
  • GP Based Care Coordination – with the use of Care Planning, Care coordination, and Care Navigation, ECCG will develop individualised plans to support patients in managing their care, and navigating their way through the complex health and care system
  • Intermediate Care Service is a hospital admission avoidance scheme that aims to reduce non-elective and A&E attendances. It has led to the introduction of seven-day working, from 8am-8pm, as well as direct pathway referrals from other services e.g. LAS 
  • Adult Social Care, which includes winter resilience to support seven-day working, is to increase weekend duty support for hospital care management services and supported discharges
  • Integrated Care Pilot aims to empower patients to self-manage and supports early interventions and re-ablement. In 2013/14, 8,642 care plans were created.

Community and GP services

  • Rehabilitation services for older people after falls and fractures to help reduce re-admission to hospital.
  • Pulmonary rehabilitation: GPs refer qualified patients on the COPD long term conditions register for pulmonary rehab services
  • Primary care services for nursing homes: a GP service for nursing home residents aims to reduce the levels of A&E attendance and non-elective hospital admissions.
  • Community palliative care: the CCG, along with Hounslow CCG, funds the Meadows House Hospice to provide care for patients near the end of life.
  • Musculoskeletal services: outpatient, follow-up and radiology tests are now being delivered in a community setting.
  • Community transport pilot is being carried out in response to patient and public concerns, and aims to test transport services for those experiencing difficulty in attending appointments in the community and acute services.
  • Following the completion of a competitive tender, tele-dermatology is now provided in the community for outpatient and follow-up appointments.
  • Diabetes: a new community outpatient service for stable Type 2 diabetes patients is provided in multiple community locations, meaning patients don’t need to go to hospital for outpatient appointments.
  • Extended hours: all 79 GP practices are working to extend their practice hours. There are three GP practices open for four hours on a Saturday and four hours on a Sunday, with bookable appointments via 111.
  • Efficient appointments: we have invested in 63 practices which offer telephone consultations as an alternative to face-to-face appointments and 52 offer longer appointments where needed.
  • Training of community staff: following on from the success of the Ealing Structured Training Programme, we have started an annual programme of training for the primary care team.

Mental health and wellbeing

  • Liaison psychiatric services are in place to support patients in mental health crisis, and provide a supported discharge service to help reduce length of stay and delayed transfers of care.
  • We are Shifting Settings of Care for mental health patients, to reduce the number of patients in the care of West London Mental Health Trust. The scheme focuses on transferring patients back to a primary care setting, with additional support to help patients avoid the need for re-admission.
  • North West London was the second area nationally to have its action plan approved for the ground-breaking Mental Health Crisis Care Concordat, ensuring better, joined up, care for people experiencing mental health crisis.

Ealing Hospital

  • Ealing Hospital has a 24/7 A&E and a 24/7 Urgent Care Centre
  • On 1 July Ealing Hospital maternity birthing unit closed
  • Care of all women booked at Ealing (approximately 750) was safely transferred with the majority of women being rebooked to their first preferred alternative hospital.
  • Continuing to deliver ante/postnatal care locally in Ealing, including on the Ealing hospital site
  • The changes to Ealing maternity unit will enable all Trusts in North West London to provide significantly more consultant-led care than currently, working closer towards the London quality standard for obstetric units to provide 24/7 consultant cover, 365 days of the year.
  • As a result of the changes North West London has been able to improve maternity care for women across North West London by improving the midwife to birth ratio and increasing continuity of midwife care. There are currently 934 whole time equivalent (WTE) midwives in North West London and based on current plans there will be an additional 107 WTEs once recruitment is complete
  • It has also improved obstetric consultant cover in the six maternity units across North West London. For O&G consultants there are currently 98 WTE and once recruitment is complete there will be an additional eight
  • These consultants and midwives will be based in one fewer site so the increase will be magnified as there will be the additional staff across only six rotas rather than seven.
  • The changes also allow us to upgrade facilities at the six maternity units, expand the number of community midwives and invest in the home birth team
  • There are also now increased opening hours in the Emergency Gynaecology Unit.

Our future plans

Whilst we have made significant improvements, there is still more we want to do to improve care in Ealing.

Integrated care

  • The rollout of the Whole System approach to commissioning and delivering services will continue in 2015 with a further two pilot sites identified.
  • Integrated adult social care and GP IT systems enabling seamless transfer of patient records between hospital, community services and GP practices improving the quality of patient care
  • Health and Social care staff are brought together from their parent organisations into a single, integrated care team
  • Helping people take control of their own personal health budgets that they direct in order to achieve their care goals
  • Intermediate care: the key components of the service will be Rapid Response, Short Term Rehabilitation and Enhanced Supported Discharge from acute hospitals for Ealing registered patients. In order to reduce and avoid emergency admissions, referral pathways straight into the new integrated Healthy at Home service will be established via a single point of access, for GPs, LAS, A&E departments, district nursing service, practice nurses, GP out-of-hours, urgent care centres, and others as appropriate.

Mental health and wellbeing

  • Urgent access and care: urgent care in North West London has undergone extensive redesign for which we have received national recognition. The CCG will ensure that the needs of a range of currently under-served groups are met (including, but not limited to: the needs of those in transition from Children and Adolescent Mental Health Services (CAMHS), those with a learning disability, and those with personality disorder and severe behavioural disorders). Implement quickly any remaining performance improvement to deliver the North West London mental health access standards.
  • CAMHS: deliver equitable access to sustainable, high quality, productive and efficient CAMHS services, wherever a service user resides in North West London. Jointly commission Behavioural Support Teams for children and adolescents with learning disabilities. Jointly commission training and public education programmes with public health partners and safeguarding boards.
  • Dementia: the CCG is developing an integrated health and social care dementia pathway with joint responsibility shared between the CCG and Local Authority.
  • Improving Access to Psychological Therapies (IAPT): significant transformation and increased capacity in IAPT services. Implement the recommendations from the pan-London work led by the Anna Freud Centre on the coordination of children and young people’s IAPT specifically in relation to building capacity in voluntary and community sector organisations (VCSOs) to deliver early intervention mental health support for children and young people.
  • Learning disabilities: for those with learning disabilities and their families, following on from the Winterbourne View Concordat, implement recommendations from the national guidance from the recently established Joint Improvement Programme and NHS England National Expert and Advisory Group.
  • Perinatal: commissioning intentions for perinatal services, as with dementia services will be informed via the process of a strategic review across all eight CCGs which also commenced in Q2 2014/15. This will continue through to 15/16, where the CCG wish to see continued implementation of the Shaping Healthier Lives 2012-15 core initiatives including: Urgent Care, Liaison Psychiatry and Whole Systems/Shifting Settings

Community and GP services

  • Build on the successes of the Integrated Care Pilot as it dovetails into Better Care Fund to deliver an integrated model of care through enhanced GP-based coordination of care, including:
  • Care planning and case management: screening through individualised care plans in order to prevent unnecessary emergency admissions.
  • Care co-ordination: support for patients to get proactive, co-ordinated, responsive care closer to home, without having to repeat themselves.
  • Care navigation: support patients to navigate their way through the complex health and care system.
  • Joint care team (JCT): a multi-disciplinary team comprised of mental health, social workers, community nursing teams, community pharmacists and the voluntary sector.
  • Self-care: supporting patients to feel empowered to manage themselves but know when to reach out for help and where.
  • Community transport: in order to support patients to access community sites, a pilot to explore how a community transport service may work is being developed.
  • Expand primary care service offering care to 1000+ nursing home residents: reduce the levels of A&E attendance and non-elective admissions for residents of nursing homes. The Argyle practice will continue to provide enhanced primary care service to nursing homes in the Ealing borough.
  • Out-of-hospital services: current service provision over and above core services in primary care is not consistently provided across the whole population. The Federation of practices are starting to implement a suite of 18 services, which are over and above the core contract, ensuring coverage across the whole population by April 2016. This will include extended hours during the week and at least 12 hours over the weekend. At the heart of this work is the intention to improve the quality of general practice and reduce the known variation.
  • Increasing outpatient and elective services in the community: the CCG has identified cardiology, respiratory, gynaecology, paediatrics as areas where outpatient activity requires high levels of clinical expertise, but relatively little equipment; therefore can be delivered outside of hospital settings and closer to patients’ homes.
  • Improved buildings: Ealing is investing in the primary care estate needed to deliver more services in an out-of-hospital setting. Eight practices will receive a share of £1.3m to improve their buildings.  In addition, three out-of- hospital hubs at Ealing Local Hospital and North and East Ealing are planned to deliver extended access to integrated care to patients across the borough.

Ealing Hospital

  • North West London will make a significant investment of approximately £90m to develop Ealing into a local hospital, with A&E department, to better serve the needs of the local population.
  • A proportion of that investment will develop a primary care hub on the site.
  • The local hospitals will play a critical role within the wider urgent and emergency care network to admit patients, provide local services, and work with the specialist emergency centres as part of the network.
  • Paediatric inpatient services at Ealing Hospital are due to close on 30th June 2016, although the majority of paediatric activity will remain at Ealing Hospital and elsewhere in the borough. In-patient paediatric services will see no changes up to this point.
  • All out-patient services, including day-case, those for children with additional needs, child and adolescent mental health services will continue unchanged.
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