Hillingdon

Hillingdon is the second largest of London’s 32 boroughs, made up of 22 wards it covers an area of 42 square miles.

  • The Hillingdon Hospitals NHS Foundation Trust provides hospital services.
  • Central and North West London NHS Foundation Trust provides community nursing, therapy services and mental health services.

Hillingdon CCG 2015/16 annual report.

The chair of Hillingdon CCG:

Dr Ian Goodman

Population demographics

  • 287,000*
  • The population is most heavily concentrated in the centre of the borough. By 2021, the overall population in Hillingdon is expected to grow by 8.6% to 320,000
  • This future increase is mainly due to an expected 10% rise in population under 15 years and a 15.4% rise in the population of those 75 years and over.
  • Hillingdon is an ethnically diverse borough with around 30% of the population from black and minority ethnic communities (lower than the London average 35%).
  • The largest ethnic community is the Asian community, with the Indian community forming 13% of the total population.

*based on 2013 ONS figures

Health challenges

  • Rates of diabetes, hospital admissions for alcohol-related harm and tuberculosis rates are all higher than the England average.
  • There is an expected rise in the over-75-year-old population over the next 10 years and as a consequence, it is expected that there will be an increase in rates of conditions such as dementia.
  • Hayes and Harlington locality has the most significant health challenges.

Service improvements

Integrated care

  • Integrated Care Planning: giving patients with long-term conditions a care plan that considers all their health and social care needs; keeping people healthier for longer and reducing the need for hospital care. Unmanaged long-term conditions are a major cause of emergency admissions to hospital; so better support through care plans is an essential part of reducing pressure on hospital services. We have so far supported nearly 13,000 patients with care plans.
  • New Health and Social Care Coordinators and Primary Care Navigators help deliver care plans for people with long-term conditions and signpost patients to health services in Hillingdon.
  • Home Safe: a joint team with staff from the hospital, community nursing and Age UK to help people regain their independence after a serious illness or accident, helping speed up discharge from hospital.

Community and GP services

  • We have redesigned and implemented seven planned care pathways across musculoskeletal, ear nose & throat, gynaecology and urology services. This has led to a reduction of approximately 2,774 first outpatient appointments and approximately 7,397 follow up appointments.
  • Community dermatology service: a new consultant-led service running from three locations across the borough, giving patients faster access and more choice of locations convenient for them. Ophthalmology is now also operating as a community-based service.
  • Rapid Response service: receives referrals from A&E, GPs, London Ambulance Service and care homes and currently supports 5 people a day to avoid unplanned admission via A&E.
  • Co-ordinate My Care: a tool for patients with terminal illnesses that allows them to share decisions and wishes about their care with all health and care services supporting them. The tool supports patient choice, helps avoid hospital admissions and supports people to have a comfortable death. The tool is now available across Hillingdon.
  • Convenient access to GPs – 96% of practices offer electronic prescription services, 84% of practices offer online appointment booking, 76% of practices offer consultations via telephone with 84% of practices using telephone triage by clinicians, while nine practices offer early morning and late evening appointments ranging from 7.30am-8.30pm and 12 local practices are now open on Saturdays.
  • Urgent Care Centre opened in Oct 2013, providing a 24-hour GP-led service for minor illnesses and injuries. Since then, 100,932 patients (Oct 13 – Dec 14) have used the service. The service sees approximately 60% of people walking into A&E.
  • GP networks are developing to offer a wider range of care from general practice. Programmes are being developed to offer 24-hour blood pressure monitoring, respiratory reviews, diabetic care, wellness programmes and targeted clinics for those currently using A&E and Urgent Care Centres (to provide alternative care through GPs).
  • Improved buildings – Hillingdon is investing in the buildings needed to deliver more services in an out-of-hospital setting closer to home.
  • Productive Practice – GP networks participating in a programme designed to create capacity in general practice through more efficient working.

Mental health and wellbeing

  • Psychiatric liaison service and home treatment service for adults and older adults.
  • Rapid Response service for patients with urgent mental health needs. The team supports patients by providing mental and physical health, and therapeutic care in community settings.
  • Integrating Mental Health: shifting care to ensure people receive the most appropriate care, closer to home.
  • 125 patients now receiving support from general practice (excluding Child & Adolescent Mental Health Services, Mother & Baby community services, specialist teams and memory services).
  • Additional investment in Child & Adolescent Mental Health Services, Perinatal and IAPT (improving access to psychological therapies) services.
  • 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.

Our future plans

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

Integrated care

  • Improve integrated case management of long-term conditions (LTC) through key components of the Integrated Care Programme (ICP). LTC related A&E attendances are believed to account for approximately 50% of all A&E attendance. Developing integrated care pathways to support LTC management is expected to reduce emergency admissions by 300 a year, first outpatient appointments by 750 and follow-up appointments by 1,950.
  • Enhanced risk assessment, including a health and social care risk stratification tool, and proactive early identification of people with susceptibility to falls, dementia and social isolation.
  • Extend care planning to all people with complex health and care needs, and include people with medium risk who will benefit from care planning and introduction of self-care pathways.
  • Multi-disciplinary teams regularly meeting at a local level, including nursing, pharmacy, social care, mental health, third sector with General Practice at the centre. Care-coordinators as a first point of contact for patients and carers with the role of coordinating all patients’ activities.
  • Develop an open access IT platform to share real-time information enabling joined up care for patients receiving help from several services.
  • Expand Rapid Response service, including embedding social care, operating over seven days, and creating a single intermediate care team which will include dementia, re-ablement, community rehabilitation, equipment, telecare and homecare.
  • Expand the Early Supported Discharge service (Home Safe) to specialty wards for older people in addition to the Acute Medical Unit of The Hillingdon Hospital. Establishing a service that operates at scale for patients across the borough.

Mental health and wellbeing

  • Deliver Year 2 of our Joint Mental Health Strategy with London Borough of Hillingdon. For mental health, we will redesign and invest in the following:
    • Urgent care
    • Child and adolescent services
    • Dementia
    • Older adults services
    • Acute inpatient beds and
    • Learning disabilities
  • These changes will improve access for patients, especially those in crisis, reduce waiting times and improve early detection of dementia so users and carers can get the support that they need at an early stage.

Community and GP services

  • Establishing different models of care for different groups of patient (e.g. working population, patients with complex needs) to make care more tailored to their needs and to reduce avoidable use of urgent care/A&E.
  • GP master classes and training opportunities for primary care staff to build skills and capacity within general practice; supporting the shift to more care and support available outside of hospitals.
  • Expand and improve the provision of online services for patients, including extending online access to medical records and the availability of online appointments.
  • Improved buildings: Hillingdon is investing in the primary care estate needed to deliver more services in an out-of-hospital setting. Four practices will receive a share of nearly £800,000 to improve their buildings.
  • In addition, we are developing three hubs across the borough. These hubs will provide a base for the delivery of out-of-hospital services and integrated care. The first hub has been developed in the south of the borough at the Hesa Centre, with a further two hubs planned.
  • Enhance intermediate care services and provide seamless community services including review and realignment of community services to emerging GP networks.
  • Improve care of people in nursing and care homes, including advanced care planning and increased clinical support and skills development with the benefits of managing the care of residents within the care home and preventing unnecessary attendance at or admission to hospital.
  • Extend recently redesigned community based services (musculoskeletal (MSK), otorhinolaryngology (ENT), gynaecology and urology) to be available from more sites across the borough.
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