The overall Trust position remains stable in all the areas except for the 4 hour emergency care transit time standard of 95%. The Trust has worked closely with the regulators, system partners and the staff towards delivering sustained improvements in this key delivery area. Whilst the year end position for the 4 hour transit time standard was at 84.6%, the month of March ended with 77.6% of our patients being discharged, admitted or transferred within 4 hours.


In 2018, the Trust successfully applied to be one of the first wave of seven organisations implementing the NHSI Vital Signs programme, an improvement methodology based on lean and systems-thinking principles. The Trust’s implementation of the programme is the Hillingdon Improvement Practice (HIP), and represents a significant strategic engagement in establishing a continuous improvement culture across the organisation.

As the HIP becomes established across the Trust, it will form the single improvement methodology, allowing clear vision and sharing of improvement in all areas. The approach is based on enabling and supporting staff delivering care and services to identify and implement their own improvement, with close links to the voice of patients and service users. The leadership team will support, enable and coach teams to deliver the change that counts for both staff and patients.

Achieving greater efficiencies

A number of changes improved our efficiency and saved money. These included:

  • Better utilisation of our Theatre lists by 3.9% 2018-19 v 2017-18 reducing the need for extra weekend lists
  • A continuing reduction in our outpatient ‘did not attend’ rate (DNA) from 9.8% (2016/17) to 8.5% (2017/18) to 8.4% (2018/19)
  • Improved control and reporting of agency staffing, and a drive to increase recruitment and usage of the staff bank, has delivered a 17% (£2.1m) reduction in agency spend across all staff groups, significantly 19% reduction in nursing agency spend(£1.3m)
  • Work by our Facilities and Procurement Teams delivered a 19% (£950k) reduction in general supplies and services spend (bedding, linen, facilities management, cleaning & provisions)
  • Work in ED and in our ambulatory pathways led to a reduction in emergency admissions of 3.5% (900 admissions) that enabled the winter bed pressures to be managed without the requirement to open Edmunds Ward
  • From December 2018, implementation of the Patchwork system for booking to medical shifts has seen Hillingdon’s medical staffing bank increase to 320 doctors 92 of whom were external with a further 23 currently joining the bank.

Improving patient facilities

Our A&E redesign project was completed in 2018. A budget of £1.9 million was spent on building works and £200k for preparation works for the next phases scheduled for 2019/20. Work to the female day-care area was undertaken to include a separate male area, costing £400k. We spent £230k to complete final works for the CT scanner.

Funding was received for a new ambulatory care area with 6 chairs, which was completed in January 2019.

Performance indicators

performance indicators

Referral to Treatment

The Trust ended the year with a performance of 86.4% against a target of 92%. In light of growth in demand from GP referrals to the Trust for elective care during and the latter half of 2017/18 and 2018/19, the Trust has not yet reached the anticipated sustainable position of achieving RTT compliance. The Trust has adopted the IMAS Intensive Support Team demand and capacity (D&C) modelling tools to identify the scale of investment required in selected specialties with performance challenges. We continue to recognise the importance of achieving this standard.