CNWL has a plan

CNWL’s Business plan has been published and has been submitted to our regulator, Monitor. 

CNWL provides community and inpatient services for physical and mental health conditions, literally from head to toe, from birth to end of life.

We have a budget of £434 million and see 280,000 people a year in Brent, Camden, Kensington & Chelsea,  Harrow, Hillingdon, Milton Keynes and Westminster.

Claire Murdoch, CNWL Chief Executive said, “At the end of the day it falls on providers like us to make the NHS system work and our operational plan is how we will do it. For the first time in our history CNWL ended its year with a deficit of £2.5m and next year we’re planning for another, about £4.3 million; but with some asset sales, the loss will be around £700,000. This is because demand is up and contract values are down. The finances are just the framework in which we take on extra work as the population grows, health needs change, services are reorganised to be better for patients, raising quality and saving NHS resources.”

CNWL’s Strategic Priorities are:

  • High quality care and best outcomes for patients – safe, caring, effective responsive and well–led and shown to be so when benchmarked against others
  • Operational sustainability – redesign our services to improve quality, efficiency and outcomes, reducing unnecessary hospital admissions
  • Financial sustainability – we need to make savings this year of £26m.

In our mental health inpatient services there has been pressure on beds for some time which, combined with issues around discharge, led to unacceptable pressures in the last quarter of 2014/15.

Length of stay is higher here at 47 days compared to a London average of 35 days. Discharge can be delayed by a number of non-health factors like benefit loss, lack of housing, support systems and complicated re-referral routes back into specialist care. For adult services as many as a third of inpatients come from inefficiencies in the care pathway – the lack of alternatives to hospital admission - and at any one time 22 of our beds are delayed discharges.

A reduction in funding for beds in 2013/14 was made – and accepted by us – as it was hoped we could move patients to other more appropriate settings. This has not happened so we have negotiated with our commissioners for short term funding for additional beds.

The answer to system pressures is not, surprisingly, to be found in increasing the number of beds, or even redesigning CNWL alone, but in a system where patient flow is maintained across NHS organisations.

Our service redesign plans, led by our Medical Director, Dr Alex Lewis, will begin in mental health in north west London and will be developed with our staff, patients, carers, the public and our partners; so we will: 

  • Improve efficiency – with more managed discharge from services; more Peer Support Workers (former patients who can support others through experience of the condition and local service knowledge, rather than nurses or doctors) and improved integration with primary care, improved IT systems that integrate mental and physical health records.
  • Develop new clinical models - 30% of patients are with our community teams for over 7 years and another 25% over 2.5 years. Some of this is routine medical care and support which primary care could provide or social support which the third sector might do better; our teams would then see more patients who need help more urgently.
  • Create a 24/7/365 Single Point of Access for mental health services – this will make referrals and re-referrals much easier and be able to support people more quickly.

Claire Murdoch said, “Like every part of the NHS we are under immense pressure and the situation is very challenging. But we are a determined Trust! We have a very caring and compassionate workforce who want to deliver specialist care, so I am confident we will deliver high quality services. We will achieve our financial targets and make savings for the NHS of 4.2%. We will generate ideas and proposals but our Plan can only be delivered in partnership across the local NHS and that is what we are working to bring about.”

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