Agenda and minutes

Apologies for absence had been received from Ms Julie Kelly, Ms Vanessa Odlin and Mr Graeme Caul.

There were no declarations of interest in matters coming before this meeting. 

RESOLVED:  That the minutes of the meeting held on 29 November 2022 be agreed as a correct record. 

It was confirmed that Agenda Items 1 to 8 would be considered in public and Agenda Items 9 to 11 would be considered in private. 

Mr Gary Collier, the Council's Health and Social Care Integration Manager, advised that a lot of work had been undertaken with regard to shaping the future health and care system but that the publication of the planning requirements for the Better Care Fund were still awaited. 

Insofar as the system wide winter key performance indicators in respect of Hillingdon Hospital activity were concerned, the Board was advised that 74% of patients attending Hillingdon A&E each day were individuals registered with a GP in the Borough.  As the majority of people in all age groups who attended A&E were not admitted (63% in 2021 and 2022), it was queried how these patients could be educated to understand that A&E was not the most appropriate place for them to present.  It was also queried why over one third of patients presenting at A&E were admitted.  Ms Patricia Wright, Chief Executive at The Hillingdon Hospitals NHS Foundation Trust (THH), advised that the Urgent Treatment Centre (UTC) sat at the front end of A&E and only passed on patients that had had an accident or emergency.  As such the percentage of patients who were admitted from A&E was likely to be high as these were the patients that were most in need and were therefore in the right place. 

Professor Ian Goodman, North West London Integrated Care System (NWL ICS), advised that the running of the UTC had recently been changed.  The UTC had been commissioned by the Urgent Care Board and had been transferred back to THH to maintain at short notice. 

With regard to the Discharge to Assess pathway, it was requested that data be provided at a future meeting on the delays to hospital discharge, perhaps grouped by type of blockage.  Whilst Hillingdon had one of the best track records with regard to discharge, there were still patients that were staying in hospital longer than necessary and further work was needed on Emergency Department avoidance.  Ms Wright advised that there was lots of data available but that this varied on a day-to-day basis so a conversation was needed to determine what would be useful and achievable.  

Mr Keith Spencer, Co-Chairman and Managing Director at Hillingdon Health and Care Partners (HHCP), stated that the report had been useful but that it needed to include information about what partners were going to do about each of the issues.  He would be happy to take this action forward. 

With regard to addressing the budget deficit, Mr Tony Zaman, the Council's Interim Chief Executive, queried whether there was a tolerance level.  Ms Wright advised that there had been some discussion about whether the deficit sat at a place level or with the hospital and noted that THH was unable to control factors such as demand.  The NWL Integrated Care Board (ICB) held the budget and would be the body that set any tolerance levels (if they were to exist) but that it would need to set a balanced plan  ...  view the full minutes text for item 40.

Ms Kelly O'Neill, the Council's Interim Director of Public Health, advised that the whole system approach to obesity had identified Hayes as being an area of need.  Action had been undertaken to establish how best to engage with these communities and a pilot had been completed.  The core team had been set up to lay the structures that would be needed to then build a framework to understand the community better.  Initial work had been completed to target communities where obesity was prevalent and where these individuals were less likely to seek help.  This included targeting obese young people too with initiatives such as active travel, for which three bids had been submitted.  Minet School had been successful in its bid and the outcome of the other two bids was still awaited. 

The Board was advised that a workshop would be held at the end of March and consideration had been given to who would need to attend.  It would be important to develop sustainable long term engagement plans and mobilise those who had already been identified whilst also trying to identify others that were currently unknown.  Consideration would need to be given to questions such as: was there a limited ability to walk to school?; was there a perception of poor safety when walking?

A reference group would be built up over the next few months with the community.  This could then be developed so that it identified what the community saw as barriers and came up with solutions and options to tackle obesity.  Measures of success would need to be identified that meant something to residents and which they would think were important.  Although this might be the achievement of a healthier weight, it might be a feeling of being fitter or a greater sense of wellbeing. 

Concern was expressed that there had been a wave of messages being sent out to residents from local GP surgeries stating that they were overweight and that they could sign up to a programme to get help.  It was noted that GPs had been incentivised to identify overweight patients and refer them on to a specific programme that had been funded by the NHS.  Unfortunately, there had been limited spaces on this programme (which had quickly become overwhelmed with referrals) which meant that there was a 13 week wait before anything would happen.  It would be important to change behaviour with the integrated neighbourhood process and that some of this could be facilitated by non-clinicians.  A meeting had taken place on 6 March 2023 to set up networks of community champions to go into neighbourhoods and develop a programme of health improvements and integration. 

Ms O'Neill suggested that more sustainable ways of getting active were needed and less reliance on GPs as the impact on them had been huge.  Council officers had been working with communities to get them more physically active and local sports facilities had been reviewed to ensure that they were affordable.  Consideration now needed to be given  ...  view the full minutes text for item 41.

Ms Jane Hainstock, Head of Joint Commissioning at North West London Integrated Care System (NWL ICS), advised that information from Central and North West London NHS Foundation Trust (CNWL) / Child and Adolescent Mental Health Services (CAMHS) had not been available when the agenda had been published.  This information would be circulated to the Board after the meeting. 

Ms Hainstock advised that a cultural change was needed in the approach to children's mental health and wellbeing.  The old tiered model had felt like young people and their parents were having to climb a ladder to move from one tier to the next and it would be important to not create a new set of challenges in the move to Thrive.  The set up and governance needed to be established before the structural features could be determined.

The implementation of the Thrive methodology was thought to be ambitious and a service mapping exercise had already been undertaken with partners.  This exercise had tried to align the language used by the different organisations and had identified a number of gaps and some short, medium and long term actions.  The voluntary sector had identified the need for more peer support and the need to increase capacity. 

It was noted that CAMHS was not the appropriate place for some mental health issues and that sometimes young people might be experiencing emotional distress rather than mental ill health.  Action was being taken regarding the criteria for using the CAMHS service and what was needed by those young people and their families that did not meet the threshold. 

Ms Hainstock advised that the activity data illustrated the level of pressure on the system with one in four children and young people now having a diagnosable mental health condition.  It would be important to understand why these young people were unwell to then be able to address the causes rather than medicalising the issue. 

The population health management project had set out an aspiration to have a single front door for all young people's services.  This would mean that young people would not have to tell their story more than once and that a plan could be put together. 

Following on from the first two Thrive meetings, a third meeting with partners had been scheduled for April 2023 where consideration would be given to what was being done well and what was not so good.  This would show where the focus needed to be so that the right teams could be pulled together, which might take time. 

Ms Patricia Wright, Chief Executive at The Hillingdon Hospitals NHS Foundation Trust (THH), advised that the NWL Integrated Care Board (ICB) had agreed three programmes of work, one of which was in relation to children and young people's mental health.  It would be important that the work being undertaken locally in relation to Thrive was fed into that research work.  It was confirmed that the Children and Young People's Transformation Board had received a presentation on that part of the  ...  view the full minutes text for item 42.

Mr Gary Collier, the Council's Health and Social Care Integration Manager, advised that it was possible that the Better Care Fund Plan would need to considered at the Health and Wellbeing Board meeting on 13 June 2023. 

Mr Tony Zaman, the Council's Interim Chief Executive, advised that there were wider changes being introduced across London and consideration needed to be given to the role of the Health and Wellbeing Board in the new arrangements.  Rather than the Board receiving reports that provided a descriptive narrative, it was suggested that this should be more of an in-depth look at issues or that workshops should be undertaken.  Ms Kelly O'Neill, the Council's Interim Director of Public Health, noted that the Health and Wellbeing Strategy had been published about a year previously and that now would be a good time to evaluate the impact of the action taken to help the Board refocus.  It was agreed that this would be included for the next meeting on 13 June 2023. 

RESOLVED:  That the 2023/2024 Board Planner, as amended, be agreed. 

RESOLVED:  That the Part II minutes of the meeting held on 29 November 2022 be agreed as a correct record. 

Consideration was given to the future state operating model for Hillingdon.

RESOLVED:  That the discussion be noted. 

Consideration was given to the impact of strikes on Hillingdon Hospital. 

RESOLVED:  That the discussion be noted.