Agenda and minutes

Apologies for absence had been received from Richard Ellis (NWL CCG), Nick Hunt (Royal Brompton and Harefield NHS Foundation Trust), Mr Eddie Jahn (Hillingdon GP Confederation) and Ms Patricia Wright (The Hillingdon Hospitals NHS Foundation Trust - Mr Jason Seez was present as her substitute).

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

RESOLVED:  That the minutes of the meeting held on 14 September 2021 be agreed as a correct record.

It was confirmed that Agenda Items 1 to 10 would be considered in public and that Agenda Items 11 and 12 would be considered in private. 

Mr Kevin Byrne, the Council’s Head of Health and Strategic Partnerships, advised that the report provided the Board with a summary of a range of issues rather than including individual reports for each of these.  The report highlighted the appointment of Rob Hurd as Chief Executive of the NWL ICS from January 2022, Professor Ian Goodman’s appointment as Borough Medical Director for Hillingdon, Dr Mohini Parmar’s retirement from March 2022 and Pippa Nightingale’s appointment as Chief Executive for London North West University Healthcare NHS Trust.  It was also noted that, as the Health and Care legislation was likely to be delayed until beyond April 2022, the ICS shadow status would remain in place for a while longer. 

The publication and maintenance of a Pharmaceutical Needs Assessment (PNA) was a statutory function of the Health and Wellbeing Board with a prescribed process.  Engagement was being undertaken with the Local Pharmaceutical Committee (LPC), Healthwatch and the CCG.  An update on the progress of the project plan would be scheduled for the Health and Wellbeing Board’s next meeting on 8 March 2022. 

It was also suggested that the models of working and Neighbourhoods needed to include pharmacies and community pharmacies.  Consideration would need to be given to how this would work in practice at a local level and support the PNA process.  Mr Byrne would liaise with Ms Caroline Morison, Co-Chairman and Managing Director at Hillingdon Health and Care Partners (HHCP). 

Ms Vanessa Odlin, Director of Hillingdon and Mental Health at Central and North West London NHS Foundation Trust (CNWL), provided the Board with an update on the 16-25 Young Adults Service which had been developed to better bridge the gap between Child and Adolescent Mental Health Services (CAMHS) and Adult Mental Health Services (AMHS).  A lot of work had been undertaken on this over the last twelve months which had included stakeholder engagement.  This engagement had resulted in the development of ten underlying principles which had formed the base for the development of a partnership model. 

A Hillingdon implementation group had been established to lead on the work with the aim of going live in April 2022.  The new model would include multi agency young adult triage meetings with a flexible interface between services to support young adults to move from CAMHS to AMHS.  It was anticipated that discussions would be undertaken to see about embedding this into H4All. 

As Hillingdon had the highest number of CAMHS and AMHS new referrals, it was queried what action was being taken to capture data on the related intervention outcomes.  Ms Odlin advised that it was very stark from a Hillingdon perspective and that more work would be needed to record this information. 

Mr Byrne advised that tooth decay in children had been an issue of concern in the Borough for some time.  The report of the External Services Select Committee (ESSC) into children’s dental services had made nine recommendations which had been ratified by Cabinet.  The Children and Young People’s Dental Health task  ...  view the full minutes text for item 16.

Mr Kevin Byrne, the Council’s Head of Health and Strategic Partnerships, advised that 30 responses had been received in relation to the online public consultation undertaken on the draft Strategy.  Consultation had also taken place with the Council’s Housing Team to ensure that there were links to the Housing Strategy. 

As an example: 80% of respondents had agreed or strongly agreed with Priority 1: Support for children, young people and their families to have the best start and to live healthier lives, and 83% agreed or strongly agreed with the proposed associated actions.  Consideration was being given to additional actions suggested by respondents in relation to early prevention and intervention measures, a trauma-based service for children and support for unpaid carers. 

Concern was expressed that, with regard to Priority 4: Supporting people to live well, independently and for longer in older age and through their end of life, it could be difficult to get help for older people with issues other than social isolation.  As the feedback provided was anonymous and it was unclear what these other issues might be, Mr Byrne would speak to Age UK to see if they had any further information. 

Professor Ian Goodman, Borough Medical Director for Hillingdon at NWL CCG, advised that the Whole Systems Integrated Care (WSIC) system provided a linked integrated summary of patient's health and social care which could be used to help patients who needed more targeted and proactive care.  The system collected data on inequalities based on neighbourhoods, age, ethnicity, etc, and was likely to have information on deprivation too.  Mr Byrne advised that Brunel University was currently working on this with a view to having a data set that could be cut in a range of different ways. 

At the Board’s previous meeting, it had been noted that audits were being undertaken of Council and NHS owned assets in the Borough.  It was anticipated that the NHS audit would be completed by the end of December 2021.  It was agreed that an update on progress would be provided at the Board’s meeting on 8 March 2022.

RESOLVED:  That:

1.    an update on the audit of NHS owned assets be provided at the Board’s meeting on 8 March 2022; and

2.    the results of the public consultation on the Strategy be noted and that the Strategy be approved and published. 

Mr Gary Collier, the Council’s Health and Social Care Integration Manager, advised that the report provided the Board with an update on the delivery of the priorities set out in the draft Joint Health and Wellbeing Strategy.  The report set out workstream highlights and key performance indicator updates as well as key challenges such as winter pressures.  It represented a single performance report for the Hillingdon system.

It was noted that there had been an increase in the number of individuals attending A&E and that there had also been an increase in attendances at the Urgent Treatment Centre (UTC).  However, the UTC had been able to increase the number of people redirected to primary care who did not need inpatient treatment at Hillingdon Hospital.  Furthermore, NHS 111 had directly booked in more Hillingdon patients to see a GP than any other borough in North West London.  Patients were now also able to pre-book an appointment via NHS 111 with an Urgent Care Nurse Practitioner at Mount Vernon Hospital. 

The Board was advised that funding had been made available to primary care to look at accessibility.  To this end, “Advice and Guidance” had been put in place so that GPs and Hillingdon Hospital consultants were working together to ensure that the consultants only saw those patients who needed to be seen at hospital.  Hillingdon had been a pioneer with this initiative which facilitated speedy two way conversations between GPs and consultants and had reduced the length of waiting lists.

Professor Ian Goodman, Borough Medical Director for Hillingdon at NWL CCG, advised that the pandemic had prompted GPs to move towards a digital way of working.  Although the general public had been quite relaxed about this initially to prevent the spread of Covid, consideration now needed to be given to integrating face to face and virtual appointments as part of the GP offering.  Whilst younger people tended to be more supportive of this, older people were keen to get back to the way things had been pre-pandemic with in-person appointments. 

It was noted that the ability to have virtual appointments had meant that GPs were now seeing more patients each day than they had been before the pandemic and were able to prioritise more effectively.  However, as some groups were feeling / being disadvantaged by virtual appointments, it was important that this issue be thoroughly worked through. 

Dr Sharon Daye, the Council’s Interim Director of Public Health, advised that she chaired a Suspected Suicide Learning Panel (SSLP) and was aware that some calls for help were not being heard.  Professor Goodman advised that primary care needed to continue to identify vulnerable individuals but that there had been some concern about Covid infection rates and the increasing use of waiting rooms.  With regard to suicide and self-harm, it was important that any information about patterns identified by the SSLP be passed on to GPs. 

Concern was expressed that good work was being undertaken in primary care but that the publicity around GPs  ...  view the full minutes text for item 18.

Mr Gary Collier, the Council’s Health and Social Care Integration Manager, advised that the Board had previously discussed aligning the BCF budget and workstreams to provide visibility with regard to the investment that was available to support health and wellbeing.  The incremental progression towards this had been set out in the appendices. 

The Board was advised that the draft Better Care Fund Plan 2021/2022 had been submitted to the NHS England (NHSE) Better Care Support Team.  The new targets contained therein had been set to coordinate with those across North West London (NWL).  It was anticipated that any issues with the submitted plan would be received by Christmas and that a decision would then be made in the week commencing 11 January 2022. 

The Co-chairman, Councillor Palmer, and Mr Tony Zaman, the Council’s Corporate Director Social Care and Health, thanked Mr Collier for the comprehensive work that he had put into the Plan which had then provided the basis for much of the other work that had taken place in the Borough.

RESOLVED: That:

1)    the 2021/22 Better Care Fund Plan be approved as described in the report, including the proposed financial arrangements and proposed targets for the national metrics.

2)    the formal approval of the submission template and supporting narrative be delegated to the Corporate Director, Social Care and Health on behalf of the Board.

3)    authority to approve amendments to the 2021/22 plan in response to feedback from NHSE be delegated to the Corporate Director, Social Care and Health, in consultation with the co-chairmen and the Board representative of the North West London Clinical Commissioning Group and reports back in due course.

4)    the position regarding the refresh of Equality and Health Impact Assessments as set out in the report be noted.

Mr Jason Seez, Deputy Chief Executive and SRO for Redevelopment at The Hillingdon Hospitals NHS Foundation Trust (THH), apologised for the THH Chief Executive, Ms Patricia Wright, not being in attendance.  The Co-Chairman, Councillor Palmer, thanked Mr Seez for attending the meeting and hoped that Ms Wright would be able to attend the next meeting. 

With regard to the performance of the Trust, the report had focussed on four distinct areas: quality, access, people and finance.  The key to improvement would be to get all of these areas moving in the right direction at the same time.  Over the last year, significant inroads had been made to improving quality with two of the licence conditions imposed by the CQC being lifted in July 2021.  This had been testament to the hard work of the THH staff who had been driving the improvements. 

Insofar as access was concerned, there had been a national focus since April 2021 on elective recovery.  THH had continued to provide elective care during the second wave of the pandemic and a plan was in place to reduce and eliminate long waiters by 2022/2023.  Consideration would be given to how resources could be shared across hospitals to help catch up with elective care. 

Since April 2021, pressure on Hillingdon’s Urgent and Emergency Care (UEC) had been increasing and performance against the 4-hour target had deteriorated.  Work was now underway to assess how people were accessing the services and Hillingdon Health and Care Partners (HHCP) was looking at a joined-up approach with regard to access to UEC. 

With regard to people, Mr Seez noted that THH staff were tired.  Many had carried forward a lot of leave from the 2020/2021 financial year into 2021/2022 as they were unable to take time off because of the pandemic.  It would be important to communicate how hard these staff had been working and to prioritise how valued they were. 

THH had had financial issues in the last year and the Trust had been working hard with national partners to get back on track and in control of the finances.  The Trust had been put on the Financial Recovery Programme (formerly Special Measures) and would be putting a three-year financial recovery plan in place. 

Mr Tony Zaman, the Council’s Corporate Director Social Care and Health, noted that a large number of staff had been moving around between the NHS, local authority, care sector and other partners.  It was suggested that a deeper dive would be needed to address this issue to ensure stability within the workforce with regard to the recruitment, retention and integration of staff. 

Mr Seez advised that all partners should be proud of the progress that had been made with regard to the hospital development project.  Support for the new build had been wide ranging. 

In 2019, the Government’s Health Infrastructure Plan had shortlisted the development of 40 new hospitals, which had included Hillingdon.  Hillingdon had been identified as one of the pathfinders which would be the first  ...  view the full minutes text for item 20.

Consideration was given to the Board Planner.  It was agreed that the following issues be considered at the Board’s next meeting on 8 March 2022:

·         an update on the progress of the PNA project plan;

·         an update on the drivers behind health inequalities;

·         an update on the review of HHCP;

·         the NWL Needs Assessment;

·         an update on the audit of NHS owned assets;

·         an update on the tobacco alliance work;

·         an update on the Cove crisis café which had opened on 29 November 2021 (the café had been changed to be open access and was open until 10pm); and

·         an update on the effectiveness of the changes regarding 16-25 young adults mental health services and whether or not they had achieved their objective. 

The Co-Chairman, Councillor Palmer, advised that she had regular briefing meetings with officers on a range of health and social care issues.  It was agreed that, where appropriate, these issues would be raised at subsequent Health and Wellbeing Board meetings for wider discussion. 

RESOLVED:  That:

1.    the following updates be included on the agenda for the meeting on 8 March 2022:

a.    the progress of the PNA project plan;

b.    the drivers behind health inequalities;

c.    the review of HHCP;

d.    the NWL Needs Assessment;

e.    the audit of NHS owned assets;

f.     the tobacco alliance work;

g.    the Cove crisis café which had opened on 29 November 2021 (the café had been changed to be open access and was open until 10pm); and

h.    the effectiveness of the changes regarding 16-25 young adults mental health services and whether or not they had achieved their objective; and

2.    the Board Planner, as amended, be agreed.

RESOLVED:  That the PART II minutes of the meeting held on 14 September 2021 be agreed as a correct record. 

The Co-Chairman, Councillor Palmer, advised that this would be the last Health and Wellbeing Board meeting that Dr Sharon Daye, the Council’s Interim Director of Public Health, would be attending.  Dr Daye would be leaving the Council on 31 December 2021 and Councillor Palmer thanked her for her service to the Borough and wished her well.  On behalf of the Board, Councillor Palmer also thanked Dr Fran Beasley, the Councils’ Chief Executive, who would also be leaving on 31 December 2021 and wished her well. 

It was noted that Ms Caroline Morison, Co-Chairman and Managing Director of Hillingdon Health and Care Partners, would be chairing the next Health and Wellbeing Board meeting on 8 March 2022. 

RESOLVED:  That the discussion be noted.