Agenda and minutes

Apologies for absence had been received from Councillor Alan Chapman (Councillor Shehryar Ahmad-Wallana was present as his substitute).

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

RESOLVED:  That the minutes of the meeting held on 26 January 2023 be agreed as a correct record. 

RESOLVED:  That all items of business be considered in public. 

The Chairman welcomed those present to the meeting and noted that Members continued to speak to families involved with children and young people’s mental health services in the Borough.

Mr Alex Coman, the Council’s Director of Safeguarding, Partnerships and Quality Assurance, advised that the Council had a role in early intervention and prevention as well as statutory intervention and prevention.  Targeted adolescent services were available and included face-to-face sessions as well as online support.  Group therapy sessions were also provided through Hillingdon MIND.  It was noted that non-attendance at school impacted on a child’s wellbeing.

In 2022, the service had received 380 referrals which were triaged within seven days.  Of those, 350 were accepted and resulted in 1,500 counselling sessions with the children – around 100 children attended sessions each week.  Consideration was being given to the development of further services such as providing counselling in the child’s first language (this would be useful for asylum seeking children) and a yoga for wellness pilot. 

Of the 20,000 contacts made each year, about 30% had a statutory assessment, and mental health featured in the top three biggest issues arising.  During the year, many of these contacts would be signposted to mental health support.  Emotional wellbeing had been included in the Child Protection Plans and the Your Choice programme used Cognitive Behavioural Therapy (CBT) to engage with families. 

Members were advised that the School Inclusion Team had developed a guide for schools to help them to identify and deal with children with disruptive behaviour.  It was important that services worked with the whole family to avoid escalation. 

With regard to looked after children (LAC), Mr Coman advised that the Council acted as the corporate parent for around 350 children and young people.  Research had shown that LAC were more likely to suffer with mental ill health.  As such, assessments were undertaken annually with those aged over five and every six months for those under five years old.  A strengths and difficulties questionnaire was completed by children and young people to measure their wellbeing and gave them a score out of 40 (with a lower score being better).  In Hillingdon, LAC scored an average of 12.7 compared to a national score of 13.7.  If a LAC in the Borough scored 13+, action would be taken to investigate the matter further and referrals could be made to the psychology service. 

Members were advised that Give Space was a moving therapy that involved performing arts and had been piloted in Hillingdon with six young people.  Ask Jan was also available and provided individual sessions to around 60 young people in the Borough (the contract for this service would end this year with the possibility of an extension). 

When asked what success looked like, Mr Coman advised that all young people would have a plan in place based on their needs with targets, actions and outcomes identified.  Key performance indicators (KPIs) were in place for things like assessment timescales and were monitored during the routine reviews  ...  view the full minutes text for item 64.

Mr Richard Ellis, Joint Lead Borough Director at North West London Integrated Care System (NWL ICS), advised that the move of phlebotomy to GP practices had taken place almost two years previously and it had been anticipated that it would have capacity for around 185,000 blood tests per year.  This year, the service was on track to do approximately 165,000 tests so there was still some capacity in the system.  It was noted that the actual number might have been lower than anticipated as the new system prevented some patients from having unnecessary repeat tests or the original data might have been incorrect. 

Members were advised that there had been a small logistical issue at one point in relation to a nation shortage of the bottles used to store the blood samples but that this had been resolved within 6-8 weeks.  Although the majority of blood tests were routine for the ongoing monitoring of a patient's health and could wait for three days for the results, a new urgent blood test provision had been introduced that could get results by the end of the day.  If the sample was taken in the morning, the results could be relayed by the GP to the patient in the afternoon.  If the sample was taken in the afternoon, the results could be relayed to the patient by NHS 111 if the GP practice was closed. 

Mr Ellis noted that staff that had previously been employed at Hillingdon Hospital in the phlebotomy service had been given the opportunity to work in the GP practices when the service had transitioned (although there was still a phlebotomy service available at the hospital).  Health Care Assistants (HCAs) had been given the opportunity to retrain as phlebotomists but there had been some delays.  Some practices had felt that they were not able to provide the phlebotomy service and had made arrangements with another practice to do their phlebotomy for them.  High demand had caused some bottlenecks in the service which had since been resolved. 

The concept of one GP practice providing services for another was being investigated further.  Consideration was being given to the provision of tests such as ECGs across practices.  The use of north, central and south hubs was also being looked at for the provision of diagnostic services so that local services could be arranged locally.  Members were assured that these hubs would be based in an NHS GP practice.  Dr Ritu Prasad, Co-Chair of the Hillingdon GP Confederation advised that the hubs would be GP-led, similar to the extended access hubs that were currently available in the Borough that were accessible to patients. 

There had been a significant increase in the number of request for GPs to carry out bloods on behalf of hospital departments and community services when the service had been modelled on GPs only managing this work up to the time when a patient attended hospital.  As well as impacting capacity, this raised clinical governance issues as responsibility to manage the  ...  view the full minutes text for item 65.

Mr Keith Spencer, Managing Director at Hillingdon Health and Care Partners (HHCP), advised that HHCP was not really an organisation but was a place-based partnership comprising The Hillingdon Hospitals NHS Foundation Trust (THH), Central and North West London NHS Foundation Trust (CNWL), H4All, and the Hillingdon GP Confederation.  HHCP worked with the local authority and North West London Integrated Care System (NWL ICS) to get all parts of the system working together and holding each other to account to improve population health and join up care in the Borough. 

It was noted that HHCP and the Council had a Joint Health and Wellbeing Strategy with six priorities which included support for the mental health of children and young people.  The delivery model included three big moving parts:

1.    six integrated neighbourhoods – population health, proactive and anticipatory care and same day urgent primary care.  These services aimed to move to local preventative interventions;

2.    joined up Borough-based services – urgent same day unplanned community response.  Currently, about 5,000 residents used 70% of Hillingdon's health and adult social care resource and this needed to be managed carefully; and

3.    Hillingdon Hospital – hospital services. 

In terms of performance, Mr Spencer advised that NWL measured place based metrics, comparing each of the constituent local authorities and benchmarking against England / London.  To ensure that any action taken really made a difference, the Borough had focussed on three key strategic priorities:

1.    developing Hillingdon 'place';

2.    building 'Team Hillingdon'; and

3.    delivering transformation programmes. 

Dr Ritu Prasad, Co-Chair of the Hillingdon GP Confederation, advised that the national demand on GP appointments had increased by 35 million between 2019 and 2022 which had put massive pressure on the system, especially when trying to care for people with long term conditions.  During the pandemic, systems had been rapidly digitised over a very short space of time and the choice for patients to have virtual consultations rather than face-to-face had been retained.  Overall, there were more appointments available now than there had been before the pandemic.  Although virtual appointments tended to be more convenient for individuals that worked, there were conditions that needed to be dealt with face-to-face and it often was better to see children in person. 

The move to digital services had meant that data could be gathered to identify how many telephone / virtual (decreased from 39% to 30%) and face-to-face (increased from 61% to 70%) appointments had been booked and the number of patients that had not attended their appointment had reduced to around 9% in December 2022.  It was thought likely that the percentage of virtual appointments would remain around 20-30%. 

In between appointments, GPs undertook other tasks such as sorting out prescriptions, writing hospital letters, etc.  It was anticipated that the move to digital services would help keep patients out of A&E but there were challenges with delays for elective surgery.  In addition, GPs had continued to use the messaging services where appropriate. 

With regard to GP appointments, Dr  ...  view the full minutes text for item 66.

Ms Kelly O'Neil, the Council's Interim Director of Public Health, advised that some of the recommendations from the review into children's dental health needed to be revisited in light of the Health and Social Care Bill and the change in the Secretary of State for Health.  Some of the issues had been superseded and the local strategy had not been sufficiently ambitious.  As Hillingdon was unable to have its water supply fluoridated in isolation, there needed to be a consensus with other local authorities which was unlikely to happen. 

Some of the recommendations in the final report were included in the Healthy and Wise programme and needed parental support and some of them were more long term actions such as dental epidemiology which took a sample of around 250 children and then tracked them over time. 

Actions had been taken such as the fizzy drinks levy and Borough-based catering controls and these were seen as big ticket issues.  However, there was some challenge about whether it should be the parents that took control rather than the Council.  Whilst Hillingdon's children did not have the worst dental health in London, it was still very poor and a more ambitious approach was needed to address the issue. 

Ms O'Neill noted that it was not just about children being in pain from poor dental health and subsequent tooth removal, it was also about good dental health to promote self esteem, etc.  She would return to a future meeting with clear success outcomes, the amount invested, return on investment and what this actually meant in terms of improving the situation.  It was noted that the Hillingdon Health and Care Partners' Child Transformation Programme would be looked at in March and would fit closely with this work. 

RESOLVED:  That:

1.    Ms Kelly O'Neill provide Members with an update at a future meeting; and

2.    the discussion be noted.

Consideration was given to the Cabinet Forward Plan.

RESOLVED:  That the Cabinet Forward Plan be noted. 

Consideration was given to the Committee’s Work Programme. 

RESOLVED:  That the Work Programme be noted.