Agenda item

It was noted that effort had been made to change the tone when the Commissioning Intentions document moved to Strategic Intentions (SI).  The SI provided a more coherent plan that was jointly owned and aimed to improve care, services and the use of resources in Hillingdon.  Work had been undertaken in North West London (NWL) in relation to system intentions across the eight NWL CCGs and the resultant document would be considered by the Board at its meeting on 3 December 2019.

The Board was advised that the SI themes had been aligned to the Health and Wellbeing Strategy and to the Better Care Fund.  The report provided a two year plan which looked at the work of the Integrated Care Partnership and Primary Care Networks to identify how this would move Hillingdon forward. 

It was noted that Hillingdon was below target with regard to measles vaccinations and work was also needed to increase tuberculosis (TB) vaccinations.  Concern was expressed about whether progress was being made to vaccinate the cohort of unvaccinated residents in the Borough.  Barriers tended to be in relation to patient choice rather than supply / delivery.  As such action was being taken by Hillingdon CCG (HCCG) to focus on prevention and self care.

Although TB vaccinations were not provided by HCCG, it did have a scheme in place to identify patients at risk of TB and refer them on.  Fifteen years ago, Hillingdon had had one of the highest rates of TB vaccination in London.  The PCT had commissioned GPs and the Health Visiting Service to target specific communities.  When NHS England (NHSE) took over responsibility, Health Visitors were no longer involved in vaccinations.  Responsibility had since passed back to councils via Public Health with the Council funding Health Visitors and NHSE funding the vaccinations.  It was suggested that consideration be given to reinstating Health Visitor involvement in vaccinations in the short term or appeal to NHSE for increased action whilst the uptake was low.  It was noted that there was no reason why the role of Health Visitors could not be re-profiled to include vaccinations and refresher training put in place to deliver this.  The Board was assured that, whilst measles posed a significant risk, TB did not pose a huge risk to residents in Hillingdon. 

As MMR immunisation rates had reduced, London no longer benefited from herd immunity.  A team within the Department of Health had identified the barriers to immunisation as:

·         Chaotic lives preventing engagement (Health Visitors had been great at catching these individuals);

·         Affluent individuals who had believed the media hype about the risks of MMR; and

·         Minority ethnic individuals who might query the appropriateness / content of the vaccinations (misinformation needed to be corrected).

The Board was advised that the model contract for hospitals included neonatal so a catch up TB service was provided by CNWL.  However, it was queried whether the neonatal service would be retained in Hillingdon. 

Concern was expressed that, despite Hillingdon Hospital having a contractual obligation to provide TB vaccinations, this did not appear to be happening.  It was suggested that this inaction could be as a result of anything from staff workload or midwife/patient ratios, to discipline or leadership.  The Council’s External Services Select Committee would be asked to seek further information from NHSE and The Hillingdon Hospital NHS Foundation Trust (THH) at a future meeting.  Mr Tahir Ahmed, THH’s Executive Director of Estates and Facilities, advised that he would raise this issue with the THH management team. 

It was acknowledged that the Strategic Intentions document read better than the Commissioning Intentions iteration had.  It provided a narrative and placed prevention at the forefront of work.  Although reference to work around health based places of safety was encouraging, it was noted that further information as still needed with regard to shaping services. 

RESOLVED:  That Hillingdon CCG's Strategic Intentions for 2020-2022 be noted.