Agenda item

Mr Keith Spencer, Managing Director at Hillingdon Health and Care Partners and Co-Chair, advised that, following on from the workshop held in November 2024, it had been clear that partners needed to be able to hold each other to account on delivering objectives.  Although a work in progress, the report had been drafted providing a synthesis of priorities derived from five documents.  Once agreed, partners would need to agree what ‘good’ looked like (and establish how they would know when this had been achieved) and a dashboard would be created for the priorities.  It would be essential to identify who was responsible for each action (and the associated deadline) else it was unlikely that action would be taken.

There were a number of challenges which included rising health inequalities (particularly in Yiewsley and West Drayton, but also in Harefield), increasing levels of chronic disease, hypertension and anxiety and depression.  Referrals to adult social care had increased by around 40% and issues such as poor air quality were compounding the challenges.  As such, it would be important to take a more focused approach around three themes: early intervention and prevention (there was currently no credible strategy for dealing with early intervention); enhanced programmes; and targeted interventions. 

Work was underway in relation to environmental health initiatives but more needed to be done around digital innovation.  This would be key in terms of getting a handle on the metrics and what needed to be measured rather than just measuring what was available. 

Ms Kelly O’Neill, the Council’s Director of Public Health, advised that people were living longer but were living unhealthy lives for longer.  There had been a significant increase in the demand for adult social care which would just get worse if it was not addressed.  Preventative action would be key and should be underpinned by the residents’ needs.  It was suggested that demand could be tackled by looking at the short and long term actions that could be undertaken with a focus of children and families.  Social and economic determinants were driving ill health so this would need to be seen as a long term mission.  The plan would need to be updated every three years but it was unlikely that much would really change in three years.  Significant change could be initiated but there would need to be a real drive for action.

Mr Tony Zaman, the Council’s Chief Executive, advised that partners needed to identify tangible material actions for which they could be held to account.  Consideration would need to be given to identifying the top five or six issues that needed to be prioritised because they would make the biggest material difference in five years.  Thought would also need to be given to how residents ‘consumed’ health and wellbeing services in Hillingdon and how this could be changed (would digital access be a way of helping those that needed the services the most?). 

It was agreed that partners needed to identify a small number of priorities.  Councillor Jane Palmer, Cabinet Member for Health and Social Care and Co-Chair, noted that it would be important for residents to be included on this journey as they did not seem to know that the Council had a role in keeping them healthy.  Residents could mistakenly think that the Council only dealt with things like things like moving the library to the Civic Centre.  It would be important to showcase what action had already been taken and the difference that this had made.  She suggested that obesity should be included as one of the priorities. 

Councillor Sue O’Brien, Cabinet Member for Children, Families and Education and Vice Chair, noted that the key challenges would be in relation to engagement with residents.  There were issues in relation to access to information, language, etc.  Ms O’Neill advised that inequalities should form the foundation of all action taken by partners.  Action was needed to look at how engagement was undertaken because there had been some concerns about upsetting people. 

Core20PLUS5 was a national NHS England and NHS Improvement approach to support the reduction of health inequalities at both a national and a system level.  The approach defined a target population cohort (the ‘Core20PLUS’) and identified ‘5’ focus clinical areas requiring accelerated improvement.  Ms O’Neill believed that this approach would help contribute towards improvements in residents’ health.  Ms Sue Jeffers, Borough Director at North West London Integrated Care Board (NWL ICB), advised that the ICB had a responsibility to focus on the Core20PLUS groups most impacted by health inequalities but that they needed to identify ways of engaging with these communities.  There had been a 15% increase in homelessness between December 2024 and January 2025.  Targeted groups would include people who were homeless, asylum seekers, Looked After Children, the transgender community and those with learning disabilities. 

Ms Lesley Watts, Chief Executive at The Hillingdon Hospitals NHS Foundation Trust, noted that the report included more than a small number of priorities and that these needed to be reduced.  Consideration would need to be given to identifying what ‘normal’ behaviour looked like because things like obesity and anxiety seemed to have been medicalised.  She also believed that more needed to be done in relation to children and to ensuring that those who needed it were seen in a therapeutic environment. 

Thought would need to be given to what the acute unit was there to do for the population.  Currently, it didn’t seem to be providing the best care as it was having to take action in relation to things that it shouldn’t have to. 

Concern was expressed that partners tended to identify the same issues repeatedly but that progress never seemed to be made.  It would be important to put responsibilities back onto individuals.  Professor Ian Goodman, NWL ICB, believed that obesity was more important that hypertension in Hillingdon as obesity had been underrepresented and hypertension had been overrepresented.  Inactivity was a key driver of obesity and falls were caused by inactivity. 

The Board was advised that GLP-1s had become popular amongst celebrities to treat diabetes and obesity but GPs were only allowed to prescribe them if the patient was diabetic and obese.  As well as being able to help reduce weight, the drugs had also been shown to reduce the likelihood of dementia and heart attacks.  Many of the residents who were overweight did not exercise and then found it difficult to exercise because they were overweight – it became a cycle.  It was anticipated that GLP-1s would eventually become commonplace (like statins) and that partners needed to plan for this. 

Ms O’Neill advised that GLP-1s would not provide a quick systemwide change as there would only be a small number of people who would have access to the drugs over the next three years (220,000 doses across the whole country).  As such, the focus should be on preventing residents from becoming obese in the first place. 

Mr Edmund Jahn, Chief Executive Officer at the Hillingdon GP Consortium, advised that integrated neighbourhood teams were now up and running and working with the acute trust.  There were different versions of the strategy with neighbourhood level priorities that were adjusted to meet the needs of specific neighbourhood populations.  The information included in the report dovetailed with the neighbourhood work.  Ms Watts noted that it would be important to ensure that basic services were provided to the most deprived areas.

Mr Zaman suggested that the partners needed time to think about setting the priorities.  Some of them would be health related but some might be financial.  Either way, consideration would need to be given to setting smart criteria for choosing priority areas that would make the biggest difference. 

In summary, the Board would need to:

1.    identify five or six priorities which would make the most significant difference;

2.    focus effort in the most deprived areas; and

3.    look at engagement and what would be different this time. 

Mr Spencer noted that things needed to change to be able to cope with the increasing demand for services.  It was agreed that Mr Spencer would work with Mr Zaman, Ms O’Neill, Ms Watts, Ms Taylor, Mr Jahn and others to identify the priorities. 

RESOLVED:  That the Board’s comments on the draft joint Hillingdon Health and Wellbeing priorities for 2025-2028 be noted.