Agenda item

Mr Keith Spencer, Co-Chair and Managing Director of Hillingdon Health and Care Partners, advised that this item would also cover the discussion that would have taken place under Agenda Item 7: Proactive Care Developments Update / Neighbourhood Health.  He noted that a discussion had taken place at the last Health and Wellbeing Board meeting in relation to the need to identify a smaller number of priorities.  The report provided more detail on:

1. five proposed health and wellbeing priorities:

1. start well - improve early years outcomes, reduce child obesity and promote readiness for school and life.
2. live well - prevent and / or delay the onset of Long Term Conditions, particularly hypertension, improving mental wellbeing and enhancing access to early intervention and support for carers.
3. age well - implement ‘at scale’ proactive frailty management and better end-of-life care that enabled people with multi morbidity to maintain independence for as long as possible in order to: avoid non elective presentations; avoid admission to long term care; and promote early discharge.
4. healthy places - tackle housing, environment, employment and social isolation.
5. equity and inclusion - target resources and interventions where inequalities were greatest using Core20PLUS5: specifically Hayes, Yiewsley, and West Drayton.

2. progress to implement these priorities; and
3. a series of metrics and diagrams to quantify progress.

It had been proposed that the first two years would focus on the ‘ii. live well’, ‘iii. age well’ and ‘v. equity and inclusion’ priorities, whereby resources would be targeted on areas with the greatest inequity.  Work would still also be undertaken in relation to the ‘i. start well’ and ‘iv. healthy places’ priorities, but to a lesser degree.  Professor Ian Goodman, North West London Integrated Care Board (NWL ICB), suggested that, if effort was going to be focussed on priorities ii, iii and iv, this would need to be discussed outside of the medical model and moved away from acute medical care.

Mr Spencer advised that the priorities would be delivered through a new seven-day place operating model and two key transformation programmes in 2025/26: integrated services focused on preventing crisis (live well/equity); and integrated services focused on responding to crisis (age well/equity).  Preventing crisis would involve the neighbourhood teams which had progressed well with three strands:

1. access to primary care to prevent overspill into acute care;
2. proactive care for those with multi morbidity; and
3. preventing long term conditions. 

Consideration needed to be given to the place-based offer available to help people live at home for longer and prevent them from going into hospital. It was suggested that the key metrics needed to be clear and should be built from the hospital redevelopment programme, national targets (for example in relation to Better Care Fund and reablement) and hypertension.  Board members were asked if they would be happy to adopt these as the initial metrics which could then be built upon or changed at a later date (progress on these had been highlighted in the report). 

Hillingdon performed well with regard to neighbourhood health and proactive care but had faced challenges in relation to greater case management.  Although the Borough did well against the NWL benchmark, more could be done to improve reactive care.  For example, the Care Connections Team was currently case managing around 5,000 patients, yet there were around 10,000 Hillingdon residents that were living with severe frailty, which meant that only half of those that needed help were being supported by the Team.  Action would also be needed to reduce non-elective admissions / long term care for hypertension and to endure that at least 80% of patients with diagnosed hypertension had their blood pressure under control by 2028. 

Metrics would also include a reduction in the number of patients without criteria to reside to no more than 34 by 2025.  Progress had also been made in relation to services focused on responding to crisis (admission and Emergency Department (ED) avoidance).  A new Urgent Response Service would be implemented from September 2025 which would have access to GP clinical supervision via Same Day Urgent Primary Care Hubs and consultant support through the Frailty Assessment Unit. There would be a single co-ordination Centre which would enable partners to tackle the current overuse of ED by this cohort (34 appointments above target per day). Hillingdon had been working with the NWL ICB to access additional funding.

The Lighthouse had been set up as a diversion scheme for mental health patients attending the ED (averaging nine patients per day).  However, as only an average of one patient per day was being seen at the Lighthouse, the model and plan had been rethought and would move to a model akin to a mental health ED from the end of June 2025.  Ms Vanessa Odlin, Managing Director - Goodall Division at Central and North West London NHS Foundation Trust (CNWL), advised that the Lighthouse numbers were far too low and that the Trust had been working with Dr Ritu Prasad, Chair of the Hillingdon GP Confederation, to increase usage.  Service users had also been involved in identifying improvements and it appeared that the Lighthouse was sometimes not used because people were unaware of the crisis alternatives. 

It was suggested that consideration needed to be given to same day emergency care for individuals with mental health needs and what this would look like.  Ms Odlin had been looking at a model whereby patients did not need to present at the ED before they went to the Lighthouse and therefore only had to tell their story once (the Lighthouse was located approximately 100 yards from the ED).  System partners would be meeting to discuss this at the end of June / beginning of July 2025. 

A demand, capacity and pathway review had been undertaken in relation to Urgent Community Response Services.  This multi-agency work had involved primary care and community services and had highlighted that the capacity was not available to meet the patient numbers (capacity would need to double to about 7,500 annual referrals).  As such, consideration was being given to bringing services together with a new model and the implementation of a new mobile Intravenous Antibiotics Service (a key component of the future service) which would be implemented by the end of June 2025 using funding from the Better Care Fund. 

Ms Sandra Taylor, the Council’s Corporate Director of Adult Social Care and Health, advised that she supported the five priorities as they dovetailed with the adult social care perspective, particularly in relation to issues such as hypertension which would need to be aligned with Public Health.  Even though the Council was also having good outcomes from its work with CNWL, she also supported the targeted and universal work in relation to early help and young people. 

Ms Lesley Watts, Chief Executive at The Hillingdon Hospitals NHS Foundation Trust, advised that she did not have any issues with the priorities but that the timescales for delivery needed to be realistic.  Clarity would also be needed in terms of identifying who would be responsible for delivering which actions.  The new hospital would not be big enough to meet residents’ needs if the priorities were not delivered. 

As there was a tendency to want to boil the ocean, it would be important to focus on a small number of issues and do them well.  To this end, focussed work had been undertaken in relation to mental health, reactive care and children’s services but clear numbers were needed.  It was noted that Roy Lilley had reported that children under the age of one year were the greatest users of the ED but not all of these children needed to go to hospital.  Further work was needed to educate new parents on the most appropriate alternative pathways for common issues.  The issue of vaccinations had also been raised following the recent media coverage of the increasing prevalence of measles (particularly in London).  Consideration would need to be given to increasing vaccination rates through the 0-19 service, GPs and screening. 

Ms Odlin agreed with the proposed five priorities.  CNWL continued to work with the local authority on the Family Hub and the Urgent Crisis Response for physical health had been prioritised.  Partners had been delivering some good services but had not been very good at publicising their successes. 

Concern was expressed at how partners were going to be able to deal with demand and capacity.  It was noted that the current spend would need to go further by, for example, bringing resources together.  Additional resources had also been sought through a bid for £20m funding (by September 2025). 

Following the discussion, Mr Spencer agreed to update the priorities to include responsibilities and timescales for the vaccination update.  Insofar as discharge was concerned, Hillingdon faced two challenges:

1. the Borough had a target of 34 for ‘no criteria to reside’ but the figure hovered around 40.  Work had been undertaken in relation to P2 patients (who needed rehabilitation) but it was still being oversubscribed; and
2. the Borough faced a deficit of discharges at the weekend and a surplus during the week.  A seven-day model of care was needed. 

With these changes, the priorities would provide a single version of the truth. 

Ms Amanda Carey-McDermott, Hillingdon GP Confederation, advised that there were risks associated with same day urgent care capacity.  Although HHCP had identified additional funding to support this, the GP Confederation was only able to contribute 60% of the funding that it had done in the previous year.  It was hoped that the gap would be mitigated by the success of other funding bids. 

RESOLVED:  That:

1. the priorities, as amended, be agreed; and
2. the discussion be noted.