Agenda item

Mr Sean Bidewell, Joint Borough Director at North West London Integrated Care Board, advised that the report provided an update on the progress against the Health and Wellbeing Board’s key priorities and consolidated the latest developments across three core areas:

1.    Health and Wellbeing Board metrics;

2.    Integrated Neighbourhood Teams (INT) – three collocated multi-agency INTs would be established with three core functions: same day urgent primary care through three Neighbourhood Super Hubs, proactive care; and a preventative and anticipatory care programme; and

3.    Reactive Care Programme – to prevent unnecessary non-elective episodes for patients with complex needs and to promote rapid recovery and prompt discharge after acute inpatient stay, a new Urgent Response Service and a new Active Recovery Service would be implemented. 

In response to growing health needs, inequalities and system pressures, five strategic priorities had been established to strengthen prevention, reduce unplanned care and target inequality at neighbourhood level: Start Well; Live Well; Age Well; Healthy Places; and Equity and Inclusion.  Delivery in the first two years would focus on Live Well, Age Well and Equity and Inclusion. 

Mr Bidewell advised that all three of the INTs were now live and 50% of the severe frailty cohort was being case managed, delivering a 36% reduction on non-elective admissions (the remaining 50% would be case managed by the end of April 2026).  Hypertension prevalence recording had increased from 10% to 13.8% (with a target of 16% by March 2026), and 85% of diagnosed cases were under control.  It was anticipated that the Reactive Care Coordination Hub would go live in December 2025 and there would be expanded capacity within the Lighthouse Mental Health Crisis model in the next four weeks.  This had been made possible with additional funding from the Integrated Care Board (ICB) for additional staffing and a shift from a bedroom model to a mental health A&E model.  It was recognised that someone in mental health crisis should not be presenting at the Emergency Department (ED) so the new model looked at promoting crisis alternative initiatives for “mental health only” issues.  If someone with mental ill health presented at the ED, they needed to be walked through to the Lighthouse.  It was suggested that this initiative needed to be widely publicised and information circulated through partners as well as in Hillingdon People. 

The report provided performance data against the target for each metric and the action being taken to remedy any shortcomings.  Weekday hospital discharges had improved to an average of 55 per day (this had been 51 per day in June 2025) and, although weekend discharges had increased, improvements were still needed.  A system taskforce and eight-week delivery plan had been put in place to reduce the number of patients with no criteria to reside during September / October 2025 (currently 46 against a target of 34).  Conversations were being undertaken as it was not anticipated that this would improve unless radical action was taken. 

There were a number of challenges still being faced which included:

·         ED attendances remained significantly above target at 196 per day against a target of 164;

·         Urgent Treatment Centre activity was 189 per day against a target of 180; and

·         Estates and funding constraints risked delaying the Neighbourhood Super Hubs and full same day urgent care rollout. 

Insofar as diagnostics in care homes was concerned, discussions had been undertaken with an organisation that delivered mobile diagnostic solutions such as ultrasound and x-ray (including staffed solutions).  Consideration needed to be given to the logistics for pathways from care homes to the Confederation Hillingdon CIC and a six-month pilot would be undertaken (it was hoped that the improvements would outweigh the cost).  Whilst it was thought that the introduction of mobile diagnostics would help (and the technology was getting better and better), treatment escalation plans needed to be consistently in place for residents in care homes.  Partners would be able to work with the care home staff forums and groups that were already in place. 

It was noted that there were around three hospital admissions from care homes each day so consideration would need to be given to what work needed to be undertaken with care homes to enable them to administer things like intravenous antibiotics (and whether this was something that carers could be trained to do).  As around half of all London Ambulance Service (LAS) transfers came though NHS 111, and most of these were unnecessary, it was suggested that the ‘call before convey’ approach be more widely used.  

Partners had been proactive in taking action together before things became an issue as this would be the only way that the system could be managed effectively. Reactive care support needed to be taken forward to help Adult Social Care and residents to reduce hospital admissions and prevent people from going to the ED in an ambulance as they would be able to get better care at home. 

It was recognised that partners needed to be positive about developments but that they also needed to get better at implementing initiatives.  To this end, consideration needed to be given to lessons learned and case studies so that partners did not try to reinvent flat tyres. 

Whilst the report set out the targets, it needed to show where Hillingdon was not meeting those targets (exception reporting).  The report format would be developed to add deep dives and feedback from residents about specific initiatives.  It should also show what had been learnt from past experiences and identify the barriers to progress. 

RESOLVED:  That the discussion be noted.