Agenda item

The Chair welcomed those present to the meeting.  Mr Keith Spencer, Managing Director at Hillingdon Health and Care Partners (HHCP), advised that the report provided an update on the progress against the HHCP transformation programme.  The update focussed on two core areas of place-based delivery (Integrated Neighbourhood Teams (INTs) and Reactive Care) and set out the risks and priorities for the next six months.

It was noted that the place-based model had been demonstrating early signs of measurable system-wide improvements.  Hillingdon had been the only London borough to see a reduction in emergency demand between June and December 2025 (4.9% compared to the same period in the previous year), despite demographic growth and sustained winter pressures.  Insofar as the Emergency Department (ED) waiting times were concerned, Hillingdon Hospital had been either the best or second best performing borough in North West London (NWL) in the last quarter.  Those patients that had not gone to the ED had attended alternative community settings which meant that they had waited less time than they would have if they had been in the ED and the 12 hour breaches had been reduced. 

There had been a 34% reduction in the No Criteria to Reside (NC2R) delays (down to 33 per day from 55 per day which was below the new hospital development target of 34).  By December 2025, fewer than 4% of Hillingdon Hospital beds were occupied by patients without a clinical need to remain, significantly outperforming the averages in NWL (14%) and London (12%). 

Mr Spencer noted that emergency admissions amongst the 5,000 Borough residents with severe frailty had reduced by 36%, reflecting the impact of proactive neighbourhood case management and integrated community primary care and social care support.  The three INTs were now fully established and had helped to reduce the number of emergency admissions for people with frailty and frailty case management would be expanded towards full population cohort coverage (10,000) by April 2026, using the new frailty dashboard to monitor admissions, falls and Multi Disciplinary Team follow up.  

Urgent same day primary care had been expanded and the mobile diagnostics service had been initiated in November 2025 and had been working well in places like care homes, reducing the need for residents to go to the ED.  The mobile diagnostics service would be reviewed and it was anticipated that it would be rolled out across the Borough in the next few months. 

The Lighthouse service capacity had been increased from six to ten patients each day following a review in December 2025, diverting people experiencing mental health crisis away from ED into more appropriate, therapeutic environments.  Mr Sean Bidewell, Joint Borough Director for the Integrated Care Board (ICB), advised that, as the Lighthouse had been running for about two years, the review and redesign of the services had been undertaken to improve the treatment for patients and make the environment more comfortable.  Subsequent improvements had included an increase in the number of patients going home sooner and the referrals from the ED were being initiated much faster.  As a result, patients were being treated quicker and more effectively.  Although the service had been using bank staff, permanent staff recruitment was underway.

Members were advised that the reductions in the NC2R had been driven by improvements in the discharge processes and practice and strengthened by senior cross-partner leadership oversight.  However, this level of oversight was not sustainable and an alternative would need to be established.  Hillingdon had been outperforming other NWL boroughs on everything except P2 (P0 were patients that could go home without any support; P1 were patients that could go home with some support from a nurse or the local authority; P2 were patients that were waiting for an NHS rehabilitation / non-acute bed until they could return home; P3 were patients who were transferred to a new long term bed or usual residence and received complex support for their needs). Mr Spencer advised that, to some extent, Hillingdon had been the victim of its own success.  Twelve months ago, 80% of the P2 patients had been from Hillingdon and 20% from other boroughs.  Now, this was a 50/50 split and other boroughs would not necessarily prioritise their residents at Hillingdon Hospital over their residents that were in hospitals in their own boroughs.  Hillingdon had little control over the discharge of patients from other boroughs.  However, partners had been looking at data driven proposals and the time it took from being medically optimised to being discharged and reducing this from ten to seven days for Hillingdon residents. 

It took more than three months to turn performance around but things had been improving during this period. That said, winter pressures had created a fragile situation.  Mr Spencer advised that the Hospital avoided adding contingency beds as this would mean adding additional beds to existing wards, which did not result in ideal care.  It was also not preferred practice to keep wards free as a contingency as these beds would very easily fill up. 

Members had seen the journey that partners had been on and were encouraged by the service improvements but noted that one of the risks missing from the report was in relation to embedding these improvements, given that some of the drivers were territorial.  Mr Spencer advised that the partners had worked well together to achieve most of the metrics needed on discharge ready for the new hospital in 2030 but that work needed to continue to deflect people from the front door.  A lot had been learnt in the last 3-6 months and work was still needed to embed diagnostics and neighbourhoods. 

Mr Spencer advised that, with regard to the sustainability of improvements, partners had been working on five-year trajectories to new hospital viability and that they were on track against this.  It was thought that around one third of the Hillingdon population had hypertension at any one time.  If more of these people could be identified, it would help to reduce the number of associated strokes and heart attacks.  Mr Spencer advised that it would be important to hold the current levels for ED attendances, length of hospital stays and NC2R so as not to peak too soon. 

Members were pleased to see that targeted outreach for Heathrow Villages had been included in the transformation programme and asked what would be done to ensure that it worked well.  Mr Spencer advised that previous efforts had included the use of a portacabin and a bus but partners had recently been working closely with residents and those who managed community assets such as Harmondsworth Church to deliver services that would start in March 2026.  Health Inequity Funding had also been secured to recruit a community champion to work with residents in the Heathrow Villages, particularly on mental health issues.  

Work on the three Integrated Neighbourhood Hubs continued and it was anticipated that the business cases would be completed by April 2026 to satisfy the Treasury if required.  Mr Spencer advised that these three superhubs had been planned for the Nestle site, Civic Centre and Pembroke Centre.  It would provide about 2,500m² of development and would need around £30m in capital as well as consideration of the revenue consequences.  HHCP had been working with the ICB to make this a reality in the next three years, with each superhub providing services such as musculoskeletal, pharmaceutical and occupational therapy from smaller sub-hubs. 

RESOLVED:  That the discussion be noted.