At this meeting, the Hounslow Health and Wellbeing Board discussed the recent transfer of Hounslow Community Healthcare Services to West London NHS Trust, the work of the Joint Strategic Needs Assessment, and the performance of the Health and Wellbeing Strategy. The Board approved both the Better Care Fund plan for 2024-25 and the final spend for 2023-24.

Transfer of Hounslow Community Healthcare Services

Dr Christopher Hilton, Chief Operating Officer at West London NHS Trust, provided a verbal update to the Board on the transfer of adult and children's community health services from Hounslow and Richmond Community Healthcare NHS Trust (HRCH) to West London Trust. He reported that the transfer, which took effect on 1 July 2024, has gone smoothly and that residents of Hounslow should see no change in the services provided.

Dr Hilton acknowledged that the transfer was an accelerated process and that there were a number of logistical challenges to overcome, such as acquiring 750 new laptops for staff, but reassured the Board that all of these matters were being addressed.

Councillor Lily Bath, Chair, asked Dr Hilton for assurance that the transfer would not result in any loss of services or funding for Hounslow. He responded:

To be absolutely clear, the process that both commissioners and both trusts were applying was a lift and shift of the Hounslow services into a new host organisation. So, there's no change in the nature of the services, the size of the services, the funding for the services.

Martin Waddington, Director of Integrated Care Partnership (ICP) and Commissioning, added his thanks to Dr Hilton and his team at West London Trust, as well as the staff at HRCH, for their work in achieving such a successful transition in such a short timeframe. Dr Hamid Gupta, Borough Medical Director, also expressed his appreciation for Dr Hilton's sensitivity to the needs of staff during the transfer.

Kelly O'Neill, Director of Public Health, noted that the transfer had provided a significant opportunity to further improve integration between health and social care services in the borough. She cited the statistic provided by Dr Hilton that West London Trust already knew 40% of the people being supported by HRCH community services through their other services, such as mental health, as an example of the potential for more joined-up care in the future.

Joint Strategic Needs Assessment

Sukhjit Gill, JSNA Programme Delivery Manager, gave a verbal update on the work of the Joint Strategic Needs Assessment (JSNA).

Ms Gill reported that the JSNA team had been supporting a variety of projects and activities across all four thematic areas of the Health and Wellbeing Strategy, including:

• Start Well: A range of reports on topics such as flu vaccination uptake, oral health, infant mortality, childhood vaccines, and school readiness.
• Live Well: A sexual health dashboard, a smoking and vaping snapshot, a smoking cessation insight report, and analysis on heat awareness in Hounslow.
• Age Well: An interactive dashboard for Hounslow Connect, which allows residents to find their local voluntary, community and social enterprise organisations.
• Healthy Places: Work to support net-zero neighbourhoods and a flood risk and resilience insight report.

Ms Gill also highlighted the publication of new Ethnicity Group Deprivation Index data, which provides a more nuanced understanding of deprivation in the borough.

In response to a question from Councillor Bath about how the work of the JSNA translates into changes and improvements to services, Ms O'Neill explained:

...there are three different types of products. One's a deep dive and that's used particularly around things like health need assessment or when we're commissioning big pieces of work where there is a real need for really solid, robust and in-depth evidence to allow us to make recommendations about what the service needs to look like and what's the need in the borough...

She went on to explain that insight reports provide a good picture of a particular area of health or social need and that snapshots provide headline information for colleagues to use on a day-to-day basis.

Better Care Fund

Mr Waddington presented the Board with the Better Care Fund (BCF) planning submission for 2024/25 and the final spend for 2023/24. The BCF is a pooled budget between the Council and the ICB that aims to support integration between health and social care.

Stephen Forbes, Executive Director of Children's and Adults Services, pointed out that the BCF is becoming increasingly complex and noted that there is tension at present between the desire for localism and the ICB's need for consistency across the eight boroughs in North West London. He added that a review of the BCF across all eight boroughs is currently underway and is due to conclude in September.

Integrated Care Board and Borough-Based Partnership Restructure

Mr Waddington provided a verbal update to the Board on the restructure of the Integrated Care Board (ICB) and the Borough-Based Partnership (BBP). He reported that the ICB had been asked to make a 30% staff saving and that this had resulted in the loss of three jobs in Hounslow. He added that it is important for the Hounslow Health and Wellbeing Board to work with the ICB to ensure that its governance and decision-making improve as a result of these changes.

Healthwatch Hounslow Patient Experience Report

Samrin Nohsin, Senior Project Officer at Healthwatch Hounslow, presented the Quarter 4 Patient Experience report. She reported that there had been a significant increase in positive feedback about GP practices in the last quarter, with 74% of residents rating their experience as positive. The key areas of positive feedback included the behaviour of doctors and nurses, the quality of treatment and care, and the use of online messaging systems.

The main areas of negative feedback continued to be around appointment availability and waiting times. Ms Nohsin highlighted the significant drop in positive feedback about waiting times on the telephone compared with Quarter 2.

Health and Wellbeing Strategy Report

Ms O'Neill presented an update on the Health and Wellbeing Strategy. She explained that the report, which covers all four thematic areas of the strategy, shows that most projects are on track.

Ms O'Neill highlighted a number of areas where progress was slower than expected or where there had been significant under-delivery, including:

• Start Well: Infant mortality, healthy weight in children, and children's oral health.
• Live Well: Smoking prevalence.
• Healthy Places: Net-zero neighbourhoods and social isolation.

She informed the Board that she would be bringing a more detailed report on these issues to the next meeting, including inviting officers responsible for delivering these projects to answer questions from the Board.

On the issue of smoking, she said:

We have one of the highest smoking prevalence in London, and that hasn't shifted...we've got past the low hanging fruit, we've got past the people who have found it easier to give up, but now we've got an entrenched group, a population group, that is quite significant in Hounslow, where smoking is really, really affecting health, and it's driving demand in health services.

Mr Forbes added that education is key to tackling obesity in children, as there is no pill or service intervention that can solve the problem. He said:

It is about, as Kelly says, about education, low level stuff in communities with people to encourage that change. So we do need to, I think, look at the interventions through our family hubs, our children's centres, primary care. They're all, in essence, saying the same thing to families. They keep reinforcing that actually there are healthy choices to be made.

He concluded that the Board should put more focus on the areas of the strategy that were not achieving their targets and to make sure that the next iteration of the Health and Wellbeing strategy gives greater emphasis to growth and improvement in the borough, rather than just health deficits.