The Health and Wellbeing Board met on Thursday 12 March 2026 to discuss a range of critical public health issues. Key decisions included endorsing actions to combat rising tuberculosis rates, noting progress on early homelessness prevention, and agreeing to continue developing the Joint Strategic Needs Assessment. The Board also received updates on the Community Equipment Service and the ongoing consultation regarding the Mount Vernon Cancer Centre.

Tuberculosis Health Needs Assessment

The Board endorsed a series of recommendations to address the rising incidence of tuberculosis (TB) in Harrow, which has seen an average of 105 new cases per year in the most recent three-year period, making it one of the highest rates in England. The interim Health Needs Assessment highlighted that TB disproportionately affects individuals born outside the UK, those of working age, and recent migrants, with higher incidence also observed in more deprived areas and among those with certain health conditions. A significant concern is the low uptake of latent TB screening and treatment, indicating missed opportunities to prevent active TB cases.

The Board agreed to:

• Endorse raising awareness of the Health Needs Assessment and disseminating it to relevant networks and communities.
• Partner with the North West London Integrated Care Board to explore ways to supplement the Latent TB Infection screening programme, potentially through occupational, educational, or community-based initiatives.
• Endorse a request to London Northwest University Healthcare NHS Trust to collaborate with Public Health to ensure sufficient secondary and community-based resources are available to tackle TB challenges in Harrow.

During the discussion, concerns were raised about the focus on specific ethnic groups, with a commitment made to amend the report to reflect all affected communities. The effectiveness of pre-entry screening and the management of risks upon arrival in the UK were also questioned. Officers explained that pre-entry screening only identifies active TB, not latent TB, which is voluntary to detect once in the UK. Barriers to screening uptake, such as stigma, lack of symptoms, and competing priorities like work, were also discussed.

Early Homelessness Prevention

The Board noted the ongoing work and future plans for early homelessness prevention, which aims to address the high demand for housing support in Harrow. Approximately 4,000 households approach the council annually for housing or homelessness advice, with over 1,100 making formal applications. The significant financial pressure from the use of nightly paid accommodation was highlighted.

The primary drivers of homelessness identified were the end of private rented tenancies, family exclusion, non-assured tenancies, and domestic abuse. Homelessness is concentrated in specific areas of the borough, largely aligning with deprivation patterns. Segmentation analysis identified high, medium, and low-risk groups, with a notable trend of homelessness increasingly affecting working households due to rising rental costs. Vulnerabilities were also highlighted among certain demographic groups, care leavers, and those experiencing domestic abuse.

Initiatives underway include targeted advice materials, enhanced partnership working, expanded outreach activity, and the introduction of digital tools to identify risks and connect residents to support earlier. The importance of face-to-face engagement within communities was emphasised.

Members raised questions about the increase in family exclusion, particularly among older age groups, and the underlying causes, with officers suggesting further community engagement is needed. Concerns were also raised about future homelessness projections and the council's capacity to respond, reinforcing the need for a stronger prevention approach. The development of new tools to track prevention outcomes and improve data granularity, particularly regarding ethnicity categorisation, was requested. Members welcomed the preventative approach and stressed the importance of stronger links with wider services, including mental health, substance misuse, domestic abuse services, and the voluntary sector. The need to prioritise care leavers was also emphasised.

Joint Strategic Needs Assessment (JSNA) Work Plan

The Board received an update on the Joint Strategic Needs Assessment (JSNA) work plan, which serves as a key source of intelligence for understanding local health and wellbeing priorities and informing future planning. The JSNA is a statutory requirement under the Health and Social Care Act 2012, functioning as a single, authoritative source of data and analysis about the borough.

The work programme is overseen by a steering group to ensure quality, relevance, and prioritisation, with individual assessments supported by smaller working groups. A new interactive online platform has been launched to improve accessibility. The current work programme includes published, in-progress, and planned assessments, with flexibility to adapt to emerging priorities.

Members questioned the absence of specific focus areas such as cardiovascular disease and obesity in the current work programme, seeking clarification on whether these were being addressed elsewhere. Officers advised that these topics had been covered previously and were available in the JSNA library but were not currently scheduled for update. The Public Health Director acknowledged this and confirmed that the programme could be reviewed to consider updating these areas. The inclusion of frailty and the needs of older populations within the JSNA was confirmed, with this work set to inform the older people's strategy. Members highlighted the importance of ensuring the JSNA directly informed neighbourhood health priorities and future decision-making.

The Board noted the update and endorsed the ongoing work to develop the JSNA in line with the emerging requirements of the health and social care system.

Community Equipment Service Overview

The Board received an update on the Community Equipment Service, including the response to the previous provider's liquidation and the establishment of a new service arrangement. The previous provider, NRS Healthcare, entered compulsory liquidation in July 2025, necessitating urgent action across multiple local authorities to secure continuity of service.

A consortium approach was adopted, working with a social enterprise provider, Provide Care Solutions, to establish a new service. Good progress has been made towards a business as usual position, with some aspects of the service performing better than previous arrangements, particularly in relation to the collection and recycling of equipment, leading to improved efficiency, environmental benefits, and cost savings.

The Director of Adults and Public Health explained that mitigation for financial pressures focused on improving recycling rates, ensuring appropriate prescribing of equipment, and ongoing discussions with system partners regarding funding arrangements. The likelihood of recovering costs from the previous provider's administration was considered very low. Members commended the work undertaken to respond to the provider failure, highlighting the scale and complexity of the challenge, and expressed confidence in the new arrangements.

The Board noted the update on the Community Equipment Service.

Mount Vernon Cancer Centre

The Board received an update on the public consultation and proposed service changes for the Mount Vernon Cancer Centre. An independent clinical review identified sustainability concerns with the current site due to the absence of on-site acute and critical care services, which limits the complexity of treatments that can be safely delivered and requires patient transfers.

The proposals aim to secure the long-term future of cancer services by relocating the main cancer centre to an acute hospital site, with Watford identified as the preferred option. The proposals also include expanding local provision, such as chemotherapy services at other hospitals, increasing care closer to home, and exploring options like home-based treatment and virtual appointments.

The Board noted that while some patients may experience increased travel times, the proposals aim to reduce overall travel burden through fewer treatment visits, improved local access, and additional radiotherapy capacity. An update was provided on the ongoing public consultation, including engagement activity and community conversations, with feedback to inform a decision-making business case later in the year.

The Chair sought clarification on patient experience, particularly regarding radiotherapy treatment and travel requirements, and highlighted concerns about the impact of longer journeys on patients undergoing frequent treatment. The presenter acknowledged these concerns and explained that reducing the number of treatment sessions and increasing local provision were key considerations. Members queried how community engagement could be further extended and suggested additional routes, including local community groups, faith organisations, and patient participation groups. The importance of capturing the views of patients with lived experience was emphasised.

The Board noted the update on the consultation and proposals. The Chair, Councillor Jean Lammiman, announced that this was her final meeting, marking her retirement after over 30 years as a Councillor. She reflected on the development of the Health and Wellbeing Board and expressed her thanks to partners and officers for their support and contributions.