The Health and Social Care Select Committee reviewed the council's budget and spending for the 2025/26 financial year, noting a projected overspend of £6.5 million. The committee also received updates on various health services and transformation programmes across the borough, including progress on Integrated Neighbourhood Teams and mental health services for children and young people. Finally, the committee noted the Cabinet Forward Plan and agreed its work programme for the upcoming year.

Budget and Spending Report

The committee noted the 2025/26 Month 10 budget monitoring position, which forecasts a net overspend of £6.5 million against the budget for services within the committee's remit. This represents an adverse movement of £0.8 million from the Month 7 position. The report attributes this overspend to consistently high demand for Adult Social Care, with funding from the Department of Health and Social Care not keeping pace with increasing client demand, complexity, and market pressures.

Within Adult Social Care & Health, the forecast overspend of £6.5 million is comprised of £8.0 million in pressures offset by a £1.5 million underspend in SEND transport and £2.0 million in savings achieved through effective vacancy management. The overspend is driven by ongoing growth in demand across all service areas, particularly in Learning Disabilities and Mental Health services, where client numbers continue to rise above budgeted assumptions. The underspend in SEND transport is due to more economical procurement of personal assistants and maximised efficiencies through a mix of delivery options. An adverse movement of £0.9 million in the month was due to £0.5 million in placement growth from client capital depletions and backdated support plans, £0.3 million from the impact of Department for Education guidance disallowing the use of DSG for Personal Transport costs, and £0.1 million for contingent labour and one-to-one support in Direct Care Services.

For the services within the committee's remit, the savings requirement for 2025/26 is £8.3 million. At Month 10, £3.7 million (44%) of these savings are recorded as banked or on track for delivery, with a further £0.2 million (2%) at initial stages of delivery. £4.4 million (54%) of the savings are reported as at risk in 2025/26, including £1.7 million expected to slip into 2026/27.

The report highlighted that demand at the Adult Social Care front door remains consistently high, with 61,154 contacts managed over the reporting period, averaging over 5,000 per month. Approximately 63% of these contacts relate to physical support needs, followed by support with memory and cognition, mental health, learning disabilities, and social support needs. Safeguarding activity is also a significant component of demand, with 13,868 safeguarding contacts received, progressing to 3,783 concerns and 305 Section 42 enquiries. Performance data shows strong focus on outcomes and risk management, with over 80% of completed Section 42 enquiries having a clearly identified desired outcome, over 96% of which were fully or partially achieved.

The Hillingdon's Technology Enabled Care (TEC) programme has been noted for delivering significant improvements through digital tools, enhancing early intervention, improving safety, and helping residents remain independent at home. The aim is to fully transition to digital systems by 2027.

Health Updates

The committee received comprehensive updates from various health partners.

Hillingdon Health and Care Partners (HHCP) reported significant improvements in system-wide performance, including a reduction in emergency demand and improved Emergency Department (ED) waiting times. Hillingdon was the only London borough to see a reduction in emergency demand between June and December 2025. The No Criteria to Reside (NC2R) delays had reduced by 34%, and fewer than 4% of Hillingdon Hospital beds were occupied by patients without a clinical need to remain. Emergency admissions among residents with severe frailty had reduced by 36% due to proactive neighbourhood case management and integrated community support. The three Integrated Neighbourhood Teams (INTs) are now fully established, and frailty case management is being expanded. Urgent same-day primary care has been expanded, and a mobile diagnostics service was initiated in November 2025. The Lighthouse service, which supports patients experiencing mental health crises, has increased its capacity.

Concerns were raised about the sustainability of improvements in discharge processes, particularly regarding patients from other boroughs. While Hillingdon is outperforming other North West London (NWL) boroughs on most metrics, the split of P2 patients (those waiting for rehabilitation or non-acute beds) from Hillingdon and other boroughs has become 50/50, with Hillingdon having limited control over discharges from other boroughs. Efforts are underway to reduce the time from being medically optimised to discharge for Hillingdon residents.

Targeted outreach for Heathrow Villages has been included in the transformation programme, with services to be delivered in partnership with community assets and a community champion recruited to work with residents, particularly on mental health issues. Business cases for three Integrated Neighbourhood Hubs are anticipated to be completed by April 2026.

Central and North West London NHS Foundation Trust (CNWL) provided an update on the Thrive initiative, an integrated approach to children's and young people's mental health services. A new website has been developed, providing links to council services, a digital directory, referral information, and crisis contacts. The Thrive framework operates on a no wrong front door principle. CNWL also reported progress in reducing waiting lists for children's neurodevelopmental assessments, with investment in additional capacity and transformation of their own assessment pathways. The rollout of Mental Health Support Teams (MHST) in schools is progressing, with Hillingdon having approximately 60% coverage, aiming for the national 100% target by 2029.

Royal Brompton and Harefield Hospitals (RBH) reported progress in reducing long waiting patients, with plans to achieve zero 65-week waits by the end of March 2026. Cardiology and respiratory services remain the most challenged. The Trust is transforming outpatient care and implementing 'Advice and Refer' for GP referrals. Clinically urgent elective cardiac surgery remains a significant risk, with 868 patients waiting. Diagnostic performance, particularly for echocardiography and sleep studies, remains an operational pressure. Harefield Hospital has seen a significant increase in lung transplants and has performed 29 heart transplants. The Trust is expanding its robotic surgery programme and hopes to establish a Pan-London Cardiogenic Shock Network.

Healthwatch Hillingdon presented an update on its recent activities, including the Patient Experience Programme, the Enter & View programme, and an upcoming Hospital Discharge project. Key themes from the Patient Experience Programme include persistent telephone waits and difficulties with online systems for GP access, and long waits and limited real-time updates in A&E for hospital experience. The Enter & View programme in nursing homes and assisted living settings has been positively received, leading to practical recommendations. Challenges remain in achieving consistent operational-level access and a full understanding of the Healthwatch remit in some areas.

Cabinet Forward Plan Monthly Monitoring

The committee noted the Cabinet Forward Plan, which outlines key decisions and other decisions to be taken by the Cabinet collectively and individually over the coming year. The committee has the opportunity to comment on items within its remit as part of its pre-decision scrutiny role.

Work Programme

The committee reviewed and agreed its Work Programme for the current municipal year and noted the meeting dates for 2026/2027. It was agreed that a report on spending and savings targets would be brought to each meeting, with the next such report to be considered on 26 March 2026. The committee also noted that Councillors Denys, Chamdal, and Punja would provide an update following a meeting of the Joint Health Overview and Scrutiny Committee (JHOSC) regarding the Mount Vernon Cancer Centre proposals. The draft final report for the Adult Social Care Early Intervention and Prevention (ASC EIP) review will be considered at the committee's next meeting.