The Health and Wellbeing Board meeting on 7 March 2023 focused on integrated health and care performance, public health initiatives, and the implementation of the Thrive mental health framework for children and young people. Key discussions included addressing the financial deficit within the health system, strategies for tackling obesity in Hayes, improving NHS Health Check uptake, and the progress of the Thrive initiative to enhance mental health support for young people.

Integrated Health and Care Performance Report

The Board received an update on the 2022/2023 Integrated Health and Care Performance Report, which detailed progress on the Joint Health and Wellbeing Strategy and the Better Care Fund (BCF). A significant portion of the discussion centred on the underlying financial deficit within the NHS organisations in Hillingdon, exacerbated by the pandemic. Plans for the post-April 2023 environment are being developed, with a focus on preventing hospital attendances and managing demand. The report highlighted that while Hillingdon performs well in discharging patients, there are still patients staying in hospital longer than necessary. The Board noted that the Better Care Fund plan for 2023-2025 will need to address health inequalities and hospital discharge.

Discussions also touched upon the performance of Hillingdon Hospital's A&E department, with 74% of attendees registered with local GPs. While the majority of A&E attendees were not admitted, questions were raised about educating the public on appropriate use of A&E services. The Urgent Treatment Centre (UTC), which sits at the front of A&E, was noted to be transferring back to The Hillingdon Hospitals NHS Foundation Trust. The Board requested data on hospital discharge delays to identify potential blockages.

Regarding the financial deficit, it was explained that the deficit is viewed as a place-based issue, with the Integrated Care Board (ICB) holding the budget and setting tolerance levels. Negotiations are ongoing with the ICB to develop a balanced plan for 2023/2024, addressing both hospital efficiencies and place-based demand management. A three-to-five-year plan is being developed to achieve a balanced budget for the borough.

Professor Ian Goodman of the North West London Integrated Care System (NWL ICS) highlighted concerns about increasing waiting times for surgery for older people, which had risen from 145 weeks to 166 weeks. The Board was assured that efforts would be made to investigate this issue.

The Board noted the discussion on the Integrated Health and Care Performance Report.

Public Health Update

The Board received an update on two key public health initiatives: a Whole System Approach (WSA) to healthy weight in Hayes and improving the uptake of NHS Health Checks.

Whole System Approach to Healthy Weight in Hayes: This project aims to pilot a WSA to tackle obesity in Hayes, identified as an area with the highest prevalence of overweight and obese residents. A core team has been established to build the project's framework, including initial community engagement and a Hayes Orientation to understand local assets and stakeholders. The project has successfully secured grant funding for a 'School Superzone' at Minet School, with two further bids pending. A Healthy Hayes workshop is planned for March 28, 2023, to bring together stakeholders and residents to develop a shared understanding of the issues, prioritise actions, and build a systems map to disrupt the cycle of excess weight. The project will also focus on developing sustainable long-term engagement plans and identifying community-defined measures of success, which may include feeling fitter or a greater sense of wellbeing, not just weight loss.

Concerns were raised about the current system where GPs are incentivised to identify overweight patients but face long waiting lists for referral to support programmes, leading to resident frustration. The importance of integrated neighbourhood working and the involvement of non-clinicians in promoting health improvements was emphasised. The Council is also working to increase physical activity through better utilisation of local parks and green spaces, particularly targeting groups less likely to be active, such as South Asian women.

Improving the NHS Health Check Programme: This mandated programme aims to identify long-term conditions and rising health risks. While invitations for health checks are on track, the uptake rate is less than 50%. The programme is working to reduce variation among GP practices, improve access for under-served groups, and raise awareness of its importance. Targeted support has been provided to four GP practices, and work is underway with the GP Confederation to explore improved data reporting and point-of-care testing. Community outreach activities, including blood pressure checks, have been conducted. Further data analysis is being completed to compare ethnicity data with health check attendance, indicating potential under-screening in certain ethnic groups, particularly in the Hayes and Harlington locality. Future plans include focused service improvement with GPs, resident engagement through surveys, community outreach in Yiewsley and West Drayton, and piloting community health checks at Hayes Islamic Centre.

The Board noted the discussion on the Public Health Update.

Thrive Update

Jane Hainstock, Head of Joint Commissioning for the North West London Integrated Care Board (NWL ICB), provided an update on the implementation of the Thrive methodology for children and young people's mental health and emotional wellbeing in Hillingdon. She emphasised that implementing a THRIVING needs-led system requires significant cultural change and time.

The Thrive leads in Hillingdon have conducted workshops to map local services, identify gaps, and assess the system's progress using the Thrive Implementation Assessment Tool. These workshops have highlighted variations in language and interpretation of service segments, particularly between Getting HELP and Getting More HELP. Emerging issues include a need for increased peer support and parenting support, and challenges in supporting families whose needs do not fit the criteria for specialist services.

The current phase of development is Phase 1, focusing on understanding the system and prioritising areas for redesign. A self-assessment using the Thrive toolkit is underway to evaluate performance at macro (population health), meso (needs-based groups), and micro (collaborative working) levels.

It was noted that the impact of COVID-19 has led to an increase in diagnosable mental health conditions among young people, with one in four 16-18 year olds now affected, compared to one in six pre-pandemic. The importance of understanding the root causes of this distress, beyond medicalisation, was stressed. An aspiration to create a single front door for all young people's services is being explored to streamline access and prevent families from having to repeat their stories.

The Board noted the Thrive Update.

Board Planner & Future Agenda Items

The Board discussed its forward planning, with a potential inclusion of the Better Care Fund Plan at the June meeting. There was a consensus that the Board should move towards more in-depth discussions and workshops on strategic issues, rather than just receiving descriptive narratives. The Board also agreed to evaluate the impact of the Health and Wellbeing Strategy, now a year old, at its next meeting to refocus efforts.

The Board agreed the 2023/2024 Board Planner, as amended.