The Joint Health Overview and Scrutiny Committee (JHOSC) met on Tuesday 18 July 2023 to discuss the North West London Strategy for Provision of Acute Beds, the standardisation of ophthalmology services, and the development of musculoskeletal services. The committee considered a recommendation to investigate further the integration of health and care services and noted a discussion regarding the provision of baseline access times and expected improvements for musculoskeletal services.

North West London Strategy for Provision of Acute Beds

The committee received an update on the North West London Integrated Care System's (ICS) strategy for acute beds. Rob Hurd, Chief Executive of the Integrated Care Board, and Dr Bob Klaber, Director of Strategy, Research and Innovation at Imperial College Healthcare NHS Trust, presented the strategy, which aims to ensure patients receive the best care in the most appropriate setting, rather than solely focusing on increasing bed capacity.

Key points discussed included:

• Focus on Need and Demand: The strategy emphasises understanding the need for services before considering demand and capacity. This involves joint strategic needs assessments and understanding community needs.
• Population Projections: The ICS uses Greater London Authority (GLA) figures for population projections, which differ from the Office for National Statistics (ONS) figures used nationally. This has led to discussions regarding hospital size modelling.
• New Hospital Programme: The committee was updated on the national New Hospitals Programme. While Hillingdon Hospital's rebuild has received approval to proceed, funding for St Mary's Hospital, Charing Cross Hospital, and Hammersmith Hospital has been delayed beyond 2030. This delay raises concerns about the condition of existing facilities and the ability to meet future demand.
• Alternative Funding Models: Imperial College Healthcare NHS Trust is exploring mixed funding models for St Mary's Hospital, potentially involving government funding, land sales, and partnerships with life sciences organisations.
• Models of Care: There is a strong focus on changing models of care, such as Same Day Emergency Care (SDEC) and hospitals at home, to reduce the need for inpatient stays.
• Delayed Discharges: Improving coordination with care services to reduce delayed discharges was highlighted as a priority. Rob Hurd pointed to Hillingdon's integrated discharge hubs as a positive example.
• Occupancy Rates: The target for bed occupancy is 92%. While current rates are higher, the strategy aims to reduce this through better utilisation of beds and appropriate care settings, rather than building more beds.
• Health Inequalities: The committee raised concerns that high bed occupancy could exacerbate health inequalities. The strategy aims to address this by developing responsive local services.

Councillor Nick Denys proposed a recommendation for the committee to investigate further how vertical and horizontal integration of health and care services will be implemented across North West London.

Standardisation of Adult & Paediatric Ophthalmology Services Across North West London

Rob Hurd presented an update on the proposed standardisation of adult and paediatric ophthalmology services across North West London. The current service provision is fragmented, with significant variations in availability across boroughs.

Key aspects of the proposed changes include:

• Optometrist-Led Community Services: The new model aims to increase accessibility by delivering services through high street optical practices, making better use of optometrists' expertise.
• Services for Adults: The community service will cover cataract care with shared decision-making, glaucoma referral refinement through second pressure checks, and community eye care for minor conditions.
• Paediatric Services: Paediatric community ophthalmology services, currently offered in Ealing and Hounslow, will transition to hospital-based services. A review of paediatric services is planned for the latter half of 2023.
• Direct Referrals: Optometrists will be able to make direct referrals to hospitals, streamlining the process and ensuring GPs are informed.
• Engagement: A comprehensive engagement programme has been undertaken, including online webinars, face-to-face events, and surveys, to gather feedback from residents.
• Procurement: The procurement process for new contracts is underway, with a phased go-live expected from December 2023.

Concerns were raised about ensuring the quality of care across all optometrists, particularly regarding conditions like glaucoma. Rob Hurd explained that standardisation, clear contract specifications, and performance monitoring would be used to ensure consistent quality. The issue of representation for residents of Hammersmith and Fulham in the engagement survey was also addressed, with assurances that face-to-face events and ongoing engagement would capture feedback from all boroughs.

Development of Musculoskeletal Services Across North West London

Joe Nguyen, Borough Director for Westminster at NHS North West London Integrated Care Board, presented an update on the development of musculoskeletal (MSK) services. The current provision is inconsistent across boroughs, leading to inequities in access and outcomes.

The proposed new model of care aims to:

• Personalised Care: Focus on tailoring services to individual needs and goals, moving away from a checklist approach.
• Holistic Approach: Integrate fitness and physical health as key components of MSK management, supporting patients in optimising their conditions for employment and economic activity.
• Early Intervention: Improve access to diagnostics and treatment options within communities, and foster collaboration with secondary care colleagues to identify complex patients early.
• Standardisation: Reduce unwarranted variation in service provision and access across North West London, ensuring equitable access to high-quality, clinically effective community MSK services.
• Self-Referral and Prevention: Emphasise self-referral, education, and self-management, with a focus on prevention.
• Integration: Work in tandem with Primary Care Networks and new Community Diagnostic Centres (CDCs), and align with the Elective Orthopaedic Centre.

Councillor Ben Wesson highlighted the growing prevalence of MSK conditions and questioned the future-proofing of the proposed model. Rob Hurd responded that the focus on efficiency and best practice is crucial given anticipated workforce and funding constraints.

Concerns were raised about diagnostic access, with a specific example of a patient in Hammersmith needing an X-ray in Brentford. Joe Nguyen confirmed that improving diagnostic offer and timeliness is a key part of the development. Lucy Knight shared her personal experience of long waiting times for physiotherapy and questioned how the new initiative would improve this. Joe Nguyen acknowledged that while Kensington and Chelsea has an integrated pathway, wait times remain an issue, and feedback is crucial for improvement.

The committee noted a discussion regarding the provision of baseline access times and expected improvements for musculoskeletal services.

Work Programme and Recommendations Tracker

The committee noted the North West London Joint Health Overview and Scrutiny Committee's 2023-24 Work Programme and the Recommendations Tracker. Councillor Natalia Perez expressed her gratitude for her election as Vice Chair and her commitment to supporting the committee's work. George Kockelbergh, the scrutiny officer, was thanked for his support as he moves to a new role.