The Health and Social Care Select Committee met on Wednesday, 13 September 2023, to discuss a range of health updates and budget planning for the upcoming financial year. Key discussions included improvements in mental health services, the development of integrated neighbourhood teams, and the financial challenges facing the council.

Health Updates

Central and North West London NHS Foundation Trust (CNWL)

Vanessa Odlin, Managing Director for Hillingdon and Mental Health Services at CNWL, provided an update on mental health services. While CAMHS in Hillingdon is meeting its response time targets and no longer admitting patients out of area, there is a concern about the number of patients waiting over 12 hours for a mental health bed at Hillingdon Hospital, ranging from one to nine per week. Efforts are underway to reduce this to zero. Access to Improving Access to Psychological Therapies (IAPT) also requires further attention.

Community mental health hubs have been established, integrating primary and secondary adult mental health services under a no wrong front door approach. Caseloads in these hubs have increased by over 600 between April and September 2023, indicating positive engagement. The Lighthouse service, located at Hillingdon Hospital, offers therapeutic interventions near the Emergency Department from 8 am to 8 pm, seven days a week. CNWL has bid for funding to extend this service to 24/7, with hopes of implementation by Christmas 2023. The Crisis House has seen a significant increase in access, with only one patient requiring hospital admission since its move. An additional Health Based Place of Safety (HBPOS) has opened at Hillingdon Hospital, and the Crisis Café has been relocated to a more accessible site.

A wellbeing bus is set to launch by the end of September, initially serving the Heathrow Villages once a week. This initiative aims to reach hard-to-reach communities and will offer services such as IAPT support and basic health checks from a practice nurse. Consideration is being given to including a GP and pharmacy services in the future.

Significant progress has been made in reducing waiting times for children's mental health services, with a reduction in the number of children waiting for their first appointment and for treatment to commence. However, there are still a number of inappropriate referrals to CAMHS, which are being addressed through a mental health summit and by promoting self-referral options.

Hillingdon Health and Care Partners (HHCP)

Keith Spencer, Managing Director of HHCP, highlighted the progress in developing integrated neighbourhood teams, with six expected to be in place by December 2023. These teams aim to deliver care closer to home, integrate physical and mental health services, and establish a common management structure. Adult social care teams are also aligning with these neighbourhoods to improve service coordination. Two same-day urgent care hubs have been planned, with one opening in July 2023 and another in Hayes expected in October 2023, aiming to divert patients from A&E and LAS.

Work is underway to integrate services previously only offered in hospitals, such as ECGs and phlebotomy, into primary care settings. Hypertension has been identified as a major health concern in Hillingdon, and efforts are being made to increase blood pressure screening uptake through community roadshows, GP practices, libraries, and the wellbeing bus.

The Hillingdon Hospitals NHS Foundation Trust (THH)

Patricia Wright, Chief Executive of THH, presented an update on the Trust's progress, noting a significant improvement in the overall situation compared to two years ago. The Trust's 2023/24 Business Plan focuses on delivering national planning priorities, improving productivity, and investing in the workforce. Key objectives include achieving a Good rating from the CQC, improving staff engagement, and reducing waiting times.

THH has made progress in reducing elective waiting lists, with plans to eliminate all 65-week waits by March 2024. Theatre utilisation is high, and emergency performance is improving. The Trust has delivered its financial plan for 2022/23 and is on track to meet its savings targets for 2023/24. A significant development is the upcoming implementation of the CERNER electronic patient record system on 6 November 2023, which aims to streamline patient pathways and improve data sharing across NWL. The new hospital development remains on track for completion by 2030.

Concerns were raised about staff survey results, which remain below national averages, and the impact of the ULEZ charge on staff recruitment. The Trust is working on improving staff recognition and wellbeing. Regarding allegations of sexual harassment, THH has a Freedom to Speak Up policy and is reviewing its related policies.

Royal Brompton and Harefield Hospitals

Derval Russell, Harefield Hospital Site Director, reported on the progress of elective recovery, noting improvements in cardiology waiting times, although cardiac surgery waiting lists remain longer than pre-pandemic levels. The hospital is part of a larger group, Guy's and St Thomas' NHS Foundation Trust, which allows for better use of mutual aid across sites to increase patient treatment. A new electronic patient record system, EPIC, will go live on 5 October 2023. Transplant activity has increased, and efforts are being made to improve organ utilisation. Industrial action has impacted elective recovery, particularly junior doctor strikes, and the Trust is hopeful for a resolution.

The London Ambulance Service NHS Trust (LAS)

Chris Reed, Hillingdon Group Manager at LAS, provided an update on the implementation of Teams Based Working, which aims to improve efficiency and information sharing. A new Hospital Withdrawal Procedure has been introduced to reduce ambulance handover times. The Trust is also expanding its fleet of electric vehicles and has launched the London Care Record app to provide clinicians with better access to patient information. LAS is working to improve response times and is championing the use of alternative care pathways to reduce unnecessary hospital conveyances. Performance in cardiac arrest care is strong, with Hillingdon crews achieving a higher return of spontaneous circulation rate than the LAS average. Recruitment and retention remain challenges, with efforts being made to attract and retain staff.

North West London Integrated Care Board (NWL ICB)

Sue Jeffers, Joint Borough Lead Director at NWL ICB, explained that commissioning responsibilities for pharmacy, opticians, and dentists have now been delegated to ICBs from NHS England. While contracting and commissioning functions are still managed centrally by a London-wide hub, budgets are now held locally by each ICB. This delegation allows for greater flexibility in local planning and the potential to focus on priorities such as children's oral health and underserved communities. Dental services are still in recovery post-pandemic, and national contracts offer limited flexibility. The NWL ICB is exploring opportunities to expand community pharmacy services, which will require additional resources.

Healthwatch Hillingdon (HH)

Lisa Taylor, Managing Director of HH, reported that around 400 residents had contacted Healthwatch Hillingdon in the past six months, with common issues including difficulties accessing GP and dental appointments and concerns about communication. Healthwatch Hillingdon is preparing to publish its 10th annual report and is actively recruiting new volunteers and board members. The organisation continues to have a presence in the Pavilions, with a focus on digital engagement and podcasts to reach local communities.

Budget Planning Report for Services within the Remit of the Health and Social Care Select Committee

Chris Mayo, Assistant Director of Financial Management, and Andy Goodwin, Head of Strategic Finance, presented the initial budget planning report for 2024/25. The council is facing a significant budget gap, largely due to inflation and increasing demand for services. The Health and Social Care portfolio has identified savings of almost £2.4 million for 2023/24. However, inflation has added approximately £60 million to the overall budget gap, with further pressures anticipated from pay awards and demographic growth. The council is exploring various strategies to address the budget gap, including service transformation, procurement efficiencies, and preventing demand. Members expressed concerns about the accuracy of inflation forecasts and the potential impact of higher-than-anticipated costs. The council holds reserves to mitigate financial risks, and the Covid-19 reserves have been largely utilised. Further details on specific budget proposals will be presented in January 2024.

Cabinet Forward Plan Monthly Monitoring

The Committee noted the Cabinet Forward Plan, which outlines upcoming key decisions. It was agreed that the Committee would receive the Carer Support Services report and the 2023/25 Better Care Fund Section 75 Agreement report for consideration prior to their presentation to Cabinet.

Work Programme

The Committee discussed its work programme for the upcoming year. It was agreed that the draft recommendations for the CAMHS referral pathway review would be circulated to members for comment. The Cabinet Member for Health and Social Care will be invited to attend the meeting on 19 March 2024. Information on the Drug and Alcohol Partnership Board will be included in the health updates in January 2024. Members will provide suggestions for a single meeting review topic, with initial ideas including how the council provides services to different communities, care home services, and palliative care. The Committee also noted that the 2023-25 Better Care Fund Section 75 Agreement and Cabinet Report would be moved to the meeting on 21 November to align with the carer support services update.