The Health and Social Care Scrutiny Sub-Committee met on Tuesday 5 March 2024 to discuss winter pressures on the Harrow Health and Care System and to receive an update on mental health services in Harrow provided by Central and North West London NHS Foundation Trust (CNWL). The committee noted the information presented on both topics.

Winter Pressures

The Sub-Committee received an update on the pressures faced by the Harrow Health and Care System during the winter period. It was reported that the system experienced its peak pressure in the first week of January, coinciding with a post-Christmas surge in patient attendances and a Junior Doctors' strike.

Key points highlighted included:

• A&E Attendance: Average A&E attendances were 2,170 per week, an increase on the previous winter and a level that would have been considered unusually high before the COVID-19 pandemic.
• Hospital Admissions: Non-elective admissions to Northwick Park Hospital averaged 600 per week, reaching a peak of 718 in the week before Christmas.
• Ambulance Handover Delays: While delays in handing over patients from ambulances to A&E staff had reduced due to stricter time limits, this had led to an increase in long waits within A&E. The number of 12-hour waits in A&E averaged 395 per week since October, compared to 313 in the previous winter.
• Bed Occupancy: During November and December, an average of 97% of hospital beds were occupied, with patients frequently being boarded on wards before a bed became available.
• Social Care Caseloads: The number of individuals on social care caseloads post-hospital discharge had tripled compared to the pre-COVID-19 period.

Concerns were raised by committee members regarding the impact of the junior doctors' strike on elective care and staff stress, although emergency and cancer care were not significantly affected. Clarification was sought on the term boarding, which was explained as patients being managed in corridors with clinical oversight until admitted, a measure taken to allow ambulances to respond to other emergencies.

Members questioned why 12-hour waiting times in A&E had not reduced, noting that neighbouring boroughs experienced shorter waits. It was explained that Northwick Park Hospital is one of the busiest in the country, serving patients from Harrow and surrounding areas, with 48% of users being Harrow residents.

Regarding community services, staff sickness rates were discussed. The Sub-Committee was informed that sickness rates had reduced to 1.1% over the winter period, down from an average of 3.9%, and that the previous higher rates were attributed to common illnesses like flu and colds, rather than stress.

Members also inquired about long-term planning for increased demand. It was reported that ongoing evaluations of additional discharge funding were in place, alongside work on a long-term strategy for sustainable demand management. New schemes, such as the bridging care service, had seen significant uptake. The effectiveness of GP access and walk-in centres in reducing A&E pressure was also discussed, with the conclusion that while primary care access is important, walk-in centres had not shown a clear correlation with reduced A&E attendance.

The Sub-Committee resolved to note the presentation.

Harrow Mental Health - CNWL

The Sub-Committee received an update on mental health services provided by Central and North West London NHS Foundation Trust (CNWL) in Harrow, outlining the pathways for service users.

The report covered several key areas:

• Harrow Talking Therapies: This service offers up to six sessions with a trained therapist for individuals experiencing anxiety or depression. The service has been extended to include individuals aged 16-18. Residents aged 11-25 across North West London can also access digital support tools through Kooth. The contract with Harrow MIND for psychological wellbeing practitioners is transitioning to CNWL.
• Community Mental Health Offer: Harrow was an early implementer of the National Community Mental Health Framework, establishing a Community Hub Model in September 2020. This hub provides integrated care with additional staff, including Community Navigators, family therapists, and a social prescriber. Referrals are typically made by GPs or the Single Point of Access (SPA). Mental health link workers are also present in each Primary Care Network (PCN). A Young Adult Pathway has been introduced for those aged 16-25. The service has piloted a successful voluntary sector alliance with Hestia. A redesigned service now includes a single Triage team to ensure appropriate signposting and a new Recovery pathway is planned.
• Perinatal Mental Health Services: CNWL provides a community Perinatal Mental Health Service for Harrow residents, supporting women and their partners during the perinatal period. The Maternity Trauma and Loss Care Service is also available for those who have experienced a traumatic birth. A mother and baby unit at Park Royal in Brent offers inpatient care.
• Crisis Care: Improvements have been made to crisis care access, including the expansion of the Harrow Mental Health Emergency Centre (MHEC) at Northwick Park Hospital and the opening of the Mental Health Crisis Assessment Service (MHCAS) at St Charles Hospital. These services offer alternatives to A&E for individuals experiencing a mental health crisis.
• Inpatient Services: The focus is on providing care within the community where possible, with an emphasis on trauma-informed approaches (TIA) being embedded in inpatient wards.
• Older Adult Mental Health Services: These services include a community mental health team, a memory service for diagnosis, and a Home Treatment Team (HTT) to support older adults at home. Efforts are underway to secure funding for Admiral Nurses to support carers and those diagnosed with dementia.
• Community Learning Disability Services (LD): Management of these services has transferred to Harrow Borough and is being redesigned to meet national standards.

Members raised questions about the range of mental health conditions addressed, the support for older people and their families, the integrated approach to mental health services, statistics on self-referrals and waiting times, pathways for individuals with language or cultural barriers, and how mental health issues are addressed in schools. An update on the transition of the Mind contract to CNWL and the success of the partnership with Hestia was also provided.

The Sub-Committee requested that the Children's Mental Health Service, the impact of junior doctors' strikes on operations, and the effects on cancer and maternity patients be discussed at a future meeting.

The Sub-Committee resolved to note the report.