This meeting was about the approval of the Better Care Fund (BCF) plans for 2024/25 and the consideration of reports from partner organisations on a range of topics relevant to the Hounslow Health and Wellbeing Strategy 2023-26¹. The meeting included updates on the transfer of Hounslow Community Services to the West London NHS Trust (WLT), the Better Care Fund, and mental health services.

Mental Health Services

Dr Christopher Hilton, of the WLT, and Healthwatch Hounslow were scheduled to present updates on mental health services in the Borough.

The report pack included a report titled Joint working between West London NHS Trust and Healthwatch² which detailed activities underway to support High Intensity Users of health services. The report explained that people who frequently attend emergency departments (EDs) are a small percentage of the population, but account for a high number of ED visits, ambulance journeys and non-elective hospital admissions.

This report was co-authored by Tom Heffernan, of the Chelsea and Westminster Hospital NHS Foundation Trust (CWFT), and by Dr Omer Mahmoud, of the WLT.

0.67% of the English population are HIUs of UEC services, they account for 16% of all ED attendances, 29% of all ambulance journeys and 26% of all non-elective hospital admissions in England, with an estimated cost to the NHS of £2.5bn per year.

The report went on to describe the key drivers of high intensity hospital use in more detail, and the work that is underway to better understand the needs of these service users in Hounslow. In particular, it explained the composition of a new team being established to identify cases and provide proactive support, the details of which can be seen below:

• Full time HIU Care Coordinator (community based)
• Full time HIU ED Case Worker (ED based)
• Part time Emergency Medicine (EM) clinical & training lead(s)
• Part time primary/community care clinical & training lead
• Part time MH clinical & training lead

The report pack also contained another report titled Joint working between West London NHS Trust and Healthwatch³ which described the work undertaken by Healthwatch Hounslow to engage with patients on the acute wards in the two Mental Health Units run by the WLT, Lakeside Mental Health Unit on the West Middlesex site, and Hammersmith & Fulham Mental Health Unit.

This report explained the challenges of the work, including a high turnover in Healthwatch volunteers and the challenges of engaging patients with acute conditions, and why they chose to collect data through one-to-one meetings with patients rather than using a more traditional focus group model. The report included data on the number of responses they received from each site, and noted that they found significant variation in the views of different service users.

Our findings show that patient experience - both in terms of patient ratings of different service areas and sentiments towards the key themes – widely varies per patient. Ratings and key themes are not predominantly positive or negative but reflect the mixed experiences that patients have with different service aspects.

The report included appendices describing positive sentiments from patients about the staff, and positive sentiments about other aspects of their care.

High Intensity Users of Emergency Services

The report pack contained an update from Dr Omer Mahmoud of the West London NHS Trust and Tom Heffernan of the Chelsea and Westminster Hospital NHS Foundation Trust about the activities underway to support High Intensity Users of emergency services.

The report pack also included a presentation about patient experiences from Aastha Binjrajka of Healthwatch Hounslow.

The Better Care Fund

The agenda included a report on the Better Care Fund which asked the Board to approve both the 2024/25 Quarter 1 reporting template for submission to NHS England, and the 2023/24 year end submission template.

The key purposes of the Quarter 1 reporting template were:

• To confirm the status of continued compliance against the requirements of the BCF.
• Provide an update on spend and activity against the Additional Discharge Fund.

Health and Wellbeing Strategy Progress Report

The agenda included a report on the Health and Wellbeing Strategy Progress Report which reviewed the progress on each of the four thematic areas of the Strategy: Start Well, Live Well, Age Well and Healthy Places.

The report used a traffic light system to indicate the status of each project, and included a short description of progress or issues for each project.

Some of the issues identified in the report included:

• Delays in establishing a working group to take forward recommendations about improving the health of women of childbearing age.
• The need to develop a pilot project that integrates support from local partners to improve school readiness.
• The need to increase the uptake of the NHS Healthy Start scheme.
• The need to improve the pathway for pregnant women to get support from the locally commissioned stop smoking service.
• The need to address the increasing levels of obesity prevalence of children in Year 6.
• The challenge of reducing the prevalence of smoking in Hounslow.
• The need for greater focus on the Healthy Places theme of the Strategy.
• The need to address the high number of rough sleepers in long term temporary accommodation.
• The need to address issues with the delivery of the Social Housing Decarbonisation Fund (SHDF) Wave 2 Project.
• The need to recruit more volunteers for the mental health befriending service.
• The need to retender the drug and alcohol treatment services to ensure effective services are in place by April 2025.

Rough Sleeping

The meeting pack included a presentation from Pauline Jones about Rough Sleeping, which described the challenges of supporting Rough Sleepers in Hounslow, and included case studies of people with No Recourse to Public Funds (NRPF) who were accommodated in temporary accommodation but at risk of being evicted.

Tobacco Control

The meeting pack included a presentation from Buvana Ailoo on Tobacco Control, which described the work being undertaken by the Hounslow Tobacco Control Alliance, a collaboration of stakeholders in the borough, to reduce the prevalence of smoking.

The presentation explained that the alliance was working on a number of initiatives, including:

• The provision of a stop smoking service.
• Ensuring that all tobacco used in the borough is lawfully permitted.
• Targeted lung health checks.
• A proposal to implement smokefree spaces in areas where children and adults interact.

The presentation also explained that the alliance was working on a number of other projects, including:

• A smokefree homes campaign.
• Education and outreach in schools.
• Work with National Trading Standards on the importation of vapes.
• Recycling of single use vapes.

Joint Strategic Needs Assessment Update

The meeting pack contained a verbal update from Sukhjeet Gill on the Joint Strategic Needs Assessment (JSNA) process. The update explained that the Policy and Insight team was analysing data to support the delivery of the Health and Wellbeing Strategy, and that much of this data was being published on the Hounslow Data Hub.

The report explained that the team had recently created a number of insight reports, including:

• An oral insight report focussed on children.
• An infant mortality insight report.
• An infant and young children health and wellbeing insight report.
• A pregnancy risk factors report.
• A school readiness and attainment report.
• A childhood vaccine snapshot.
• A children's mental health snapshot.

It also explained that they had created a number of snapshots, including:

• A smoking and vaping snapshot.
• A heat awareness snapshot.

It was noted that some data could not be published due to its sensitive nature.