The Health and Wellbeing Board of Harrow Council met on Thursday 7 November 2024 to discuss a range of critical health and care services across the borough. Key discussions included an update on the Harrow Borough Based Partnership's activities, the organisational restructure of the North West London Integrated Care Board, and the results of the GP Patient Survey. The Board also reviewed the Annual Report of the Director of Public Health, progress on the Learning Disabilities and Autism Strategy, the Harrow Safeguarding Adult Board's annual report and strategic plan, and the Better Care Fund Q2 update.

Harrow Borough Based Partnership: Managing Director Update Report

The Board received an update on the activities of the Harrow Borough Based Partnership (BBP) for August and September 2024. Lisa Henschen, Managing Director of the BBP, highlighted the partnership's role in integrating health and care services, involving key stakeholders such as Central London Community Healthcare (CLCH), Central and North West London NHS Foundation Trust (CNWL), Harrow Council, the North West London Integrated Care Board (ICB), London Northwest University Hospital Trust, and local voluntary sectors.

The finalised Winter Plan was mobilised, incorporating lessons learned from the previous year. Initiatives focused on reducing hospital admissions through vaccination programmes, warm hubs, urgent community response support, and safe discharge processes. Discharge funding was allocated to expand bridging services and increase bed capacity for individuals with dementia and delirium, alongside piloting a 24-hour home care service.

The Preventing Admissions Steering Group has implemented measures to address high admission rates, with admissions from Ambulatory Care Sensitive conditions beginning to plateau. Proactive care planning and multidisciplinary team involvement are ongoing to support vulnerable residents. The partnership is also evaluating its three-year plan and drafting a new strategy and delivery plan for April, which will be influenced by the upcoming NHS 10-year plan. Efforts are focused on assessing public needs and improving system performance.

Development of Integrated Neighbourhood Teams (INTs) has progressed, with Harrow's three neighbourhoods (West, Central, and East) confirmed. Emphasis is placed on aligning health and social care services within these neighbourhoods, with frontline staff receiving support to collaborate and deliver coordinated care. Positive trends have been noted in reducing tooth decay in children under five and in patient-reported access to general practice services. While admissions remain high, they are showing signs of plateauing for ambulatory care sensitive conditions.

Ongoing challenges include occupational therapy provision for children, discharge capacity, and gaps in children's continence services. The Board raised concerns about the termination of discharge funding on 1 November 2024, but the Managing Director confirmed that additional funding had been secured to continue services until March 2025. An action plan is in place to reduce non-elective admissions for ambulatory conditions, focusing on asthma, diabetes, and kidney disease, with efforts including IV antibiotic management in the community and increased asthma reviews in primary care.

Difficulties in arranging safe hospital discharges, particularly for elderly patients, were discussed. The Voluntary Home and Settle programme was noted as available but potentially not sufficiently communicated. The need for improved dementia care support, especially for ethnic minorities, was highlighted, and a detailed report on dementia services was requested for the next meeting. Clarity on the leadership and oversight of child mortality reporting was also sought, with the Board agreeing to follow up on this. The importance of preventive care, in partnership with the voluntary sector, was emphasised, and a report to formalise and enhance collaboration with community groups was requested.

RESOLVED: The Board reviewed and noted the updates on the winter plan and the work of the Borough-Based Partnership.

North West London - Integrated Care Board (ICB) Organisational Restructure

The Board received a briefing on the North West London Integrated Care Board's (ICB) organisational restructure, driven by NHS England's directive to reduce running costs by 30% and adapt to the evolving NHS landscape. The ICB, serving 2.1 million residents in North West London with a £6 billion annual budget, aims to enhance healthcare quality, address inequalities, and optimise resource use. The restructure involves significant reductions in staffing and estate costs.

The nine priorities of the Integrated Care System (ICS) were reviewed, aligning with borough partnership priorities and focusing on reducing health inequalities. Key priorities include the development of Integrated Neighbourhood Teams (INTs) for improved access and proactive care for those with long-term conditions or complex needs, enhanced CYP mental health services, improved community mental health services for those in crisis, embedding access to high-quality community-based services, optimising patient flow across the system, transforming maternity services, and addressing perinatal deaths.

The Harrow Borough team has been reduced from 24 to 14 staff members, encompassing both clinical and non-clinical roles, with limited full-time clinical support. The team is adapting to new working methods and strengthening collaboration with stakeholders.

Concerns were raised regarding Harrow's specific funding allocation within the ICB's budget and the monitoring of performance against goals. The Harrow Borough Director explained the complexity of NHS funding formulas, which consider GP-registered populations and deprivation levels, confirming Harrow's historical underfunding challenges and calling for greater transparency in resource allocation. The Harrow Borough Based Partnership Managing Director addressed historic funding gaps, particularly in primary care, and noted the ICB's commitment to equalising funding across the system, with recent significant investments in Harrow's primary care as part of a levelling up agenda.

The reduction in the Harrow team from 24 to 14 members raised concerns about potential impacts on service delivery and the preparedness of partner organisations to support affected areas. The Harrow Borough Director assured that all workstreams continue to be supported, though with reduced depth, managed through broader responsibilities across partnerships and NWL ICB Programme Teams. The potential for gaps due to the centralisation of ICB resources was discussed, with the observation that Harrow teams might need to focus more on delivery than strategic functions, with centralised ICB teams providing support. The importance of maintaining strong local relationships for services like continuing healthcare and mental health aftercare was emphasised. The Chair proposed ongoing monitoring of these risks, with any emerging concerns to be escalated to the Council, and the Director of Public Health suggested logging these risks on the BBP risk register.

RESOLVED: The report was noted, and further monitoring measures were approved.

GP Patient Survey Results and Improving Access

The Harrow Director of the North West London Integrated Care Board (ICB) presented the GP Patient Survey Results and initiatives to improve primary care access. Primary care encompasses not only GP appointments but also preventive care and proactive management of long-term conditions. Challenges in primary care, particularly regarding access, are growing.

GP access remains a priority, with methods to improve accessibility including online platforms, video and phone consultations, self-care pathways, and pharmacy-first schemes. New roles within practices have significantly increased appointment availability, with over 15.5 million GP appointments annually and an additional 1.1 million online consultations. Enhanced Access Hubs provide appointments outside core hours, including weekends, to alleviate pressure on primary care.

Harrow, with a registered population of approximately 300,000 served by 31 GP contracts across five Primary Care Networks (PCNs), provided 1.6 million appointments in the past year, yet demand continues to rise due to increased health needs and population growth. The NHS National Patient Survey, with over 3,300 responses, indicated varied patient satisfaction, with one Harrow PCN scoring highest in ease of contact in North West London, while most PCNs were around the national average. Plans are in place to address performance variations. HealthWatch surveys provided additional insights, highlighting high ratings for care quality and compassion but challenges with telephone access and hospital wait times.

Significant challenges include an aging GP workforce, the need for improved estates, digital exclusion, health inequalities, and rising demand due to population growth. The ICB aims to increase same-day access, reduce reliance on urgent care due to lack of same-day appointments, and address winter pressures. Workforce development is also underway, introducing diverse roles such as pharmacists, mental health practitioners, and social prescribers in primary care settings.

Concerns were raised about over 50% of GPs in Harrow being over 65 and the potential for practice closures, with plans to attract new GPs through a recruitment scheme. The Board noted a lack of continuity of care due to an increase in locum doctors, but clarification was provided that Harrow has a stable salaried GP workforce with fewer locum issues. Difficulties elderly residents face with digital systems like Patches were highlighted, emphasising the need for improvements for those unable to access digital platforms. Ongoing efforts to improve same-day access and alternative communication methods are confirmed.

NHS dental access in Harrow was also questioned, with the ICB stating progress is being made, including budget reallocations for children's procedures. Concerns about NHS dental availability were echoed, and plans for preventative oral health programmes targeting children were outlined. Funding prioritisation for primary care, related to population needs and practice mergers, was clarified, with primary care funding based on GP registrations and ongoing efforts to expand primary care estates. Digital poverty affecting patient access was raised, suggesting collaboration with voluntary sectors.

RESOLVED: The Board noted the report, highlighting increasing demand for primary care services due to an aging population and population growth, and supported the initiatives and actions to improve access, particularly concerning estate challenges.

Annual Report of the Director of Public Health

Carole Furlong, Director of Public Health for Harrow Council, presented the Annual Public Health Report. The report adopts a monthly theme approach, aligning with awareness events and community relevance, covering topics from Alcohol Awareness in January to Isolation and Loneliness in December. Each theme includes an online webpage with resources and key messages. Harrow performs well in several health indicators, including low rates of preventable deaths and violent crime, but faces challenges in childhood vaccinations and self-harm admissions.

The Board praised the health walks and acknowledged the dedication of volunteer walk leaders. A request was made for more specific data in the report, such as a breakdown of road safety incidents into fatalities and serious injuries, and for actual numbers alongside percentages for the location of deaths. The Director of Public Health agreed to incorporate this in future reports. Concerns about loneliness among the elderly were discussed, with mention of the West INT project's befriending scheme and digital solutions for reaching isolated individuals. The Board commended the Director for Public Health for her detailed and accessible reports and thanked her for her service.

RESOLVED: The Board noted and supported the findings and recommendations of the report.

Health & Wellbeing Strategy Quarterly Update - Learning Disabilities & Autism Strategy Update and Progress Report

The Strategic Commissioning Manager for Learning Disabilities and Autism provided an update on the strategy, launched in December 2022 and co-produced with partners and residents. It focuses on five priority areas: personalised care and support, appropriate information and support, living in local communities, responsive healthcare, and a skilled workforce. Effective partnerships with primary care, the ICB, public health, and education are contributing to the strategy's objectives. The strategy aims to empower residents, reduce dependency, and improve access to information, supporting individuals with learning disabilities and autism, neurodivergent individuals, and family carers.

The LDA Strategic Group will be renamed the Learning Disability and Autism Strategy Monitoring Group to enhance transparency. A refresh of the outcomes framework will commence in January 2025, involving residents and partners to assess achievements and address gaps.

The Board expressed interest in the new translation service, noting its application for diverse communication needs, including sensory impairments. The collaborative work and impact of the strategy were commended. The potential for expanding collaboration with health and social care partners across boroughs for long-term resource efficiency was queried. Efforts to extend partnerships are underway. Particular interest was shown in the Reignite Employment Group for residents over 18, supporting employment and volunteering opportunities through initiatives like the West London Alliance. The possibility of integrating health and support services within a new special needs school was explored.

RESOLVED: The Board noted the report, its achievements, and endorsed the recommendations.

Harrow Safeguarding Adult Board Annual Report and Strategic Plan

The Independent Chair of the Harrow Safeguarding Adults Board (HSAB), Lesley Hutchinson, presented the Annual Report and Strategic Plan. The report highlights activities and governance changes undertaken by HSAB, including revised governance structures effective from January 2024, aligning with changes made for the children's board.

Key statistics showed that risks were reduced or removed in 89% of adult safeguarding inquiries. An area for improvement was identified, with only 70% of initial concerns leading to identified risks, indicating a need to enhance initial assessments. The board's commitment to a Making Safeguarding Personal approach was emphasised, with 80% of cases involving individuals being asked their desired outcomes, 97% of which were partially or fully achieved.

HSAB's new strategic priorities focus on prevention, early intervention, quality assurance, engagement, communication, and partnership strengthening, supported by a new quality assurance framework. While no new Safeguarding Adult Reviews (SARs) were completed in the financial year, the Board worked to complete outstanding actions from previous reviews.

The Board enquired about co-production arrangements, with acknowledgement that HSAB is in the early stages of establishing these, aiming for an engagement and communication strategy by April 2025. Collaboration with community groups, including youth and carer organisations, is planned. The need for resource investment from partners was emphasised, and the addition of lay members for a broader perspective is being considered. Feedback from a recent CQC inspection on safeguarding arrangements was discussed, noting the local authority's rating was close to Good, with some operational areas identified for improvement. Multi-agency audits are being implemented to monitor safeguarding quality and effectiveness.

RESOLVED: The report was noted.

Better Care Fund Q2 Update

The Borough Lead for NWL ICB presented the Better Care Fund (BCF) Quarter two update. The total value of BCF services is approximately £33 million, with 47.7% of funds spent by the end of Quarter 2. Delays in spending were attributed to additional discharge funding received mid-year, which was utilised for services supporting hospital discharge, such as temporary residential care and home care. Spending is expected to align by year-end, with no immediate concerns. All winter preparedness initiatives are in place.

Inaccuracies in national data for unplanned hospitalisations for chronic ambulatory care-sensitive conditions were noted. Harrow Borough Partnership has developed an admission avoidance strategy focusing on these conditions through integrated neighbourhood teams, virtual wards, and monitoring programmes. A data accuracy review is underway by NHS England. The target for discharge to a usual place of residence is 95.9%, with a current achievement of 94.9%, impacted by complex cases with social and housing needs. Additional discharge funding aims to improve this by supporting reablement efforts. National data for emergency admissions for falls in individuals over 65 also appeared inaccurate, despite the implementation of an integrated falls service. Admissions to permanent residential care are assessed annually, with various initiatives and funding applied to minimise these.

The Board expressed disappointment over unreliable data and raised concerns about quarterly data collection and processing delays, suggesting a more rigorous approach. The Assistant Director of Clarification confirmed that data collection occurs locally but issues arise during central processing. The Board agreed to treat data accuracy and processing as a separate issue for monitoring. Frustration with delayed confirmation of discharge funding was noted, impacting planning. The Chair suggested the Board support efforts to ensure data reliability.

RESOLVED: The Board noted the report and acknowledged the challenges with data collection and processing.

The meeting concluded at 4:37 pm.