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North West London Joint Health Overview and Scrutiny Committee - Thursday 5 December 2024 10.00 am
December 5, 2024 View on council websiteSummary
The North West London Joint Health Overview and Scrutiny Committee was scheduled to receive updates about the NHS's plans for winter, efforts to reduce health inequalities in North West London, and to review how the recommendations of previous meetings had been implemented. The committee was also scheduled to receive a report on the performance of the London Ambulance Service (LAS).
North West London Winter Plan
The committee was scheduled to receive the North West London Integrated Care System (NWL ICS) winter planning programme for review and comment. The report pack included a number of documents describing the background to, and objectives of, the plan.
The plan proposes a range of measures to support residents in the community, for example by Supporting those with Long Term conditions over winter (and year round) to prevent unnecessary exacerbations and admissions
and by Ensuring our hospitals and LAS have sufficient plans to deal with seasonal pressures, so patients needing acute care can access it without undue delays.
The report pack also includes information about Enhanced Access and Out of Hours services
like the Urgent Community Response
which is exceeding its target of responding to 90% of referrals within 2 hours.
The report pack also included plans for communications and engagement with the public, for example by promoting the Pharmacy First
scheme, and through the use of advertising, social media, and working with community groups.
The London Ambulance Service's winter plan was also included in the report pack.
London Ambulance Service Performance
The report pack included an update on the performance of the LAS. It predicted that if the 9% year-on-year increase in 999 calls continues we expect to see a category 2 response time this December of 57 minutes and 10 seconds.
The report pack included the LAS's winter plan. It proposes a range of measures to mitigate pressure on the service during winter, such as:
Increased operational staffing in line with expected increase in demand. Winter delivery cell 7 days per week. Maximised 999 'hear and treat'. Specific referrals to GPs from LAS (as agreed through consultation with pan-London LMC). Maximised 'Fit to Sit' for suitable patients. Earlier and simpler process to implement LAS cohorting. Trusted assessor to access alternative pathways e.g. SDEC. Ensure 999 does not impact on 111 service delivery.
It also proposes a Patient Flow Framework
to enable hospitals to manage demand during busy periods. This includes a six-level escalation framework which Demand and risk assessment inform the level. Progression through levels is not linear (i.e. it is possible to move from BAU to any level straight away if the situation on the ground requires it).
Level 1 involves diverting ambulances within the hospital trust, and the plan escalates through to Level 6 which is a FULL CLOSURE
.
The LAS's plan also proposes a new Clinical Safety Plan (CSP)
with two new levels - Red and Purple - to be activated in response to sustained pressure. The Red level is ICS specific and may include completing the patient handover at 30 minutes
. Purple applies London-wide and involves Rapid release – immediate handover
.
Health Equity Programme
The committee was scheduled to receive an update on the NWL Health Equity Programme.
The report pack included the following key messages about the programme:
Our data shows that people in the most diverse and deprived communities in NWL are dying earlier than they should. As well as ethical and moral imperatives to reverse this, there is also a financial imperative as this has an impact on longer term resources. The health equity programme has been working in partnership across the ICS to deliver against a range of milestones and deliverables using its available levers to impact on these inequalities and is monitoring the impact of these interventions. We work closely with partners right across the system, working collectively to build trust and design services that work for all of our communities, taking a proactive, preventative approach. We have recently delivered a successful NW London health equity summit and we want to continue to build these cross-system partnerships and raise our ambitions for reducing the disparities in health outcomes we see in our population.
The report pack explains that people in the most deprived areas are likely to suffer from multiple conditions 10-15 years earlier than in more affluent areas
and that When controlling for gender, age and deprivation Asian, Black and Mixed ethnic groups are more likely to be multi-morbid than White ethnicities.
It goes on to say that alongside the ethical imperative to reverse this trend, this variation in health outcomes is driving increased costs to the healthcare system and creating an urgency for the ICS to tackle this issue.
The programme is organised around three pillars:
- Clinical Care: Focussing on the NHS England Core20Plus5 framework, which focuses on five key clinical priority areas and on improving outcomes for the most deprived and marginalised groups.
- Population Health Management: Building capabilities in key skills to deliver the local 'Focus-on' PHM methodology, creating a data-driven decision making culture.
- Wider Determinants: Focussing on the wider determinants of health and health behaviours.
The report pack also includes a number of case studies of projects that have been delivered to support health equity in North West London.
Recommendations Tracker
The Committee was scheduled to note the latest scrutiny recommendations tracker for the 2023/24 and 2024/25 municipal years. These tracker documents are included in the report pack, and provide a summary of recommendations made during the year, responses from the NHS, and the status of implementation. The documents show that most of the recommendations of previous meetings had been implemented or were in the process of being implemented.
The 2023/24 tracker includes recommendations and information requests from meetings held on 18 July and 05 December 2023 and 14 March 2024. The 2024/25 tracker only includes recommendations and information requests from the meeting held on 22 October 2024.
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