The Health and Social Care Scrutiny Sub-Committee met on Tuesday 4 March 2025 to discuss services for women during menopause and the pressures faced by the local health and care system during winter. The committee noted the progress on the 2024/25 Winter Plan and reviewed the current provision of menopause services in Harrow.

Services to Support Women During Menopause

The committee received a comprehensive overview of the menopause services available to Harrow patients, provided by London Northwest Healthcare NHS Trust. These services, which have been in place since 1991, have evolved into a specialist offering supported by the 2022 Women's Health Strategy for England and the 2024 'Shattering the Silence about Menopause' initiative. The service provides weekly access to a consultant gynaecologist, a GP, a consultant pharmacist, and a specialist psychologist, catering to women with premature ovarian insufficiency, those in perimenopause, and those experiencing induced or complex menopause.

Improvements planned for the service include developing a pathway for women experiencing cancer-related menopause, standardising data collection to address inequalities, increasing patient-initiated follow-ups, and improving representation in research and drug trials. The North West London Integrated Care Board (ICB) is committed to raising awareness of national support resources. A recent survey indicated that 13% of female respondents in Harrow expressed concern about menopause and available resources. Identified service gaps include knowledge gaps among GPs, patient awareness, and general awareness of existing services. GPs in Harrow have expressed keenness to adopt the menopause service, with one practice already developing a project.

Members raised concerns about the accessibility of services, particularly for those in different communities and for male employees who may need education on the topic. The Divisional Medical Director explained that corporate efforts are underway to promote inclusivity and respect, including detailed education on menopause. The Associate Director of Planned Care NW London ICS noted that while Harrow's participation figures are mid-ranking for a London borough, there is a need to build trust within communities to improve engagement. The committee discussed the importance of supporting women in the workplace and ensuring that Hormone Replacement Therapy (HRT) is tailored to individual needs, acknowledging that not all GPs have specialist training in this area.

The Sub-Committee resolved to note the report on services to support women during menopause.

Overview Scrutiny Report Winter Pressures 2024-2025

The committee received an update on the 2024/25 Winter Plan, a collaborative effort involving all system partners, including the local acute trust, the Council, GP and primary care networks, and local and voluntary sector organisations. The plan aims to support each other and communities across the borough through preventative measures, effective communication, and addressing the wider determinants of health.

Key actions have focused on the interface between services, data and escalation, prevention, community-based admission avoidance, in-hospital care, and the discharge pathway. Members highlighted concerns about community-based admission avoidance actions being at risk and requested an update on these areas. The Borough Director responded that data review is ongoing, with key areas identified but further work needed to understand specific at-risk cohorts.

Discussions also addressed discharge rates, with improvements noted in patient transportation and earlier discharge times. However, a lack of hard data was acknowledged, with a more comprehensive update promised. The Chair questioned the reasons for increasing winter pressures year on year, with the Borough Director citing an ageing population and increased activity post-COVID-19 as major contributors. Harrow faces a particular challenge due to its high rate of over-65 admissions.

The committee also discussed pathways for unregistered residents, with assurances that they can still access GP services, urgent care, and A&E. Efforts are being made to encourage registration to ensure correct patient pathways and reduce pressure on urgent care services. The Chair queried the lack of funding for services in Harrow and potential solutions. The Borough Director acknowledged funding disparities between outer and inner London boroughs and confirmed efforts to secure greater funding, including a case for further investment from the Integrated Care Board and community providers.

The Sub-Committee resolved to note the report on winter pressures.

The meeting also included the resolution to note the attendance of reserve members, confirm no declarations of interest were made, and sign the minutes from the previous meeting held on 10 December 2024. Marie Pate was appointed as a non-voting adviser to the Sub-Committee for the 2024/2025 Municipal Year. No public questions or petitions were received, and no references were made from other committees.