The Health and Wellbeing Board met on Thursday 27 March 2025 to discuss key public health concerns, review the Better Care Fund, and consider a report on child deaths. The Board approved the Better Care Fund submission for 2025/26 and noted reports on health protection and child mortality.

Health Protection Update

The Board received an update on significant public health issues, including a notable increase in measles cases across London, with Harrow recording 99 confirmed cases in 2024, making it the third highest in the city. While case numbers have since declined, the outbreak highlighted concerns about declining vaccination uptake. The meeting also addressed a more severe seasonal flu outbreak than the previous year, with six outbreaks reported in Harrow care homes. Tuberculosis (TB) rates in Harrow were reported as the highest in North West London, prompting discussions on awareness campaigns and targeted interventions. Other updates included the downgrading of Mpox Clade 1B from a high consequence infectious disease, a recent Lassa fever case requiring contact tracing, and upcoming changes to Health Protection Regulations from April 2025 that will expand mandatory reporting for infectious diseases.

During the discussion, Board members sought clarification on how TB cases were identified and why Harrow had the highest rate in North West London. The Consultant in Health Protection, Alicia Thornton, explained that increased screening likely contributed to higher case detection and that demographic changes and migration patterns were also factors. Regarding measles, it was confirmed that low vaccine uptake during the pandemic was a significant contributor to the outbreak. The Board also discussed strategies for targeted measles vaccination efforts, including collaboration with schools and community leaders, and noted the importance of promoting MMR vaccinations to adults who may have missed childhood immunisations.

Q3 2024/25 Better Care Fund (BCF) Review and 2025/26 BCF Submission

The Board reviewed the Q3 2024/25 Better Care Fund (BCF) performance and approved the proposals for the 2025/26 BCF submission. Harrow is on track to meet its target for hospital discharges to normal places of residence, although data quality issues persist for unplanned hospitalisations and emergency admissions due to falls. The review with North West London ICB and other boroughs indicated that Harrow does not receive additional NHS contributions to the BCF, relying on the minimum required funding. The NHS's announced 50% reduction in additional BCF contributions for 2025-26 will not affect Harrow's current position. Recommendations from a review of community equipment funding could potentially increase NHS contributions to the Council.

The 2025/26 BCF plan focuses on three key priorities: reducing emergency hospital admissions for those over 65, decreasing hospital discharge delays, and minimising long-term admissions to residential and nursing care homes. Funding changes include consolidating elements into a single fund and an uplift in the NHS contribution and the Disabled Facilities Grant.

During the discussion, Board members expressed concerns about Harrow being historically one of the lowest-funded boroughs in North West London for BCF and questioned how the levelling-up agenda would address these disparities. The Assistant Director – Strategy and Commissioning explained that BCF allocations are determined by a central government formula and that while the ICB strategy includes reallocation plans, there is no clear timeline for implementation. The Board also raised concerns about Harrow, already a productive borough, potentially facing increased pressure to further enhance productivity without additional support. The Assistant Director acknowledged this and stated that a review of resource allocation in community services is underway to ensure equitable access to care. The Board approved the Q3 2024/25 BCF Review and the 2025/26 BCF Submission proposals.

North West London Annual Child Death Overview Report for 2024

The Chair of the Harrow Safeguarding Children and Adult Board presented the annual report from the North West London Child Death Overview Panel (CDOP). The report analysed child deaths across eight boroughs to identify trends and areas for improvement. It was noted that the expansion to a regional panel has improved data analysis. Key statistics highlighted included a significant proportion of deaths being perinatal or due to congenital conditions, disparities in mortality rates by ethnicity and deprivation, and that 33% of reviewed cases had modifiable factors that could have reduced the risk of death, compared to 48% nationally.

The report outlined areas for learning and action, including concerns about medication prescriptions for children abroad, the need for stronger reporting duties for drivers with epilepsy, disparities in palliative care nursing support, and the necessity for improved interpreting services. A national inquiry into misaligned longline catheters in neonatal care and inconsistencies in BMI guidance for expectant mothers based on ethnicity were also mentioned. A map of Harrow identified clusters of child deaths, underscoring the importance of using this data for local health and wellbeing strategies.

In the subsequent discussion, the Board inquired about the data set's robustness and the subjectivity in categorising child deaths. The Chair of Harrow Safeguarding confirmed the collaborative approach across North West London and the establishment of a pan-London CDOP process. The Board also sought clarification on how deaths of looked-after children placed outside the borough are recorded and explored potential links between maternity care quality and neonatal deaths. The Chair stated no direct link had been identified but noted concerns regarding CTG monitoring and staff expertise. The Board also discussed the disproportionate number of Asian British child deaths, exploring potential links to consanguinity and the need for better demographic recording. The report was noted by the Board.