The Community and Wellbeing Scrutiny Committee met on 5 March 2025 to discuss urgent matters concerning Northwick Park Hospital's A&E and maternity services, as well as the Start Well programme for maternity provisions across North Central London. The committee also addressed the issue of nicotine addiction and vaping in Brent, with input from Brent Youth Parliament, and reviewed the annual school standards and achievement report, alongside challenges in adult and children's social care workforces.

Urgent Updates on Northwick Park Hospital Services

Pippa Nightingale, CEO of London North West University Healthcare NHS Trust, provided an update on two urgent matters at Northwick Park Hospital. She reported on the significant pressures faced by the A&E department during the winter period, noting a 9% increase in attendance, partly attributed to an outbreak of norovirus and the ineffectiveness of Out of Hospital Strategies. Despite these challenges, Nightingale highlighted the positive performance of the Trust's Urgent Care Centres, which were operating at 99% capacity and meeting the target of seeing, treating, and discharging patients within four hours. The Trust has also opened additional winter beds and funded a new 32-bed acute ward, which has been fully occupied since its opening in April 2024. Mental health compliance rooms have also been established to address the needs of patients with co-occurring mental and physical health issues.

Nightingale also presented a positive update on Northwick Park's maternity services, detailing a £6 million investment in estates, including a new birth centre and a bespoke triage service. The neonatal service has been renovated, and a new bereavement suite has been opened. She reported a significant reduction in midwifery vacancy rates from 48% two years ago to 7% currently. These improvements have led to a stillbirth rate lower than the national average and a neonatal mortality rate also below the national average. The Embrace report, a national mortality report for maternity, shows Northwick Park with a 15% lower than national expected mortality rate, and the service has met 10 CNST safety targets for the past three years. Friends and family tests indicate that 94% of women and pregnant people would recommend the service. The committee discussed the importance of communicating these improvements to build public confidence, with plans to engage primary care, GPs, and social media channels. A confidence-building exercise through the Trust's Maternity and Neonatal Voice Partnership (MNVP) and engagement with faith groups are also planned.

Maternity Provisions in North Central London

Anna Stewart, Service Development Director for NHS North Central London (NCL) ICB, presented the outcomes of the public consultation on proposed changes to maternity, neonatal, and children's surgical services under the Start Well programme. The consultation, which ran from December 2023 to March 2024, considered two main options for maternity and neonatal services: closing the unit at the Royal Free Hospital in Hampstead (NCL's preferred option) or closing services at Whittington Hospital in Highgate. In both scenarios, services would be retained at Barnet Hospital, North Middlesex Hospital, and UCLH. The consultation also addressed the potential closure of the standalone midwifery-led unit at Edgware Hospital, with antenatal and postnatal care to be retained and enhanced.

Stewart reported strong agreement on the need for change, with nearly 70% of respondents believing improvements were necessary. There was also agreement on offering a minimum of Level 2 neonatal care at all sites. While there were mixed views on consolidating services, more respondents favoured closing the Royal Free site over the Whittington site. The committee raised concerns about the impact of increased journey times for residents in areas like Harlesden, Stonebridge, and Willesden, and discussed the Integrated Impact Assessment conducted to address potential impacts on various demographics, including travel time analyses and mitigation strategies. Specific feedback from communities, such as the Orthodox Jewish community regarding Shabat rooms and Kosher food at the Royal Free, was also discussed, with NCL working to ensure alternative sites can meet these needs. The proposed changes would not be implemented immediately, with a transition period of approximately three years planned.

Nicotine Addiction and Vaping in Brent

Dr Melanie Smith, Director of Public Health for Brent Council, presented a report on nicotine addiction and vaping in Brent, highlighting local contexts alongside national policy. The report noted that while smoking is the primary focus of national policy, Brent also sees significant use of shisha and chewing tobacco, the health risks of which are not always well understood. Research on the long-term impacts of vaping, particularly on young people, is still in its early stages. The council has secured additional funding to tackle nicotine addiction, including the recruitment of a Smoking and Nicotine Addiction Team.

Representatives from Brent Youth Parliament (BYP) introduced their anti-vaping campaign, stemming from the Make Your Mark ballot where crime and safety were identified as top priorities. Their concerns include underage vaping, the sale of vapes with illegal substances, and the accessibility of vapes for young people. BYP highlighted the potential harm of vaping to developing brains and called for greater focus and research on its effects on young people. The committee discussed the expansion of support services for young people, with the new smoking, vaping, and nicotine addiction service to be located within the Elev8 young people's service, which is experienced in handling confidentiality and consent. Recommendations were made to include parents in prevention efforts, share learning with other local authorities, engage underserved communities, set targets for reducing tobacco use, and meet with young people to understand their experiences. An information request was made for data on smoking and vaping prevalence among 8-18 year olds.

Annual School Standards and Achievement Report

The committee received an update on school standards and achievements in Brent for the 2023-24 academic year. The report indicated that Brent is performing well above the national average for schools judged Good or Outstanding by Ofsted, with 98% of schools achieving these ratings compared to the national average of 90%. The report detailed pupil attainment across Early Years, Key Stage 1, Key Stage 2, Key Stage 4, and Key Stage 5, showing Brent students performing at or above national averages in most measures. Specific attention was given to ensuring fair and equal access to education, with initiatives in place to support underachieving groups, including a focus on improving outcomes for Black Caribbean boys. The Brent Schools Race Equality Programme was also highlighted, aiming to embed an anti-racist culture and improve attainment for underperforming ethnic groups.

Adult and Children's Social Care Workforce Challenges

The committee reviewed a report outlining the challenges and strategic responses related to the recruitment and retention of social care professionals in Brent Council. Both Children's and Adult Social Care services face significant difficulties, particularly in recruiting and retaining regulated professionals, within the context of wider national shortages. The report detailed measures implemented, including improvements to recruitment processes, enhanced support for newly qualified staff, retention payments, and the conversion of agency workers to permanent roles. Early evidence suggests these strategies are having a positive impact on workforce stability. The report also highlighted the importance of training and development, with initiatives such as the Brent CYP Learning Academy and the Adult Social Care Skills Academy. Feedback from staff indicated a positive working environment and strong support systems within the council.

Scrutiny Recommendations Tracker

The committee noted the Scrutiny Recommendations Tracker, which documents the progress of previous recommendations, suggestions for improvement, and information requests. The tracker is used for ongoing monitoring, with updates expected in future meetings. The committee requested that deadlines for action completion be included in the table.