The Health and Social Care Scrutiny Sub-Committee met on Tuesday 17 June 2025 to review the Annual Quality Account for the Royal National Orthopaedic Hospital (RNOH), discuss Adult Social Care performance for 2024-25, and consider the emerging Adult Social Care Strategy. The committee noted the RNOH's Quality Account, which highlighted improvements in patient safety and care, and reviewed the performance of Harrow's Adult Social Care services, identifying areas of strength and areas requiring further improvement.

Annual Quality Account, Royal National Orthopaedics Hospital

The committee reviewed the Annual Quality Account for the Royal National Orthopaedic Hospital NHS Trust (RNOH) for 2024-25. The report detailed the Trust's commitment to improving the quality of its services, focusing on key priorities such as the Go for Gold accreditation scheme, improving harm-free care, and enhancing pain management. The RNOH reported successful accreditation of all 13 targeted clinical areas and advancements in their pressure ulcer prevention strategy with the adaptation of the PURPOSE-T tool. The Trust also highlighted its embrace of the Patient Safety Incident Response Framework (PSIRF), leading to improved staff confidence in reporting incidents.

Key priorities for the upcoming year include the introduction of a patient portal, development of an Enhanced Therapeutic Observations of Care (ETOC) model, and further focus on harm-free care and medicines safety. The report also detailed the Trust's participation in national clinical audits, with a 100% submission rate for eligible audits. The RNOH's commitment to patient safety was further evidenced by its performance in the NHS Staff Survey, where 85.2% of staff would recommend the Trust as a care provider to family or friends.

Adult Social Care Performance 2024-25

The committee received an update on the performance of Harrow's Adult Social Care services for 2024-25. The Strategic Director of Adults and Public Health, James Mass, presented the Service Performance Scorecard and year-end position on Flagship Actions. Overall, the directorate showed significant improvements in several areas, including a reduction in staff turnover and a decrease in the Occupational Therapy (OT) backlog, with no residents referred before the financial year still waiting for assessment.

However, the service is facing a significant budget overspend, attributed to increased demand and complexity of needs, as well as inflationary pressures from care providers. Sickness rates among staff remain high, averaging 15.1 days. While the number of outstanding Deprivation of Liberty Safeguards (DoLS) applications has reduced, there was a nearly 25% increase in applications received compared to the previous year.

The Public Health scorecard indicated good performance, with no red indicators. However, four amber indicators related to drug treatment services require attention. The report highlighted a statistically significant drop in childhood tooth decay, from 42.4% in 2019 to 28% in 2024, attributed in part to the Supervised Tooth Brushing project in schools. Safeguarding concerns are being addressed more quickly, with an average completion time of 8 days in Q4, though this is still short of the 3-day target. The committee noted that 11 out of 18 key performance indicators met their targets, with three rated amber and four rated red.

Adult Social Care Strategy

The committee was presented with the emerging Adult Social Care Strategy for Harrow, which aims to put residents at the centre of service delivery. The strategy builds on the Home First philosophy, emphasising prevention, early intervention, and personalisation to reduce long-term need and improve wellbeing. It acknowledges evolving demographics, health inequalities, the need for integration with health services, and financial sustainability.

The strategy outlines five key preventative approaches: Advice and Guidance, Asset-based approaches, Physical activity promotion, Social prescribing, and Enablement/reablement. Engagement with residents, staff, and analysis of demographic and needs data have informed the strategy's direction. Case studies were presented to illustrate the impact of preventative and enablement-based approaches, including Imran's story of regaining independence through the LD Enablement model and the positive impact of the Conversation Café on resident wellbeing and access to services. The committee was asked to consider the strategy's direction, advise on areas needing focus, and support its alignment with wider council and system priorities. A draft strategy will be shared with resident groups for feedback before being presented to Cabinet in September.

The meeting also included the appointment of Councillor Maxine Henson as Vice-Chair of the Health and Social Care Scrutiny Sub-Committee for the 2025/2026 Municipal Year and the appointment of Deven Pillay as a non-voting adviser. The minutes of the previous meeting held on 4 March 2025 were also approved.