The Health Overview and Scrutiny Panel met on Wednesday 4 February 2026 to discuss urgent and emergency care at Kingston and Richmond NHS Foundation Trust, and to receive updates on public health matters and the independent review of children's and young people's mental health services. The Panel noted the ongoing challenges within urgent and emergency care, particularly concerning capacity and patient flow, and discussed strategies to improve prevention and alternative pathways for care.

Emergency Care: Prevention and Pathways

The Panel received a comprehensive report on urgent and emergency care (UEC) at the Kingston and Richmond NHS Foundation Trust. The report highlighted that demand for emergency services is rising due to demographic changes, increased clinical complexity, and wider system pressures. A significant challenge identified is the mismatch between the capacity required and that which is available to avoid attendance in the Emergency Department (ED) and to expedite patient discharge. Bottlenecks occur when patients cannot move onward, leading to crowding and extended waits.

The Trust is actively working with partners to pursue admission avoidance, frailty pathways, expanded Same Day Emergency Care (SDEC) capacity, and closer integration with community and primary care services. Further progress is dependent on continued collective action across NHS, local authority, and voluntary, community, and social enterprise (VCSE) partners, particularly in prevention, early intervention, discharge support, and public communication.

The report detailed the patient journey through emergency care, from access and triage to adult and paediatric pathways, as well as the management of mental health presentations. It also emphasised the critical role of Kingston's adult social care in facilitating discharges and managing the care provider market. The Trust is also piloting a hospital tech-enabled care (TEC) service, which has already benefited 140 patients by enabling smoother discharges.

The ageing population in Kingston was noted as a significant factor, with an increasing need for healthcare services. In response, the Trust is investing in a new frailty model to support frail patients in the community, aligning with the government's 10-year plan. Kingston and Richmond have been selected as one of seven sites across England to represent South West London in the NHSE National Frailty Discovery Collaborative, aiming to develop a model of frailty management for national rollout. A digital frailty project is also underway to explore better integration of health and care information systems.

The Proactive Anticipatory Care (PAC) Programme, rolled out across all ten Primary Care Networks (PCNs) in Kingston and Richmond, has shown positive results, including a 35% reduction in unplanned care and a 28% reduction in hospital length of stay for patients on the programme for four months or longer. The Kingston and Richmond virtual ward, which provides hospital-level care at home, has also been successful in reducing hospital admissions and improving patient satisfaction.

Despite sustained public messaging, the ED remains a common first point of contact due to its 24/7 availability, public trust, and perceived difficulties in accessing alternatives. The report noted that Kingston Hospital does not have a hospital-employed Alcohol Care Team (ACT), which is considered the gold standard for supporting patients with alcohol-related issues. However, recent data shows a fall in hospital admissions due to alcohol poisoning in Kingston residents.

Urgent and emergency care performance data for 2025/26 indicated a seasonal deterioration in performance during the third quarter, with adult ED performance identified as a priority area for improvement. The Trust's UEC Transformation Board is focusing on expanding SDEC and virtual ward use, admission avoidance schemes, and improvements to discharge processes.

Communications aim to guide residents to appropriate services through consistent messaging across various channels, encouraging the use of NHS 111, pharmacies for minor illnesses, and local mental health services. The Panel was informed that further progress requires better coordination of prevention and support for patients awaiting planned care, stronger integration between health, social care, and VCSE services, and enhanced discharge capacity.

Verbal Update on the Independent Review of Children's and Young People's Mental Health Services

A verbal update was provided on the Independent Review of Children's and Young People's Mental Health Services. While the details of this update are not fully elaborated in the provided documents, it was noted that this topic had previously been reported to the People Committee in March 2025.

Public Health Verbal Update

The Panel received a verbal update on public health matters in the borough. The Director of Public Health reported on health protection, prevention, and findings from a recent schools health survey. The service had transitioned from summer hot-weather preparedness to winter planning, with the Council reported to be well-prepared. Emphasis was placed on seasonal vaccinations, with the Director urging eligible individuals to get their flu and COVID-19 vaccines, as these remain the most effective tools for reducing winter pressures and protecting vulnerable residents. Ongoing prevention work includes targeted community initiatives to reduce health inequalities and support early intervention. The results of the schools health survey, which provided valuable insights into young people's wellbeing, will be shared with Panel Members once finalised. The Public Health update will be added as a recurring standing item when appropriate.