Agenda and minutes

To note the attendance at this meeting of any duly appointed Reserve Members.

RESOLVED:  To note that there were no Reserve Members in attendance.

To receive declarations of disclosable pecuniary or non pecuniary interests, arising from business to be transacted at this meeting, from all Members present.

RESOLVED:  To note that there were no declarations of interests made by Members.

That the minutes of the meeting held on 20 March 2024 be taken as read and signed as a correct record.

RESOLVED:  That the minutes of the meeting held on 20 March 2024, be taken as read and signed as a correct record.

To receive any public questions received.

Questions will be asked in the order in which they were received.  There will be a time limit of 15 minutes for the asking and answering of public questions.

[The deadline for receipt of public questions is 3.00 pm, 18 July 2024.  Questions should be sent to publicquestions@harrow.gov.uk

No person may submit more than one question].

RESOLVED:  To note that no public questions, petitions or deputations had been received.

Report of the Managing Director, Harrow Borough Based Partnership.

The Board received a report which provided an update from the Harrow Borough Based Partnership.

Lisa Henschen, Managing Director of the Harrow Borough Based Partnership, presented the report, which covered key points and updated the Board on the priorities and progress of the Harrow Borough Based Partnership, which comprised the local authority, NHS providers, Voluntary Community Sector, and North-West London Integrated Care Board (ICB).

The Partnership had three main objectives:

1.                  Reduce health inequalities in Harrow.

2.                  Deliver truly integrated care.

3.                  Transform care pathways.

The Partnership had been working on health inequalities with funding from North-West London ICB and these were their findings.

·                 Focus on population health management to better use data and community connections.

·                 Evaluation completed, showing progress in staff skills for data usage, but more work was needed to spread these skills across the workforce.

The team working on leading the prevention program were focusing on the following:

·                 Making every contact count.

·                 Engaging citizens through conversation cafes and community touchpoints.

·                 Promoting physical activity across all age groups using neighbourhood structures.

In terms of Integrated Care, the team were working on the following.

·                 Development of integrated neighbourhood teams in East, Central, and West Harrow.

·                 Adult social care, GP practices, and community providers were now aligned within these teams.

·                 Focus on specific community needs, such as social isolation in West Harrow and immunisation uptake in East Harrow.

·                 Working on a single operating framework for neighbourhoods to ensure integrated care delivery and better patient experience.

·                 Measuring citizen and staff experience to track progress.

In terms of Transforming Care Pathways the team were working on.

·                 Over the past two years, on integrating intermediate care pathways to improve discharge experience, support faster discharge, and prevent readmission.

·                 The integrated pathway had been live for a few weeks, showing positive results in reducing delays in reablement services.

·                 Preparation for the upcoming winter included learning from last winter’s performance and focusing on admission prevention.

·                 Addressing mental health demand, particularly among the Black younger population in specific postcodes, by raising awareness of NHS talking therapies and crisis alternatives.

·                 The Partnership was focusing on demand management, particularly around rising admissions due to multiple long-term conditions.

·                 Collaborating with London North-West Hospital Trust to validate data and address growing community health service needs.

·                 Addressing low GP registration rates in specific postcode areas through training and community engagement.

Two main risks had been identified.

1.                  Occupational Therapy Services: Increased demand for Educational Health and Care Plans without corresponding growth in team resources.

2.                  Community-Based Care Demand: Increasing complexity of patients leading to concerns about meeting community care demands.

The Chair thanked the Managing Director for the comprehensive update and acknowledged the ongoing efforts to address the outlined challenges.

The following questions were asked and answered: -

·                 The Board wished to discuss the tooth decay objective, specifically for children.  Harrow had one of the worst rates and were not quite on target.  Tooth decay could be a precursor to or signal to neglect and the Board wanted to know  ...  view the full minutes text for item 91.

Report of the Executive Director of Strategy.

The Executive Director of Strategy presented the Joint Forward Plan for NHS North-West London and explained the context and content of the plan, stating it was a joint effort among NHS organisations, not a joint strategic needs assessment or Joint Health Wellbeing Strategy.

The plan aimed to implement the Joint Health and Care Strategy prepared by the integrated care partnership and had nine themes, highlighting its three-stage approach and common themes across the nine focus areas: -

Stage 1:

·                 Addressing inequities across North-West London by developing a consistent set of services available to all residents regardless of location.

·                 Ensuring uniform access to pain management, rheumatology, and stroke rehabilitation services.

Stage 2:

·                 Increasing productivity of services to optimise resource use, rather than simply asking staff to work harder.

·                 Examples included tackling delayed discharges to improve efficiency and ease staff workloads.

Stage 3:

·                 Tailoring services to specific communities to overcome hesitancy in accessing NHS services.

·                 Providing bespoke services for populations with unique needs, such as rough sleepers and asylum seekers.

The Executive Director of Strategy mentioned the challenges of meeting deadlines due to election schedules and proposed starting the planning process earlier next year for better alignment.

The Chair thanked Executive Director of Strategy for the presentation and acknowledged the comprehensive overview provided and emphasised the importance of group suggestions to improve the plan and encouraged active participation from Members for constructive feedback.

The Board raised concerns about the funding allocation being 3% less than average and the Executive Director explained the historical reasons and current policies affecting the funding formula.  He also explained that North-West London’s financial balance impacted the distribution of funds, creating incentives and challenges.

The Chair highlighted Harrow’s lower proportion of funding within North-West London and stressed the need for equitable services, referencing the struggle to secure a stroke rehabilitation service.  The Executive Director acknowledged the issue and mentioned ongoing efforts to assess spending at a granular level to ensure equity.

The Board members noted the absence of a stroke pathway in the borough’s priorities.  The Executive Director confirmed it as a top priority despite its omission from the document.

The Board raised concerns about the significantly lower safeguarding funds for Harrow.  The Executive Director outlined ongoing reviews and efforts to standardise service specifications and improve funding equity.

Board Members mentioned a wider review of the Better Care Fund, including safeguarding.  The Executive Director advised that plans for a deep dive into areas with variation in safeguarding to address funding disparities.

The Board emphasised the need for a stronger focus on prevention to reduce hospital admissions.  The Executive Director suggested integrating prevention into pathway redesigns to achieve productivity gains.

Board members expressed interest in initiatives for children and young people's mental health.  The Executive Director highlighted the need for prioritisation and resource allocation to meet ambitious targets, especially for ADHD and SEN provision.

Board members discussed the issue of equally weighted priorities.  The Executive Director explained that prioritisation occurred in the sequencing of actions under each goal.

The  ...  view the full minutes text for item 92.

Report of the Director of Public Health.

Officers presented the report and reminded the Board of their commitment to discuss topics from the Health and Wellbeing Strategy at every meeting and conduct an annual review.  The report served as the annual update.

The strategy, approved 18 months ago, was divided into three parts, Healthy People, Healthy Policy and Practice, and Healthy Place.  Each part contained three themes.  Quarterly updates had covered various aspects such as family hubs, healthy schools, and nature and climate change.

Successes over the past 18 months included:

·                 Integrated Intermediate Care - covered in a previous update.

·                 Diabetes Management - Improvement in nine key care processes from under 60% to 68%, supported by the diabetes primary care enhanced service.

·                 Hypertension Projects - Innovative community settings for hypertension case finding and management.

·                 Healthy Harrow Champions Programme - Focused on maternal health, community outreach, health checks, cancer, mental health, hypertension, and diabetes prevention.  Seventy-eight maternity champions had been recruited, with over fifty fully trained.

·                 Green Flag Status for Parks: Six parks awarded, with three more planned.

·                 Investment in Harrow Town Centre - Just under £9 million for physical improvements.

·                 Affordable Homes Programme - 50 new homes across three sites by 2024-2025.

·                 Conversation Cafés - Engaged over 1,000 residents, with 85% feeling better connected.

·                 Making Every Contact Count Training - 22 training sessions conducted with positive evaluations.

Officers also highlighted the financial pressures and their impact on the NHS and local authorities, emphasising the need for partnership and collaboration to achieve good outcomes for Harrow residents.

The Chair thanked Officers for the update and highlighted the need for a new Senior Responsible Officer (SRO) following the departure of the previous officer.  She emphasised the recurring issue of maternal and perinatal deaths and the need for better embedded solutions, including early education and intervention.  Officers discussed challenges in data categorisation for BME expectant mothers and the importance of effective communication.  The maternity health champions programme aimed to improve advocacy and support within the community.  Officers also highlighted the success of the maternity health champions programme and the improvements in maternity services in northwest London.

Board members emphasised the importance of utilising GP data for better decision-making, particularly for BME communities, to address health disparities and noted ongoing work with different communities to address obesity and other health challenges, utilising data to inform local solutions and interventions.

The Director of Public Health reminded the Board to note the annual update and consider the challenges and risks.  They acknowledged the significant work involved and the need for continuous improvement and collaboration.

RESOLVED:  That the report be noted with an emphasis on continued monitoring and addressing key health indicators to improve the outcome for Harrow residents.

Report of the Director of Public Health.

The Director of Public Health praised the success of the Winter Wellness Programme, highlighting its comprehensive approach, which included warm hubs, social engagement, exercise, and mental health improvement.

Officers presented the report, and the following was outlined:-

·                 Context - This year marked the second year of the programme, funded by Public Health, and evaluated with additional funding from the Borough Based Partnership and Health Inequalities funding.

·                 Delivery - Over 20 organisations had delivered warm hubs in Harrow from early November to the end of March, focusing on preventative activities, health checks, distribution of warm packs, and information provision.

·                 Enhanced Evaluation - Six sites had received additional funding for more detailed impact analysis.

·                 Financials - Each warm hub had received approximately £7,500, with enhanced sites receiving an additional £2,500.

·                 Data - Captured volunteer hours, health checks, referrals, signposts, and distribution of warm and food packs.

·                 Social Return on Investment - Calculated a £2.50 return for every £1 spent, highlighting significant community benefits.

The officer advised of the findings:-

·                 Improved community belonging and mental well-being.

·                 Increased physical activity and access to affordable, healthy food.

·                 Health checks identified individuals at risk of diabetes and high blood pressure.

The following recommendations were advised:-

·                 Wider promotion of community hubs.

·                 Integration with other community engagement programs.

·                 Additional support for new hubs.

·                 Continued collection of baseline and follow-up data.

·                 Investment in volunteer training.

The Director of Public Health outlined the plans which included Secured funding for continuation through the Health Inequalities fund and Public Health Grant and Collaboration with Voluntary Action Harrow and other partners for sustained operations.

The Chair expressed appreciation for the programme and the involvement of Voluntary Action Harrow.

The Board Members enquired about the methodology for calculating social return on investment and emphasised the importance of year-round engagement.  Officers explained the involvement of an evaluation partner to ensure objectivity in the social return on investment calculation.  They also discussed the importance of integrating the programme with social care and neighbourhood services.

The Board highlighted the geographical distribution of warm hubs and suggested better coverage across the borough and recommended linking future iterations of the programme to areas with high mental health needs and deprivation.

The Board members supported volunteer investment and continuity in health checks.

RESOLVED:  That the report be noted and the approach for further developing the community-based offer be endorsed.

Report of the Borough Director (Harrow), NW London.

The Assistant Director Health and Wellbeing reported on the Better Care Fund (BCF) plan for 2024-2025, which required approval or amendment and submission to the Health and Wellbeing Board.  The BCF plan was submitted nationally on 10June 2024, and retrospective agreement was requested.  The plan was a revision of the second year of a two-year plan previously signed off by the NHS England (NHSE) and the local authority.

The Assistant Director of Integration and Delivery, NWL ICB (Harrow) presented the report and went through the Financial Plan Amendments:-

·                 NHS contribution to local authority remains at £7.96 million.

·                 NHS services meeting BCF objectives remain at £12.2 million.

·                 Disabled Facilities Grant and IBCF remain unchanged.

·                 Local authority discharge funding from NHSE remains at £1.56 million.

·                 ICB discharge funding from NHSE increased from £1.3 million to £2.95 million.

·                 Proposals include commissioning care for Pathway 3 patients and focusing on delirium or dementia patients.

Specific funding allocations.

·                 £1.2 million for commissioning beds for up to 6 weeks.

·                 £100,000 for innovative home support.

·                 £115,000 for additional social work and brokerage.

·                 Approximately £120,000 for rehab beds in Willesden.

·                 Around £220,000 for care falling between health and social care criteria.

·                 £50,000 for analytics support.

Metric Changes:

·                 Reduction from five to four metrics.

·                 Discontinued metric:  over sixty-fives still at home 91 days after discharge from hospital to reablement services.

The NHS representative emphasised the need for quick allocation processes for funds designated for care falling between health and social care to prevent discharge delays.

The Chair indicated that the overall sentiment was positive, recognising the changes as beneficial and addressing hospital pressures.  She also acknowledged the importance of enabling people to stay in their familiar surroundings and addressed the need for efficient discharge processes.

RESOLVED:  That the report be noted and theBCF submissions be approved.