Agenda item

Health and social care system pressures

Presentation from the Deputy Chief Executive of the London North West University Healthcare NHS Trust


The Sub-Committee received a presentation from the Managing Director of the Harrow Integrated Care Partnership, which gave an update on the recovery and management of system pressures.  The following points were raised:


·                 In regard to primary care, the Fuller report had been published in May 2022 which described a new vision for integrating primary care, improving access, experience and outcomes.  The 3 priorities included: access to care and advice to be streamlined; more proactive and personalised care from a multidisciplinary team to be provided and to help people stay well for longer.


·                 Challenges within primary care had been highlighted which included: access and for it to be ensured that face to face meetings and digital appointments were balanced; workforce in both recruitment, training and retention; estates which included the availability and cost of premises; IT hardware and interoperability; funding and patient engagement.


·                 General Practice within NW London saw continued levels of demand increase.  It was a priority that adequate provision of access was ensured and that face to face and digital appointments were balanced.


·                 The implementation of national Access DES posed to impact primary care in a number of ways which included possible fragmentation of services, destabilisation and readiness.


·                 In regard to adult social care the volume of work in early intervention had continued to increase and costs for new services had also increased.  In addition, the use of ‘three conversations’ had appeared to reduce the number of new people who need long term services, despite the increased number of discharges into social care.


·                 Adult community health services had moved out of IPC restrictions and could offer group sessions which could support waiting list recovery. Services continued to offer a flexible offering of virtual support when appropriate.  New ways to attract staff to work in harrow had been developed and waiting lists were to be monitored to avoid potential harm caused to patients.


·                 Children community health services transformation work was underway with support from CNWL who provided mental and physical health services.  Safeguarding referrals had increased which had meant for a focus on high-risk areas at the expense of promotion and preventative work.  Service demands had increased for those who required occupational therapy, demand had also increased in speech and language therapy as well as this community paediatrics had experienced long waits of up to 6 months.


·                 Mental health services had seen much higher volume of referrals compared to other acute services, pre-pandemic ward referrals were on average at 100, whereas they had recently averaged 145.  In order for mental health services to be improved: a housing pathway and accessibility for homeless people with mental health problems was to be reviewed; for creating more crisis beds was to be considered; for pathways to be improved for users with drug, alcohol and forensic needs and for better mental health reablement for to support service users in crisis.


·                 Within hospital service there was a need for the backlog of patients to be reduced and it was mentioned that 107% of elective activity needed to take place, with 120% for first outpatients and reduced to 75% for follow up outpatients.  The outpatient position had broadly recovered to the 2019/20 baseline position.  The availability of staffing continued to present itself as a challenge.  Diagnostics standard had proved to be performing well and continued to remain in the top quartile nationally.


·                 A&E patient attendance had continued at winter trend level through spring and summer, arrivals via ambulance had also increased in May 2022 compared to May 2020.  However, the number of covid-19 patients had reduced to an average of 30 inpatients at any time. 


The Chair thanked officers and NHS representatives for their updates.  The Sub-Committee agreed to have their questions on the presentation responded to in writing.


RESOLVED:  That the report be noted and answers to the Sub-Committee’s questions be responded to in writing.

Supporting documents:

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