Health & Wellbeing Board

Minutes HEALTH AND WELLBEING BOARD 30 July 2024 Meeting held at Committee Room 5 - Civic Centre Board Members Present: Councillors Jane Palmer, Keith Spencer, Susan O'Brien (Vice-Chair), Amanda Carey- McDermott (In place of Ed Jahn), Richard Ellis, Professor Ian Goodman, Claire Eves (In place of Vanessa Odlin), Julie Kelly, Jason Seez (In place of Patricia Wright) and Lisa Taylor (In place of Lynn Hill) Officers Present: Gary Collier (Health and Social Care Integration Manager), Toby Lambert (Executive Director of Strategy and Population Health) and Nikki O'Halloran (Democratic, Civic and Ceremonial Manager) 1. APOLOGIES FOR ABSENCE (Agenda Item 1) Apologies for absence had been received from Ms Lynn Hill (Ms Lisa Taylor was present as her substitute), Mr Edmund Jahn (Ms Amanda Carey-McDermott was present as his substitute), Ms Vanessa Odlin (Ms Claire Eves was present as her substitute), Ms Sandra Taylor, Ms Patrica Wright (Mr Jason Seez was present as her substitute) and Mr Tony Zaman. 2. DECLARATIONS OF INTEREST IN MATTERS COMING BEFORE THIS MEETING (Agenda Item 2) There were no declarations of interest in matters coming before this meeting. 3. TO APPROVE THE MINUTES OF THE MEETING ON 5 MARCH 2024 (Agenda Item 3) RESOLVED: That the minutes of the meeting held on 5 March 2024 be agreed as a correct record. 4. TO CONFIRM THAT THE ITEMS OF BUSINESS MARKED PART I WILL BE CONSIDERED IN PUBLIC AND THAT THE ITEMS MARKED PART II WILL BE CONSIDERED IN PRIVATE (Agenda Item 4) It was confirmed that Agenda Items 1 to 9 would be considered in public and Agenda Items 10 to 14 would be considered in private. 5. NWL JOINT FORWARD PLAN FOR 2024-25 TO 2028-29 (Agenda Item 5) Mr Toby Lambert, Executive Director of Strategy and Population Health at North West London Integrated Care Board (NWL ICB), advised that he had not included the Mental Health Strategy in this item but that he would be happy to bring a report on this issue to a future meeting to provide the Board with an update. The Joint Forward Plan (JFP) for 2024/25 to 2028/29 should originally have been considered by the Board on 11 June 2024. This meeting had been cancelled following the announcement of the election as an NHS directive had been issued that the JFP should not be discussed in public. As the timetable for submission of the JFP was subsequently changed to the day after the election (therefore not allowing enough time to arrange a new meeting), Hillingdon’s Director of Public Health had had to submit comments to NWL ICB on behalf of the Hillingdon Health and Wellbeing Board. Consideration would need to be given to how this process could be improved for the next iteration of the JFP. The Board was advised that the JFP had been a ‘joint’ initiative between the ICB and other NHS organisations (rather than between the local authority and the NHS). It built on the NHS Health and Care Strategy which had been published in November 2023 and included nine priorities with cross cutting principles: 1. Reduce inequalities and improve health outcomes through population health management; 2. Improve children and young people’s mental health and community care; 3. Establish Integrated Neighbourhood Teams with general practice at their heart; 4. Improve mental health services in the community and for people in crisis; 5. Embed access to a consistent high quality set of community services by maximising productivity; 6. Optimise ease of movement for patients across the system throughout their care – right care, right place; 7. Transform maternity care; 8. Increase cancer detection rates and deliver faster access to treatment; and 9. Transform the way planned care works. To achieve these priorities, the following steps now needed to be followed: 1. Ensuring a core / common offer across NWL - currently the offer across NWL was inequitable and needed to be levelled up (rather than being levelled to the middle). However, productivity would need to be pushed to enable funding to be freed up for this to be actioned; 2. Whilst the provision of a common offer would address some of the inequity in NWL, it was recognised that the ICB would need to work with local authorities to reach out to seldom heard groups in the community which would then result in a shift in resource allocation. The speed of implementation of these first two steps would need to keep pace with each other; and 3. Consideration needed to be given to what percentage of the population’s needs could be met by the core offer and where tailored services would be needed. It was recognised that the core offer would never meet the needs for some communities in NWL, for example, rough sleepers and asylum seekers. These groups would need bespoke solutions. The JFP would be for the whole of NWL and identified a great degree of commonality (80-90%) between the different boroughs’ Health and Wellbeing Strategies. It would enable interventions to be undertaken at scale through the core offer, and the remaining 10-20% would need to be given space as they would have divergent priorities. It was noted that the JFP had been discussed by stakeholders at a Town Hall meeting. Mr Lambert advised that the NWL ICB was keen to solicit suggestions for improving the process of developing future JFPs. The Board recognised that NWL ICB had been given a tight timeframe by NHS England regarding data publication. Although the Board supported the idea of boroughs levelling up to the same core offer and therefore providing opportunities to improve weaker areas, concern was expressed that those boroughs that were already performing well in specific areas would be required to mark time whilst the others caught up, preventing them from moving even further ahead. Furthermore, it had been difficult to compare boroughs based on the number of patients registered with GPs as this was inaccurate and could be inflated by up to 15%. This needed to be acknowledged and addressed by using population figures instead. The Board queried how the ICB would be supporting the commitment to improve stroke services in NWL and whether the JFP would be backed up by a financial strategy (without which, the JFP would be useless). Also, with the recent change in Government, concern was expressed about whether or not the JFP would be required in the future. RESOLVED: That: 1. Mr Toby Lambert provide a report on the NWL ICB Mental Health Strategy to a future meeting of the Board; 2. the comments and suggestions for improving the process for the next Joint Forward Plan be noted; 3. the challenge in securing formal feedback from all Health and Wellbeing Boards within the set deadline due to successive pre-election sensitivity periods be noted; and 4. the submission of the Joint Forward Plan to NHS England on 5 July 2024 be noted. 6. HILLINGDON JOINT LOCAL HEALTH AND WELLBEING STRATEGY 2022-2025 YEAR 2 INTERIM UPDATE (Agenda Item 6) Ms Kelly O’Neill, the Council’s Director of Public Health, advised that the report provided a mid-three year update on progress against the priorities in the Health and Wellbeing Strategy. It was noted that the last evaluation had needed some improvements and, as such, consideration had since been given to which metrics would be used to evaluate progress and what these should be measured against, e.g., previous performance, North West London (NWL), London, England, etc. The report detailed clear improvements to the current service provision and provided quite a lot of detail in some areas. Ms O’Neill stated that partners had all submitted data as requested and on time which had aided in the formation of the report. The metrics had been RAG rated based on local and national data and consideration would need to be given to how this should be reported in future. There were 17 priorities: 5 Red, 8 Amber, 4 Green. It was anticipated that the year two review of the strategy would be considered by the Board at its next meeting on 10 September 2024 and would be more concise. Consideration would need to be given to planning the development of the new strategy. The next report would be able to demonstrate what had been achieved to date. Ms O’Neill advised that children’s oral health was one of the best in NWL but that it was still lower than the London and England average despite a significant amount of work being undertaken between the ICB and Directors of Public Health in NWL. Additional funding had been secured from the NWL ICB to support work in Hillingdon around the dental health strategy. There was also NHS England funding for the children’s oral health contract which would be doubled next year. School based health mechanisms would continue to be used to drive the children’s oral health work and this would need to be drawn together with work around things like child obesity and the school water only policy. It would be important to ensure that partners were also role models by, for example, only having sugar free options in paediatrics at the hospital. Hypertension was still the most significant contributor towards deaths. Although work undertaken around hypertension had improved the statistics in Hillingdon, it was important to recognise that the results of this work would not be instant. Over time, the Borough would see a reduction in the number of strokes and heart attacks. With regard to the implementation of the Autism Strategy, it was noted that a number of key actions had been identified to be taken forward. The Board noted that homelessness had become a real issue across the whole of London. A public health review of the associated disparities was being undertaken with support from the Population Health Management (PHM) team. The PHM infrastructure was also being linked to support the development of the Integrated Neighbourhood Teams (INT). Three out of four posts had been appointed and would be in place for two years to help tackle inequalities through a place based approach. Things had been coming together around the neighbourhoods which was thought to be an exciting development - services were being aligned to contribute towards people’s health going forward. This work was thought to be a long term investment in getting upstream of the demand. RESOLVED: That: 1) the progress of strategy implementation within year 2 be noted, with the year 2 full progress report planned for the next Health and Wellbeing Board meeting; 2) new funded workstreams contributing to the strategy’s achievements be noted; and 3) the recommended process for periodic oversight and assurance, monitoring outcomes achieved, and escalation where improvement milestones are not being achieved be noted. 7. 2024/25 BETTER CARE FUND PLAN (Agenda Item 7) Mr Gary Collier, the Council’s Health and Social Care Integration Manager, advised that the report requested that the Board ratified the decision of the Co-Chairs to approve the 2024/25 BCF plan. It had been intended that the report be considered by the Board at its meeting on 11 June 2024 but this meeting had been cancelled. To ensure that the Board met the national requirement to meet the submission deadline, the Co-Chairs had been asked to approve the plan ready for submission. It was noted that the plan was largely a roll-forward from the 2023/24 plan. In 2024/25, the North West London Integrated Care Board (NWL ICB) had allocated almost £1.3m of its discharge funding towards supporting pathway 3 (block nursing step down). The ICB would be contributing £934k in Hillingdon for use to address capacity around discharge path 3 (complex care patients with conditions such as dementia and challenging behaviour). Discussions were underway with partners on how this could be best used. Having submitted the 2024/25 BCF plan, Mr Collier believed that Hillingdon had been complaint with all of the national conditions and that the Borough would be recommended for assured status in the next couple of weeks. It was thought that the targets around the national metrics were achievable, although there might be some data reliability issues in relation to the NHS targets. Part of the problem about the accuracy of the data had been in relation to the introduction of new IT systems in some of the acute trusts. As such, work was being undertaken in NWL to develop these targets. Concern was expressed that the rehabilitation beds for Hillingdon residents were on the Furness Ward in Willesden. As this facility could take Hillingdon residents over an hour to get to, it was queried whether there was anything closer, perhaps in the shires. Mr Collier advised that NWL ICB had identified this as the most suitable place and that any consideration of securing facilities outside of London / in the shires would need to be undertaken by the ICB. Mr Keith Spencer, Co-Chair and Managing Director of Hillingdon Health and Care Partners, advised that he had sat on the ICB Discharge Fund group. Furness Ward had been chosen as the best compromise based on its availability locally and its ability to ratchet services up quickly. Board members thanked Mr Collier for his diligence and professionalism in bringing this document together. Mr Collier advised that it had been a team effort. RESOLVED: That: 1. the decision of the Co-Chairs to approve the 2024/25 Better Care Fund Plan as described in the report, including the proposed financial arrangements and proposed targets for the national metrics, be ratified; and 2. the position regarding Equality and Health Impact Assessments, as set out in the report, be noted. 8. INTEGRATED HEALTH AND CARE PERFORMANCE REPORT - 2023/24 Q4 (Agenda Item 8) Mr Gary Collier, the Council’s Health and Social Care Integration Manager, advised that the Co-Chairs had approved the draft NHS England Better Care Fund 2023/24 end of year template on behalf of the Health and Wellbeing Board. It had been planned that this template be considered by the Board on 11 June 2024 but this meeting had subsequently been cancelled. The Board was advised that there had been a financial underspend in relation to the Disabled Facilities Grant. To ensure that this did not happen again, the policy was being changed to increase flexibility. Mr Collier noted that there had been a mixed performance against the different metrics with there being challenges in getting information or action against some. Obtaining updates from some partners across London had been difficult because of other things happening at the same time. It was thought that starting collation of the performance data earlier might help smooth the process. Mr Keith Spencer, Co-Chair and Managing Director at Hillingdon Health and Care Partners, advised that partners did have the data needed but that there had been a timing issue. The risk was that Hillingdon would not be demonstrating the great work that had been undertaken, for example, the Borough’s reablement performance was the best in NWL. The benchmark had now been identified and it would be important to ensure that partners provided the information in a timely fashion. Mr Spencer would take this forward as an action for the Board’s next meeting. It was important to remember that, although a significant amount of good work had been undertaken in Hillingdon, there was still room for improvement. RESOLVED: That: a) the Co-Chairs’ decision to approve the draft NHS England Better Care Fund end of year template on behalf of the Board be ratified; b) Mr Spencer report back on partners’ provision of data for inclusion in the report at the Board’s next meeting on 10 September 2024; and c) the content of the report and discussion be noted. 9. BOARD PLANNER & FUTURE AGENDA ITEMS (Agenda Item 9) Consideration was given to the Board Planner and future agenda items. It had been agreed that an update on the North West London Integrated Care Board (NWL ICB) Mental Health Strategy be provided at a future meeting. A full year 2 progress report in relation to Hillingdon’s Joint Health and Wellbeing Strategy would be brought to the next Board meeting on 10 September 2024. The Board had agreed that Mr Keith Spencer, Co-Chair and Managing Director of Hillingdon Health and Care Partners, report on the governance implications of the NWL ICB organisational changes to the next Board meeting on 10 September 2024. RESOLVED: That: 1. Mr Toby Lambert update the Board on the NWL ICB Mental Health Strategy at a future meeting; 2. a two year update on the Health and Wellbeing Strategy be considered at the Board’s next meeting on 10 September 2024; 3. Mr Spencer report on the governance implications of the ICB organisational changes to the next Board meeting on 1 0 September 2024; and 4. the Board Planner, as amended, be agreed. 10. TO APPROVE PART II MINUTES OF THE MEETING ON 5 MARCH 2024 (Agenda Item 10) Consideration was given to the confidential minutes of the meeting held on 5 March 2024. RESOLVED: That the PART II minutes of the meeting held on 5 March 2024 be agreed as a correct record. 11. BCF REVIEW UPDATE (Agenda Item 11) Consideration was given to the report. RESOLVED: That: 1. Mr Spencer provide the Board with an update at its next meeting on 10 September 2024; and 2. the discussion be noted. 12. ICB ORGANISATIONAL DESIGN: PLACE BASED IMPLICATIONS (Agenda Item 12) Consideration was given to the North West London Integrated Care Board design. RESOLVED: That: 1. Mr Keith Spencer report on the governance implications of the NWL ICB organisational changes to the next Board meeting on 10 September 2024; and 2. the discussion be noted. 13. CERNER UPDATE (Agenda Item 13) Consideration was given to the implementation of the Cerner system at The Hillingdon Hospitals NHS Foundation Trust. RESOLVED: That progress with the Cerner Stabilisation Programme at LNWH and THH, and with the Innovation Release upgrade across the APC, be noted. 14. UPDATE ON CURRENT AND EMERGING ISSUES AND ANY OTHER BUSINESS THE CHAIRMAN CONSIDERS TO BE URGENT (Agenda Item 14) Consideration was given to communication with patients in relation to appointments. RESOLVED: That the discussion be noted. The meeting, which commenced at 2.30 pm, closed at 4.15 pm. These are the minutes of the above meeting. For more information on any of the resolutions please contact Nikki O'Halloran on nohalloran@hillingdon.gov.uk. Circulation of these minutes is to Councillors, Officers, the Press and Members of the Public.

Health and Wellbeing Board report 10 September 2024 HILLINGDON JOINT LOCAL HEALTH AND WELLBEING STRATEGY 2022-2025: END OF YEAR 2 REPORT Relevant Board Members Councillor Jane Palmer: Joint Chair of the Health and Wellbeing Board Keith Spencer: Joint Chair of the Health and Wellbeing Board Sandra Taylor: Corporate Director ASC and Health, LBH Organisation London Borough of Hillingdon Report author Kelly O’Neill, Director of Public Health, LBH Papers with report None RECOMMENDATIONS That the Health and Wellbeing Board notes: 1) the reported activities that demonstrate the progress that has been achieved between year 1 and year 2 of the implementation of the Joint Local Health and Wellbeing Strategy (JLHWBS) by lead officers collaborating with HHCP partner organisations, what has been achieved since the strategy was implemented and the plans for year 3 2024/25. . 2) planning and implementation progress of the Health Inequalities funded projects. 3) that the JLHWBS three-year cycle will end in 2025 and that the Board delegate responsibility to the Director of Public Health to develop a new strategy, the timetable of which will be concurrent with the updating of the JSNA and ensure that there is effective planned and systematic engagement and consultation with Hillingdon professionals, residents, neighbourhood and community groups across the borough at all stages of the Strategy’s development that brings insight and understanding. 4) that the Year 2 interim report is planned to be presented in January 2025, the combined Year 3 final report that includes strategy closure will be presented with the new Health and Wellbeing Strategy in September 2025. INFORMATION 1. Introduction: This paper updates the Board on progress and achievements against the priorities agreed in the JLHWBS during year two implementation and the new programmes of activity that are in development that are supporting strategy delivery. 2. Context: The Strategic Priorities of the JLHWBS: There are six thematic priorities of the JLHWBS, to: 1. Support children, young people and their families to have the best start and to live healthier lives. 2. Tackle unfair and avoidable inequalities in health, access to and experience of services. 3. Help people to prevent the onset of long-term health conditions such as dementia and heart disease. Health and Wellbeing Board report 10 September 2024 4. Support people to live well, independently and for longer in older age, through to the end of life. 5. Improve mental health services through prevention and self-management. 6. Improve the way we work within and across organisations to offer better health and social care. This is delivered through six enabling workstreams: Workstream 1 Neighbourhood-based Proactive Care Workstream 2 Urgent and Emergency Care Workstream 3 End of Life Care Workstream 4 Planned Care Workstream 5 Care and Support for children and young people Workstream 6 Care and support for people with mental health challenges (incl. addiction) and/or learning disabilities and/or autism 3. JLHWBS Implementation: Year 2 Evaluation: This section demonstrates reported progress and improvement is being achieved between year 1 and year 2 of the JLHWBS implementation. Each table focuses on the priorities stated in the Strategy, and where available, the data is provided based on the KPIs that responsible officers and aligned groups are working towards achieving. The RAG status is based on national benchmarking, using published thresholds when this data is available. When a national benchmark is not available and a local assessment has been used, the priority has been asterisked. Each indicator has a progress report which states the current position and next steps to show the direction of action being taken. This information will be updated in the end of year two evaluation report that will be presented at a later H&WB Board meeting in 2024/25. Health and Wellbeing Board report 10 September 2024 3.1. Priority 1: Providing support for children, young people and their families to have the best start and to live healthier lives. Focus Areas Priority Baseline Data Year 1: Year 2022/23 RAG Year 2: 2023/24 RAG *We will transform the support offered across partner organisations to CYP and their families to promote a healthy weight and reduce obesity. 1, 5, 6. Overweight and obese children – Year R: aged 4/5 years (1:5 children): 2021/22  Hillingdon: 21.8%  England: 22.3% Overweight and obese children – Year 6:  Hillingdon: 41.7%  England: 37.8% Data used in year 1 is 21/22 – therefore data is unchanged from the baseline. R NCMP measure: Overweight and obese Children Year R: 2022/23  Hillingdon: 19.4% overweight and obese.  London: 20%  England: 21.3% Overweight and obese Children Year 6:  Hillingdon: 38.3%  London: 38.8%  England: 36.6% There has been a reduction in child overweight and obesity for both YR and Y6. For YR the prevalence is below London and England, for Y6 Hillingdon is comparable with London and continues to remain above the England average, however the gap has reduced. For solely child obesity Year 6:  Hillingdon: 23.7% (900 children in year group).  London: 24.8%  England: 22.7% There is clear progress and a reduction in the gap between Hillingdon and England – this is rated AMBER due to the prevalence of overweight and obesity in Y6 continuing to be higher than England. A Health and Wellbeing Board report 10 September 2024 What has been achieved since 2022/23 Plan for Year 3: 2024/25  There has been greater focus on understanding the healthy eating and healthy weight of school aged children and the promotion of healthy eating in schools:  Completed a schools’ health related behaviour survey for school aged children with questions on food choices and behaviours. Primary Schools: - 31 schools registered, - 16 schools completed. Secondary Schools: - 7 registered - 5 completed.  Schools engaging in the Healthy Schools London programme have been focusing on becoming Sugar Smart and Water Only (4 schools are currently active).  HHCP Fitter and Healthier Children workshop that brought stakeholders together to understand the scale of need, current service provision, including infrastructure that makes healthier choices the easiest, and gap analysis.  Hillingdon Strategic Obesity Group established with a clear purpose to take a whole system approach to healthy weight for children, YP and their families.  A tier 2 child healthy weight service specification has been developed, soft market testing completed and an evidence- based programme with face to face and online provision will be commissioned. 1. Action: Public Health will procure a tier 2 weight management programme. 2. Action: Engage Early Years providers, schools and partner organisations delivering the ‘Expanded Early Years Entitlements & Wraparound Childcare’ to support key messages around healthy diets and lifestyle choices. 3. Action: School Food survey reviewing primary school food June in July 2024 will be the starting point for engagement with school and school caterers. 54 responses received to date. Aim is for: - A minimum of 20 primary schools to assess compliance and adherence to School Food Standards (Sept – Dec 2024) - Using data and insight to influence school policy supporting healthy eating. 4. Action: Training for EHOs and Primary Education school improvement advisor on school food standards (SFS) to explore feasibility on SFS being assessed alongside food hygiene inspections – this was identified as a gap in the school Superzone; the pilot will run between September 2024 and March 2025 with 8 schools targeted due to their higher levels of obesity from NCMP data. 5. Action: Family Hub directory will be updated to include information on healthy eating, parenting skills and physical activity for CYP 6. Action: Healthy Food Advertising programme and sugar reduction campaign across childcare and education settings planned. Health and Wellbeing Board report 10 September 2024 Focus Areas Priority Baseline Data Year 1: Year 2022/23 RAG Year 2: 2023/24 RAG Increase breastfeeding initiation and sustained feeding with breast milk. 1,2. Breastfeeding initiation: 2018/19:  Hillingdon: 68.3% (2,550 women)  London: 76.3%  England: 67.4% Data used in year 1 is unchanged from the baseline. R Breastfeeding initiation: 2020/21 – PHOF identifies a new reporting method  Hillingdon: 48.7%  London: 87.7%  England: 71.3% 6–8-week sustained breastfeeding: 2022/23  Hillingdon: Not published due to incomplete data  London: Not published due to incomplete data  England: 49.2% This is rated RED due to low initiation recorded by PHOF as part of their new methodology compared with London and England and a lack of data due to insufficient recording of data for sustained BF at 6 weeks. R What has been achieved since 2022/23 Plan for Year 3: 2024/25 Breastfeeding is a high impact public health intervention which delivers optimal infant nutrition and is a protective factor for child social and emotional attachment and early child health, reducing the risk of infection and other child illnesses. Breastfeeding also plays a key protective role in child healthy weight and oral health. Hillingdon has been part of a NWL ICS steering group that is working collaboratively across all NWL boroughs and NHS providers to make every contact count for pregnant people and new parents to be understand the benefits of breastfeeding. The Breastfeeding Strategy Group has implemented:  Pans with GLL leisure sites to be breastfeeding friendly spaces.  Healthy Start (DH programme to increase vitamin supplementation for pregnant people and infants) training for all Children Centre Staff.  Healthy Start information and delivery process requirements sent to all pharmacies (through PH and updated through the Superzone project)  Children centres run Breastfeeding Support appointments across the borough. There are also four drop-in sessions for parents to see peer support workers and/or lactation consultants. 1,103 visits to gain breastfeeding support from April 2023- March 2024. 1. ACTION: There must be a review of the very low recorded initiation in maternity services to explain the significantly low breastfeeding uptake. 2. ACTION: To review data recording for 6–8-week sustained breastfeeding to ensure local feeding rates are understood. 3. ACTION: Review the effectiveness of the Breastfeeding Strategy and ensure the actions above are included as a priority, with key objectives and SMART action plan for increasing initial rates and sustained feeding and educate families of the wider health benefits linked to breastfeeding i.e. reduced levels of childhood obesity and dental caries. 4. ACTION: complete a breastfeeding and infant feeding health need assessment with the Hillingdon Hospital, EY services and 0-19 NHS services 5. ACTION: Review breastfeeding education and initiation support 6. ACTION: align the work with NWL that the DPH is leading that maximises opportunities for collaboration. Health and Wellbeing Board report 10 September 2024 Focus Areas Priority Baseline Data Year 1: Year 2022/23 RAG Year 2: 2023/24 RAG We will work to see the levels of tooth decay reduced. 1,2. Child Oral Health: DMF teeth by age 5 years (mean per child) Hillingdon: 1.20 England: 0.80 2018/19 Child Oral Health: DMF teeth by age 5 years (mean per child) Hillingdon: 1.20 England: 0.80 2018/19 R Prevalence of dentinal decay %:  Hillingdon (n=357) – 28.2%  London 25.8%  England 23.7% Whilst there has been improvement in children’s oral health, this priority is rated RED due the higher prevalence of dental decay compared to the England and to London. R What has been achieved since 2022/23 Plan for Year 3: 2024/25 The brush for life intervention, supports parents to understand the importance of oral health and toothbrushing form the eruption of their first tooth throughout early childhood, and to reduce sugar, providing healthy food education that reduces the risk of decayed teeth, laying the foundations of healthy lifetime habits. This service is available in all children centres and Family Hubs. To date this year, 1,386 families have received oral health information. The bottle to cup initiative reduces reliance of parents on bottles for infant drinks and the impact that bottle use on exposure of drinks to drink, supporting speech and language development and the natural, growth of infant’s teeth. This intervention also discourages the use of oral dummies. Education on sugar swaps is also available to parents. The oral health provider carries out online and face to face training – for early years practitioners online and for resident’s face to face workshops in libraries, children centres and community settings that family’s access. 1. ACTION: Use the NHSE Inequalities funding to provide additional evidence-based activity to improve children’s oral health. With the support of the NHS colleagues a new Service Level Agreement has been developed introducing a targeted approach to implementing “Supervised toothbrushing” via schools and early years settings in areas of high need of the borough, with the aim of complementing and enhancing the existing provision of NHS funded Children’s Oral Health Promotion Service in Hillingdon, that’s embedded within the Whittington Community Dental Services, provided by Whittington Health. 2. ACTION: Planning for procurement of a 2-year contract that includes the evidence-based activity that is being led by the NWL ICP which is bringing together the NHS, providers and the 8 local authorities to collaborate, and link together oral health, with breastfeeding, health weight, and inequalities between population groups. The new contract from April 2025 will include increased activity, targeted interventions to children at higher risk of dental decay; children with SEND needs, and children living in more deprived communities. 3. ACTION: Promote the importance of toothbrushing with parents and professionals in Early Years settings via training delivered by the Oral Health Promotion Service and continuation of Brush for Life delivery through Family Hubs, Children’s Centres. Health and Wellbeing Board report 10 September 2024 Focus Areas Priority Baseline Data Year 1: Year 2022/23 RAG Year 2: 2023/24 RAG We will work to reduce smoking in families. 1,2,3,4. Smoking prevalence in adults (15+), 2021/22; 37,231 persons Hillingdon: 13.8% England: 15.4% Smoking prevalence in adults (15+), 2021/22; 37,231 persons Hillingdon: 13.8% England: 15.4% Smoking cessation levels: Reduced LBH adult smoker prevalence 11.1% (26,200) down from 13.8%. Prevalence of smoking amongst 15- year-olds (regularly smoke) - currently LBH rate is 13.8% (2021/22) lower than London (14.8%) and England, (15.4%). Long-term mental health condition (18+) in Hillingdon, have a higher prevalence rate of (30.9%) compared to London (26.0%) and England (26.3%). Smoking at time of delivery: LBH 3.2% (Smoking status at time of delivery 2021/22), lower than London (4.5%) and England (9.1%). A There are three national PH indicators: Smoking at time of delivery (22/23):  Hillingdon: Reduced to 3.4%  London: 4.6%  England: 8.8% Smoking prevalence adults:  Hillingdon: 8.1%  London: 11.7%  England: 12.7% Smoking prevalence routine and manual group:  Hillingdon: 7.2%  London: 20.2%  England: 22.5% This is rated GREEN due sustained lower prevalence amongst the three priority target groups compared with London and England. G What has been achieved since 2022/23 Plan for Year 3: 2024/25  Tobacco Control Plan: The 2022 – 2025 Tobacco Control Plan was ratified by the Health & Wellbeing Board in June 2023 and sets out the shared ambition for a ‘smokefree’ Borough by 2030.  Agreed with the Hillingdon Tobacco Control Alliance to initiate the strategy delivery plan and clarify roles and responsibilities of Alliance organisations to reduce overall smoking prevalence, and exposure to second-hand smoke, tackle illicit tobacco sales and underage sale of cigarettes and e-cigarettes; target vulnerable 1. ACTION: Mobilise the new stop smoking contract with CNWL 2. ACTION: Align the new 5-year investment from the national Stop the Start Strategy – Year 1 there has been additional funding of £280,000 – this has increased the number of stop smoking advisors and is funding new training programmes. 3. ACTION: Deliver the Swap to Stop new vaping programme which was a successful bid to DHSC for vaping equipment as a harm reduction intervention. For 2024/25, to implement the national ‘Stop Health and Wellbeing Board report 10 September 2024 priority; reduce marketing and tackle the supply chain.  The Hillingdon stop smoking service has been retendered. CNWL has been awarded the new contract which started on 1/6/2024. This contract focuses on the nationally defined priority groups: - Children and young people under 18 years. -Pregnancy and after child birth - including partners. -Those with mental health issues including substance misuse. -People with disabilities and long-term conditions. -Routine and manual occupations The service works in partnership, with referral pathways to clinics in varied settings, including Hillingdon Hospital, Primary Care, local libraries and MH services and drop-ins at Arch. In addition to other targeted work within areas of high prevalence. the Start Strategy’. The planning assumption is that this funding will be available for 5 years to significantly increase the number of smoking quitters. The majority of this funding will be allocated to recruit additional stop smoking advisors to provide 121 support and group sessions across the borough and education sessions on the harms of smoking and vaping for Children and Young People through training in education settings. Focus Areas Priority Baseline Data Year 1: Year 2022/23 RAG Year 2: 2023/24 RAG *Consolidate the integration of therapy services for children and young people and redirect resources into early intervention. 1,2,5,6. No data provided 85% referral are reviewed by the MDT panel – with referral communicated to the referrer within 2 weeks A The contract is at the early stages and data for this new contract it not provided. This is rated AMBER due to the collaboration agreement through which the contract has been awarded being early in its implementation and there are contractual issues that need to be agreed. A What has been achieved since 2022/23 Plan for Year 3: 2024/25  The new Children’s integrated therapy service (CITS) contract has been collaboratively procured with CNWL as part of the 0-19 contract. There are areas of this contract that have yet to be agreed.  Speech and language, physical and occupational therapy early intervention services work within Children Centres to mitigate and address early concerns in child development and reduce avoidable escalation of need that is coordinated with the health visitor 10- month reviews and 2-year progress checks.  There have been 4,586 attendances across three localities for the health checks for families. 1. ACTION: Agree Key Performance Indicators for this service to enable the progress and improvement of this provision as a priority of the JLHWBS to be published. 2. ACTION: Embed the Child Health Collaboration Agreement between LA/ICB/CNWL to develop new and alternative ways of delivering services, including completion of a review of CNWL Children’s Services to deliver efficiencies and a robust service offer. Health and Wellbeing Board report 10 September 2024  Referrals for early intervention can also so be made to CITS via a stronger family team referral.  There have been 2,440 attendances at CITS sessions/speech and language sessions and appointments in 2023/24. Focus Areas Priority Baseline Data Year 1: Year 2022/23 RAG Year 2: 2023/24 RAG *Hillingdon Domestic Abuse Advocacy Service (HDAAS): Providing help and support for victims experiencing domestic abuse. 1,2,6. NA Since June 2022, the Hillingdon domestic abuse provision has evolved and is now known as HDAAS (Hillingdon domestic abuse advocacy service). The service has become more robust and grown in capacity and now offers help and support for victims experiencing domestic abuse at any level of risk. The service now consists of IDVAs (independent domestic violence advocates) for high-risk cases and Floating Support workers for low-medium risk cases. Hillingdon has been granted funding for the implementation of the IRIS programme. There is a significant need for this programme in Hillingdon and the programme will assist in reaching out to clients who may not be known to or come to the notice of other services such as the police or social care. Referrals from health services remain low, 5 years ago an IDVA was introduced into Hillingdon Hospital resulting in a significant increase in referrals. NK Due to data sensitivity the data available is from the PHOF data set which shows for domestic abuse incidents for persons aged 16 years and over:  Hillingdon – 34.5 per 1000 population  London – 34.5 per 1000 population  England – 30.6 per 1000 population This is rated AMBER due to the rate being above the national average and no data that shows an improvement. A Health and Wellbeing Board report 10 September 2024 What has been achieved since 2022/23 Plan for Year 3: 2024/25 The Domestic Abuse Steering Executive has agreed a delivery plan to progress the priorities in the 2023-25 Hillingdon Domestic Abuse Strategy and:  To ensure delivery of statutory responsibility in respect of domestic abuse (including Part 4 safe accommodation duties and Domestic Abuse Related Death Reviews).  To ensure that Hillingdon has the right range of programmes and services in place to support residents experiencing domestic abuse.  To provide comprehensive support systems for survivors, including legal, psychological, and safeguarding.  To enhance community awareness and education on domestic abuse and violence against women and girls. The Hillingdon Domestic Abuse Advocacy Service continues to provide direct support to domestic abuse victims. Domestic abuse support service contract extensions have been made to the therapeutic service for child victims of domestic abuse and the emergency safe accommodation service. Hillingdon Women’s Centre are also commissioned to provide a community support service. These services will continue until 2025. The IRIS (Identification and Referral to Improve Safety) programme is being implemented in Hillingdon. This programme supports General Practices to better identify and support victims of domestic abuse. A DRIVE programme pilots is underway which is a perpetrator programme for high-risk perpetrators of domestic abuse. 1. ACTION: Planning for the update of the 2023-25 strategy with new measures that can be included in this strategy and a DA dashboard to be developed. 2. ACTION: complete the need assessment to inform future service commissioning decisions including, the commissioning and procurement of new DA service offer 3. ACTION: Review the process for the implementation of routine enquiry across system 4. ACTION: Housing to commence work on DAHA accreditation 5. ACTION: DRIVE programme to be concluded in March 2025 and findings reported 6. ACTION: MARAC steering group o be mobilised following the MARAC review 7. ACTION: Pilot of domestic abuse CVS standards 8. ACTION: White Ribbon and 16 days of activism campaign to be a published campaign and supported by HHCP organisations. 9. ACTION: Launch of DA child practice standards Health and Wellbeing Board report 10 September 2024 3.2: Tackle unfair and avoidable inequalities in health and in access to and experience of services. Focus Areas Priority Baseline Data Year 1: Year 2022/23 RAG Year 2: 2023/24 RAG Reducing homelessness 1,2,5. Not available Households in temporary accommodation: 2022/23:  Hillingdon:  England: Households owed a duty under the HRA: 2022/23:  Hillingdon: 19.2/1000  London: 15.7/1000  England: 12.4/1000 Hillingdon is RAG rated RED on all PHOF indicators and not improving.  In 2022/23 there were 3886 approaches to LBH by homeless households: 706 show mental health as a support need and 195 show drug and/or alcohol use as support need  There were 772 bookings per month into temporary accommodation (TA) and a further 321 rehoused without a prior TA booking. R Households owed a duty under the Homeless Reduction Act (HRA): 2022/23 (PHOF Data):  Hillingdon: 19.2/1000 population  London: 15.7/ 1000  England: 12.4/ 1000 This is rated RED due to higher rates than London and England and the rate is increasing from previously published data. R What has been achieved since 2022/23 Plan for Year 3: 2024/25 Progress achieved:  In place there are partnering arrangements ongoing with P3 in relation to young people 18 to 25, particularly care leavers, who are homeless or potentially homeless. 1. ACTION: Maintain P3 provision and continue to work with homeless and potentially homeless young people in the borough providing them with advice and onward referrals to appropriate agencies. 2. ACTION: with the first stage of Project Neptune completed, a second Health and Wellbeing Board report 10 September 2024  Homeless services have been restructured, work is continuing with the transformation team under Project Neptune to refocus service on prevention  A full skills review has been carried out and extensive training programme being rolled out for staff  A care leavers protocol is in place and is being reviewed  Hospital discharge protocol in now in place with a clear focus on duty to refer  An ending Rough Sleeper Plan is in place co-produced with DLUHC  There has been significant funding approved under the Rough Sleeping Initiative, Rough Sleeping Drug and Alcohol Treatment Grant, and Rough Sleeping accommodation Programme  There has been proactive outreach work at Heathrow including patrols and in borough outreach areas.  Successful work with target 1000, most entrenched rough sleepers.  Additional funding secured under Supported Housing Accommodation Programme, Local Authority Housing Fund and Refugee Housing Programme  Additional provision via new build, acquisitions, supported shared housing, extensions, under occupiers’ schemes, and cash incentives, Olympic House first stage accommodation, Beechwood supported provision, Saviour’s Housed temporary accommodation  Increased collaboration via partnership forums Phase now seeks to embed improvements with a focus on prevention and early intervention to reduce homelessness. 3. ACTION: care leavers protocol is in place and will be reviewed again following changes to government guidance. 4. ACTION: to update the Ending Rough Sleeper Plan has been updated for 2024 and signed off by ‘DLUHC’. 5. ACTION: to be taken to work closely with pan-London colleagues, GLA and DLUHC to highlight the need for continued funding via the Rough Sleeping Initiative, Rough Sleeping Drug and Alcohol Treatment Grant, and Rough Sleeping Accommodation Programme. 6. ACTION: Additional funding secured under Supported Housing Accommodation Programme, Local Authority Housing Fund and Refugee Housing Programme. A further LAHF funding bid has been submitted. 7. ACTION: Commissioning strategy in place to increase affordable housing provision through a variety of sources including new build, acquisitions, private rented sector supply, Extensions, Under Occupiers schemes, and Cash incentives. 8. ACTION: There are ongoing partnership arrangements through collaborative forums to support the above initiatives. Focus Areas Priority Baseline Data Year 1: Year 2022/23 RAG Year 2: 2023/24 RAG *Undertake a Public Health review of disparities and inequalities in Hillingdon and recommend actions. 2. NA Information not available. NK There is data and intelligence that is supporting the inequalities agenda for live work programmes and projects, for example the Integrated Neighbourhood Teams, WSA projects and current NHSE funded programmes. A systematic review of disparities and inequalities has been delayed, timed to R Health and Wellbeing Board report 10 September 2024 coincide with the start of the JSNA update and development of the Population Health Management programme which will start to systematically identify and update how the health and care partnership tackle inequalities. This is rated RED. What has been achieved since 2022/23 Plan for Year 3: 2024/25 There has been training across HHCP to better use Population Health Management (PHM) as a toolkit for tackling health disparities through a systematic targeted programme and examples of using this approach to achieve improved and sustainable outcomes. NHSE funded PHM capacity and capability needs to be developed to support the ambitious programmes that HHCP has aspired to and embedded through a public health approach to enable system-wide transformation. 1. ACTION: The development of an updated JSNA and the new JLH&WBS will generate the information required to ensure that key health inequalities that affect the population are understood and future action to mitigate are driven by evidence and insight. 2. ACTION: link the Population Heath Management and NHSE funded projects to this agenda. 3.3: Help people to prevent the onset of long-term health conditions such as dementia and heart disease. Focus Areas Priority Baseline Data Year 1: Year 2022/23 RAG Year 2: 2023/24 RAG 1. Preventative Care: Hypertension workstream  Implementation of Fuller Report: Integrated Neighbourhood 2. See Year 1 data Hypertension: QOF prevalence (all ages): 2022/23  Hillingdon: 12.8%  London: 10.9%  England: 14.4% Mortality from hypertensive diseases: 2020/22: Per 100,000 population:  Hillingdon: All: 214.5 A KPI’s are being monitored for 24/25 in relation to the Hypertension Preventative and Proactive workstreams. Hypertension data: April 2024: WSIC:  Hillingdon: 13.2% (44,920 people) are hypertensive, the second highest borough in NWL. See table below. A Health and Wellbeing Board report 10 September 2024 Teams. Hypertension was identified as a focus for the Preventative Care workstream. 2. Proactive Care: Management of Hypertension  Further supported and embedded by the NWL Enhanced Service for Hypertension; a focus of which is on the ‘management’ of existing patients with Hypertension.  London: All: 198.5  England: All: 140.6  Hillingdon: Men: 255.7  London: Men: 242.6  England: Men: 163.6  Hillingdon: Women: 179.6  London: Women: 163.6  England: Women: 118.5 Residents aged 79 years and under with a BP recording of 140/90 mmHg or less:  Hillingdon: 60.3%  NWL: 60.3% Residents aged 80 years and over with a BP recording of 150/90 mmHg or less:  Hillingdon: 77.6%  NWL: 76.7% Mortality from circulatory disease: 2022: Per 100,000 population:  Hillingdon: 77.9  London: 75  England: 77.8 This is rated AMBER recognising that mortality data lag does not give a contemporary position for the borough, however hypertension prevalence is the second highest in NWL. What has been achieved since 2022/23 Plan for Year 3: 2024/25  Designed and rolled out a Hillingdon Health Inequalities Hypertension Dashboard which includes a summary of: - PCN and Practice Hypertension prevalence figures - Targets for increasing prevalence and management of Hypertension in line with NICE and NHSE ambitions by 2025 and 2029 - A breakdown of prevalence, management and targets for all 1. ACTION: Further develop and scale up the work that has taken place across the Hypertension prevention Neighbourhood Programme within the local Integrated Neighbourhood Teams as BAU (and led by the three Neighbourhood Directors) 2. ACTION: Implement the NHS Operating plan 23/24 3. ACTION: Greater focus on the following areas:  Increasing overall prevalence across Hillingdon (Hillingdon Health and Wellbeing Board report 10 September 2024 ethnic groups across Hillingdon  Developed a capacity and demand predictive modelling tool to help in identifying stakeholder support required to drive the increase in prevalence and support the management of this; thus, reducing pressures on Primary Care  Implemented a clinical code to track, audit and review the customer journey for patients who had received a blood pressure check at local engagement events; in addition to understanding the number of newly diagnosed patients detected at these events.  Devised a series of hypertension webinars available in several languages which are hosted on The Confederation website and have also been publicised across GP, partner and local organisation websites.  Created a hypertension comms campaign with a variety of resources publicising the community pharmacies across Hillingdon offering free blood pressure checks  Developed a Hillingdon engagement calendar highlighting opportunities for partners to further collaborate and engage with patients about their health, while offering support with some of the wider determinants  Developed processes and pathways to enable blood pressure checks captured within the community to be sent directly to General Practices, alongside protocols to escalate high risk patients currently has a prevalence of 13.4%)  Increasing prevalence of the Black British population across Hillingdon (Hillingdon is currently performing the lowest across NWL (11%) and is below the NWL average of 13.8%  Increase the overall management of Hypertension and ensure that 80% of the number of people diagnosed with Hypertension are treated to target (and have had a blood pressure check in the last 12 months)  Increase the management of Hypertension among the Black British Population (particularly age group 0-79) as Hillingdon is currently performing the lowest across NWL (54%) and below the NWL target of 60% 4. ACTION: Expand upon the MECC offer and develop a model of support; embedded within INTs to include the delivery of BP checks across wider system partners as part of daily operations. This will support with the detection and management of hypertension, while creating additional capacity, access and system alignment. 5. ACTION: Develop a sustainable model for community engagement, coproduction, opportunistic health checks and education – linked in to Neighbourhoods and supported by a robust data system in order to strengthen our approach to population health management. 6. ACTION: Review integration of technological systems across services, Neighbourhood partners and organisations within Hillingdon, alongside DSA’s, to better enable a ‘tell us once’ approach and ensure (where possible) that patient information is available and fed through at all levels. Focus Areas Priority Baseline Data Year 1: Year 2022/23 RAG Year 2: 2023/24 RAG *We will implement a Whole System Approach 1,2,3,6. Adults overweigh and obese % of population: Hillingdon: 62.3% England: 63.8% 2021/22 Adults overweigh and obese % of population: Hillingdon: 62.3% England: 63.8% 2021/22 R Adult overweight and obesity: 22/23:  Hillingdon: 59.2%  London: 57.2%  England: 64% R Health and Wellbeing Board report 10 September 2024 (WSA): Healthy Hayes: This is an asset-based community development approach to tackle unhealthy weight and inequalities, piloted in Hayes, the area of the borough with the highest levels of obesity. Levels of physical activity: Percentage of physically active adults – 2021/22: H: 64.9%, E: 67.3%, L: 66.8% Percentage of physically inactive adults – 2021/22: H: 26.3%, E: 22.3%, L: 22.9% Percentage of physically active children and young people – 2021/22: H: 40.5%, E: 47.2%, L: 45.3% Whole System Approach (WSA): Healthy Hayes: Agreed by the board that an asset-based community development approach to tackle health weight and inequalities to be piloted in Hayes, the area of the borough with the highest levels of obesity Physically active adults:  Hillingdon: 59.4%  London: 66.3%  England: 67.1% This is rated RED due to no recorded improvement in the nationally published data at borough level. Hillingdon has one of the highest rates of obesity and physical inactivity in London. What has been achieved since 2022/23 Plan for Year 3: 2024/25 New Healthy Hayes HHCP Project that takes a whole- system approach to healthy weight introduced. This has led to:  A core group established with an agreed approach to develop WSA agreed.  A health needs assessment, review of evidence, asset mapping and national toolkit completed, engaged community leaders and local insight collected, including stakeholder feedback on overweight and healthy weight, breastfeeding and food behaviours. This has been supported through place-based workshops to develop insight and shared understanding of the scale of the overweight/obesity/ health challenges in Hayes was  Healthy Hayes – build on the Healthy Hayes workshops held in February 2024 with a focus to look at current provision, key themes, challenges, areas for development  Hillingdon Strategic Obesity Group (HSOG) re-established in April 2024. A new Terms of Reference, Membership and new sub-groups set up; focus on leadership and delivery of agreed system-wide partner led actions with a strategic focus to address prevention, wider determinants of health and early intervention. HSOG to meet quarterly.  HSOG Sub-groups set up delivering on the following themes: - Early Years, Children & Young People (membership: Maternity Services; Paediatric Dietician, Children's Centre, Stronger Families, Public Health) Developing a Communication and Training Plan for professionals and Health and Wellbeing Board report 10 September 2024 reached, and causes, challenges and potential solutions were identified. Systems maps have been developed.  Engaged community leaders and local insight collected, including stakeholder feedback on overweight and healthy weight, breastfeeding, food behaviours  Workshop held on 28 March 2023 through which gained a shared understanding of the scale of the overweight/obesity challenges in Hayes reached; causes, challenges and solutions identified, and ‘Areas of Focussed work’ identified  School Superzone grant awarded by GLA for Minet area (Hayes Town ward) with 10 Council Teams engaged and HHCP represented in delivery Included in this project is the School Superzone: Hayes: this project has resulted in:  Partnership development with Hayes Muslim Centre to promote and educate on healthy eating with healthy cooking sessions delivered, and recipes shared with the local community.  Three Primary schools have active plans to become water only, sugar smart and to establish growing projects.  One school has achieved Health School London Silver award  Greater focus on active travel has led to an increase in children walking to school.  In partnership with Higgins Partnership developers, a cookery book, showing healthy swaps for cultural recipes has been published and shared by Minet Junior School.  To encourage physical activity, a community walking map has been created showing the location of local parks and walking distance from Hayes Town and has been shared with families in the 3 primary schools and with community residents; Tier 2 Pre- Procurement Scoping in progress - Food Environment (membership: LBH Strategic Planning and Regeneration; Public Health). High Street Food Advertising survey completed - Physical Activity and Active Travel (membership LBH Active Travel and Transport Lead; GLL; Public Health). Developing ‘Activating Hayes’ – universal offer - Adult Weight Management (membership: The Confederation; H4All; Learn Hillingdon; Public Health; CNWL). Developing pathways between Prevention and Early Intervention to address waiting lists and establish exit routes to healthy lifestyle options and to support ongoing behaviour change School Superzone Project: Hayes:  Hayes Muslim Centre to has set up a working group to adopt an organisation wide food and drink policy, starting with a water only position (from mid-June) and will work with the youth group on healthier food and drink options.  To partner with Mayors Fund for London to deliver cooking session as part of the universal youth offer  To develop a local running pathway that includes The Daily Mile, Junior parkrun and participation in i the Mini Marathon and other London Marathon Events. Wider development:  Align with work of Hillingdon Obesity Strategic Group and develop action plans that reflect resident insight, wider stakeholder groups and evidence based best practice  Share School Superzone insight project to reinforce the scale of challenges to impact obesity rates.  Programme with LBH School Improvement and Partnerships to plan for health improvement; Schools Health Related Behaviour Survey commissioned, baseline data at school and borough wide level.  Develop universal support offer through Healthy Schools London Framework  Minet School Superzone achievements 2023/24 Health and Wellbeing Board report 10 September 2024 groups.  Very Brief Advice developed: pharmacies to promote Healthy Start (HS) via LPC.  Children Centres trained for Healthy Start eligibility  Improve school food provision Focus Areas Priority Baseline Data Year 1: Year 2022/23 RAG Year 2: 2023/24 RAG We will increase the uptake of NHS Health Check, targeting under screened population groups. The NHS Health Check (NHSHC), the national risk assessment, awareness and management programme to reduce the risk of LTC, increased uptake and completion. 2,3. Total number of people who are eligible for a health check and received a health check 2019/20 – 23/24: 45.7% (27,998 people)  Cumulative total received an NHS HC: 2023/24  Hillingdon: 45.7%  London: 44.9%  England: 40.6% People invited for a HC per year: 23/24:  Hillingdon: 17.1%  London: 30.4%  England: 22.1% People receiving a HC per year:  Hillingdon: 9.3%  London: 12%  England: 8.8% R NHS Health Check performance for 2023/24 as reported to OHID on 16 May 2024: Number of people receiving a first offer of an NHSHC (in a five-year period):  Target: 16,804 (20.0% of the eligible cohort).  Actual: 14,362 (17.1% of the eligible cohort) Number of people receiving a completed NHSHC:  Aspirational target: 12,603 (15.0% of the eligible cohort), however, 2023/24 budget only allowed for around 8,600 (10.2%) checks.  Actual: 7,777 (9.3% of the eligible cohort)  Take-up rate: 54.1% This is rated AMBER due to under- performance in uptake against the national target for Hillingdon. A Health and Wellbeing Board report 10 September 2024 What has been achieved since 2022/23 Plan for Year 3: 2024/25  The NHSHC contract has been updated and the Confederation has been commissioned to co-ordinate NHSHC delivery through its 42 general practice members and 5 extended hours hub clinics for 7 years from 2024/25.  Programme funding has been increased to enable the future achievement of OHID’s aspirational 75% uptake target.  There has been increased collaboration with the Confederation, for example, participating in PCN roadshows, sharing resources and data, writing a grant application and developing promotional materials.  NHSHC performance for 2023/24 as reported to OHID on 16 May 2024: o Number of people receiving a first offer of an NHSHC (in a five-year period):  Target: 16,804 (20.0% of the eligible cohort).  Actual: 14,362 (17.1% of the eligible cohort) o Number of people receiving a completed NHSHC:  Aspirational target: 12,603 (15.0% of the eligible cohort), however, 2023/24 budget only allowed for around 8,600 (10.2%) checks.  Actual: 7,777 (9.3% of the eligible cohort) o Take-up rate: 54.1%  NHSHC performance for Q1, 2024/25: o Number of people receiving a first offer of an NHSHC (in a five-year period):  Target: 17,033 (20.0% of the eligible cohort).  Actual: 3,381 (4.0% of the eligible cohort) o Number of people receiving a completed NHSHC:  Aspirational target: 12,775 (15.0% of the eligible cohort).  Actual: 2,438 (2.9% of the eligible cohort) 1. ACTION: Work with the Confederation to mobilise the new NHSHC contract. 2. ACTION: Undertake a training audit for general practice staff and produce a training plan. 3. ACTION: Carry out a patient survey for NHS Health Checks 4. ACTION: Roll out the new NWL NHSHC EMIS template once this is available and update the NHSHC quarterly reports. 5. ACTION: Design and implement an intervention/s to increase NHS Health Check uptake among working age men, particularly those from an ethnic minority background, in the Hayes locality Health and Wellbeing Board report 10 September 2024 Focus Areas Priority Baseline Data Year 1: Year 2022/23 RAG Year 2: 2023/24 RAG *We will support residents with dementia and their carers We will support carers to enable them to continue in their caring role 4. NK  4,790 adult carers were on the carer register in 2021: 21.3% of the population.  1,187 young carers were on the carer register on 31/03/23. 1,000 new adult carers and 317 young or young adult carers were registered on the carers register in 2022/23. 910 new adult carers and 321 young or young adult carers were registered in 2023/24.  851 carers assessments completed compared to 810 in 2022/23.  3,003 offers of carer assessments refused compared to 3,783 in 2021/22.  New co-produced ‘Are you a carer?’ leaflet developed.  33 out of 42 GP practices have identified carers champion.   £837k in carer-related benefits secured to improve incomes of 231 households.  Support groups for bereaved carers and bereavement counselling service for carers established.  By 31/03/23 60% of GP practices had carer support service access information on their websites.  Hillingdon Hospitals visiting rules updated to reflect recognition of unpaid carers.  1,203 attendances by 192 individual young carers at school support sessions during 2022/23.  2,644 breaks delivered for adult carers.  2,586 breaks offered for young carers. A Dementia Diagnosis Rate (people aged 65+ per 100 people in that age group) 2023: Indicator benchmarked against goal.  Hillingdon: 64.9%  London: 65.6%  England: 63% Whilst this is RED solely due to the national benchmark that neither London nor England achieve. The Q4 report states an outturn of 66.2% was achieved in 2023/24 against a target of 66.7%. The England average was 62.2%, therefore rated AMBER A Health and Wellbeing Board report 10 September 2024 What has been achieved since 2022/23 Plan for Year 3: 2024/25 Progress and Achievements:  In 2022/23 3,970 carers were supported with respite or another carers service increasing to 4,789 in 2023/24.  £2.4m in additional carer-related benefits was secured for carers over the 2022/24 period.  £935k additional funding was attracted to Hillingdon to deliver carer-related services informed by carers.  The information leaflet ‘Are you a carer?’ was coproduced with carers and is in use across the Hillingdon Place.  The Triangle of Care was introduced in community mental health services to embed a ‘think carer’ approach amongst professionals.  Two carer experts by experience were identified to be members of the Carers Strategy Group.  Borough awarded Dementia Friendly Community Status with 10 venues accredited under the Dementia Friendly Venue Charter,  Residents living with dementia and their carers can now access 13 different activities weekly, offering 230 free spaces,  A new online dementia pathway has been introduced to enable residents to access information on services/ activities for dementia from point of diagnosis to end of life.  A training programme is delivered by LBH with Carers, HHCP staff and Hillingdon Hospital and LBH staff. Around 260 residents are engaged in the Dementia Friendly programme.  The Dementia Friendly Hillingdon Programme offers activities to support residents living with dementia; cognitive function, mobility and reduce social isolation and offer a wide range of post-diagnostic services and activities with partner organisations aimed at increasing social connectedness and promoting wellbeing through relevant person-centred activities.  The strategic lead through the Dementia Action Alliance to ensure that statutory, third sector and private organisations are working together to offer an improved resident experience of the dementia pathway in Hillingdon including prevention, diagnosis, support services, social activities and end of life.  Work is ongoing to ensure that residents living with dementia and their carers have access to the support they need through partnership working with the Alzheimer Society, Admiral Nurses, Age UK and Social Care.  Focused action to ensure carers have access to the information they need through the provision of regular monthly training and an online dementia pathway tool. 1. ACTION: to finalise the 2024 – 2029 Joint Carers Strategy. 2. ACTION: Retender the Carer Support Service contract to secure service stability for up to eight years. 3. ACTION: Roll out Triangle of Care across community health services 4. ACTION: Include information about how to access support services for carers on 100% of GP websites 5. ACTION: Expand the number of GP practice members of the [GP] Confederation with identified carer leads. 6. ACTION: Make changes to the new electronic patient record system (Cerner) at Hillingdon Hospitals to support identification of carers. 7. ACTION: Explore options for increasing the percentage of adult carers supported by the Council having needs met via Direct Payments. 8. ACTION: Review carers assessment process to simplify it as much as possible and encourage carers to register, including young carers assessment process. 9. ACTION: Increase the number of schools participating in a young carer recognition programme from 15 to 30. Health and Wellbeing Board report 10 September 2024 3.4: Support people to live well, independently and for longer in older age and through to the end of life. Focus Areas Priority Baseline Data Year 1: Year 2022/23 RAG Year 2: 2023/24 RAG We will tackle falls and focus on falls prevention amongst older residents in Hillingdon. 4,6. Identified as a priority for HHCP and a focus for the NWL funded OPTUM population health management programme for Hillingdon Falls Prevention is an example of how HHCP has achieved shared outcomes is the OPTUM population health management approach to reduce falls in the over 65 population group. The partnership between ICB, CARS, Age UK and Public Health has designed, with community engagement, and established a Hillingdon falls prevention programme, that includes a more effective falls pathway when a resident has fallen, and to reduce first falls, a prevention workstream. A Hip Fractures (persons aged over 65 years) per 100,000 population:  Hillingdon: 515/100k (225 people)  London: 502/100k  England: 558/100k This is rated AMBER due to the data showing no improvement from the last reporting period. Note the data is for 2022/23. A Emergency hospital admissions due to falls in people aged 65 and over directly age standardised rate per 100,000. On track to meet target which is a 1% reduction from 23/24 – the target for 23/24 was 865 (population 41,314) to achieve fewer than 856 in 24/25. Data from the National BCF Team was significantly lower than was considered realistic. It has therefore been assumed that this is inaccurate and the 2023/24 plan taken as the outturn. G What has been achieved since 2022/23 Plan for Year 3: 2024/25 With the implementation of strengths and balance sessions, 430 residents attended exercise classes in 2023/24. There are now 19 classes available a week in the borough. 280 residents attended falls prevention workshops to better understand their own risk of falling and implement a self-care management plan to reduce that risk. 1. ACTION: to re-launch a community-based falls prevention pathway including:  Community falls prevention workshops to continue and be delivered within each PCN at neighbourhood level. This will encourage self- management of falls risk. Health and Wellbeing Board report 10 September 2024 Brunel University have undertaken an evaluation of the programme. From 110 responses:  79% of participants were female and 21% male  31% reported having a diagnosis of anxiety or depression.  74% self-reported an improvement in balance function; and  80% self-reported an improvement in perceived control over falling. In 2023, the Optum Falls Prevention Project was previously reported to the Health and Wellbeing Board, this was an example of the PHM approach in practice and led to:  A refresh of the Falls referral pathways,  Production of a Falls Directory of Services,  Development of a Falls Decision Support Tool (DST),  Production of a resource pack for falls prevention and management in care homes,  Developed a falls prevention training programme for care home and extra care housing staff,  Piloted evidenced-based strength and balance training, and  Developed a community falls education programme with in-person workshops and a self-assessment guide.  The clinical pathway for Falls is overseen by the CARS team and includes a multi- factorial risk assessment with exit routes back into the community-based provision where appropriate. Falls Prevention Training has been implemented:  Targeting staff in care home who had high ED and hospital admissions (Jan to Mar 2024).  There have been 4 in-person training events.  35 ‘Falls Champions have been identified for Hillingdon Care homes.  Training outputs:-  Completed a pre and post knowledge check, in falls risk prevention and management.  PH will deliver a train the trainer programme to be implemented from June 2024 to train community falls champions within PCNs to deliver community falls prevention workshops and one to one self- assessments. This training will be aimed at Health and wellbeing coaches and social prescribers within GP surgeries to build their capacity to deliver falls prevention.  The community-based OTAGO strength and balance programmes and the seated exercise programmes will be brought under one falls prevention programme from June 24 to offer an exercise programme that responds to varying levels of mobility but also offers progression opportunities from seated to standing exercise and identifies exit routes into paid for maintenance classes.  Referrals are being received into this programme from social prescribers, the CARS team, Physio and GP surgeries. Self-referrals are also accepted. 2. ACTION: evaluate the clinical pathway for Falls is overseen by the CARS team and includes a multi- factorial risk assessment with exit routes back into the community-based provision where appropriate. 3. ACTION: PH will commission Later Life Care to Move training for top ten Care Homes. This training looks at how to incorporate movement throughout the day in a Care Home setting and maximise opportunities for increasing mobility beyond traditional exercise. 4. ACTION: to develop an online exercise programme for Care Home residents including both a seated and standing programme focused on strength and Health and Wellbeing Board report 10 September 2024  Simulation for falls risk assessment, management and exercise initiation.  Case study and group discussions on falls risk prevention and management.  Care Home staff have developed posters on what they had learnt and will bring back to care homes to reduce falls.  The Falls Resources booklet has been distributed to the care homes. Certificates given out the end of the sessions to participants.  Two key data sources are not available to assess impact due to incomplete data i.e., NWL and THH data. Data issues have been escalated. Intermediate plan is to use LAS Conveyances (assume they are admitted to hospital). Analysis in progress. Data only currently available up until March 24. Training uptake by residents:  430 residents attended strength and balance exercise classes in 23/24. There are now 19 classes available a week.  -280 residents attended falls prevention workshops to better understand their own risk of falling and implement a self-care management plan to reduce that risk. Care Home Provision:  There has been an online falls champion training developed for Care Home staff that is delivered by CNWL.  Development of an online exercise programme for Care Home residents: a seated and standing programme focused on strength and balance. Wider use of training for at risk residents:  The online exercise programme being developed for Care Homes will be cascaded to Extra Care, Sheltered Housing and be made available to housebound residents through the Council website and the social ability equipment is now available to borrow in libraries.  Three social ability devices are being trialled in libraries offering a range of exercise opportunities to assist residents unable to access community provision in increasing their mobility at home. Oversight and Governance of the Falls Prevention Programme: The falls work is being brought under the frailty agenda and opportunities for exercise and learning are being linked to frailty assessments (initially in sheltered housing) to ensure that residents at risk of frailty are able to access provision in a timely matter to help reduce that risk. balance. 5. ACTION: PH will commission PSI training for 12 staff including physios and exercise instructors to support Care Homes in setting up in-house exercise provision and identifying appropriate cohorts of patients for different exercise types. 6. ACTION: The community-based OTAGO strength and balance programmes and the seated exercise programmes will be brought under one falls prevention programme from June 24 to offer an exercise programme that responds to varying levels of mobility but also offers progression opportunities from seated to standing exercise and identifies exit routes into paid for maintenance classes. Health and Wellbeing Board report 10 September 2024 Focus Areas Priority Baseline Data Year 1: Year 2022/23 RAG Year 2: 2023/24 RAG We will reform ‘intermediate tier’ services and support hospital discharge and admission prevention. 2,4,6. Not Available HHCP Integrated Discharge Hub is fully operational. The number of step-down beds has increased from 10 to 15. Increase of EOL beds to 12 Frailty Assessment Unit is a 6 bedded unit is in place at the front door of THH to prevent admissions. Review of CCT and Care Home teams to strengthen the offer. G This information is captured in the Integrated Health and Care Performance Report. G What has been achieved since 2022/23 Plan for Year 3: 2024/25  There has been an achievement of operational targets.  The care home team realignment work completed  The HHCP Integrated Discharge Hub is fully operational.  The number of step-down beds has increased from 10 to 15.  EOL beds have increased to 12. Hillingdon are leaders in the EoL offer in NWL.  There is a 6 bedded Frailty Assessment Unit at the front door of THH to reduce avoidable admissions,  The Care Home Support Group and Care Connection Teams have been reviewed to strengthen their offer. Maximising the Home First model:  Hillingdon was one of the first health and care systems in the country to implement the Discharge to Assess model is based on evidence that the most effective way to support people is to ensure they are discharged safely when they are clinically ready, with timely and appropriate recovery support if needed. Hillingdon was one of the first health and care systems in the country to implement this model which requires that an assessment of longer-term or end of life care needs takes place once the individual has reached a stage of recovery where it is possible to make an accurate assessment of their longer-term needs. This assessment

Health and Wellbeing Board report 10 September 2024 2024/25 Q1 INTEGRATED HEALTH AND CARE PERFORMANCE REPORT Relevant Board Member(s) Councillor Jane Palmer Keith Spencer Organisation London Borough of Hillingdon Hillingdon Health and Care Partners Report author Sean Bidewell – Integration and Delivery, NHS NWL Gary Collier – Adult Social Care and Health Directorate, LBH Papers with report None HEADLINE INFORMATION Summary. This report provides an update on the delivery of the transformation workstreams established to deliver the priorities within the Joint Health and Wellbeing Strategy. This includes progress with the delivery of the 2024/25 Better Care Fund Plan. Contribution to plans and strategies. The Joint Health and Wellbeing Strategy and Better Care Fund reflect statutory obligations under the Health and Social Care Act, 2012. Financial Cost. The value for the BCF for 2024/25 is £100,025,164 made up of Council contribution of £70,173,307 and an ICB contribution of £29,658,745. Ward(s) affected. All RECOMMENDATIONS That the Health and Wellbeing Board: 1. approves the 2024/25 Quarter 1 BCF reporting template; 2. delegates authority to approve Better Care Fund reporting templates to the Corporate Director of Adult Social Care and Health in consultation with the Co- Chairs, the ICB Borough Director and the Chair of Healthwatch Hillingdon; 3. reaffirms arrangements for the monitoring of, and reporting on, activity and spend against the agreed BCF plan as outlined in the report (paragraph 9); and 4. notes and comments on the content of the report. INFORMATION Strategic Context 1. This report provides the Board with an update on delivery of the priorities within the Joint Health and Wellbeing Strategy for the April to June 2024 period (referred to as the ‘review period’), unless otherwise stated. Reference to 2024/25 means April 2024 to March 2025. 2. This report is structured as follows: Health and Wellbeing Board report 10 September 2024 A. Key Issues for the Board’s consideration. B. Work stream highlights and key performance indicator updates. 3. Reference in this report to HHCP means Hillingdon Health and Care Partners; which is an alliance of local (mainly NHS) organisations that includes The Confederation of Hillingdon- based GP practices, the Central and North West London NHS Foundation Trust, The Hillingdon Hospitals NHS Foundation Trust and H4All. HHCP’s main objective is to improve the health and wellbeing of Hillingdon’s residents and their experience of care through improved coordination and integration of services and earlier intervention to prevent crises. The Council will become a signatory to the alliance agreement in 2024/25. 4. Reference to the ICB (or NHS NWL) means the North West London Integrated Care Board. NWL means a reference to the local authorities’ areas within the North West London sector and this includes the London Boroughs of Brent, Hammersmith & Fulham, Harrow, Hillingdon and Hounslow, the Royal Borough of Kensington & Chelsea, and Westminster City Council. A. Key Issues for the Board’s Consideration 2024/25 Quarter 1 BCF Reporting Template 5. All health and wellbeing board areas in England were required to submit their BCF Q1 reporting template on 29 August 2024 and Hillingdon’s response was submitted as a draft pending formal sign-off by the Board. Sign-off by the Board, or on its behalf, is one of the national conditions for the BCF. Information required from the Q1 template is limited to spend and activity against the Discharge Fund. For ease of reference the 2024/25 spending plan for the Discharge Fund is attached to this report as Appendix 1. The completed reporting template can be found on the Council’s website via the following link Better Care Fund - Hillingdon Council. 6. The key point to bring to the Board’s attention is that schemes are currently in development to relieve additional demand during the winter period and these are due to go live in October. These will be funded from the £934k allocation to relieve pressure on discharge pathway 3 (P3) and will address the underspend currently being reported against this aspect of the spending plan. Please see below for an explanation of the discharge pathways. Hospital Discharge Pathways Explained  Pathway 0 (P0): Discharges home or to a usual place of residence with no new or additional health and/or social care needs.  Pathway 1 (P1): Discharges home or to a usual place of residence with new or additional health and/or social care needs.  Pathway 2 (P2): Discharges to a community bed -based setting , which has dedicated recovery support. New or additional health and/or social care and support is required in the short-term to help the person recover in a community bed -based setting before they are ready to either live independently at home or receive longer-term or ongoing care and support.  Pathway 3 (P3): Discharges to a new residential or nursing home setting, for people who are considered likely to need long-term residential or nursing home care. Should be used only in exceptional circumstances. Health and Wellbeing Board report 10 September 2024 2024/25 BCF Reporting Templates and Expenditure and Activity Reporting 7. The Board is asked to note that the national deadlines for reporting on BCF spend and activity are as follows:  Quarter 2: 31/10/24  Quarter 3: 31/01/25  Quarter 4 and End of Year: 31/05/25 8. As the scheduled Board meetings for 2024/25 are 26th November 2024 and 4th March 2025, it is recommended that sign-off of templates be delegated to the Corporate Director of Adult Social Care and Health in consultation with the Co-chairs, the ICB Borough Director and the Chair of Healthwatch Hillingdon. 9. Under the governance arrangements contained within the agreement between the Council and the ICB under section 75 of the National Health Service Act, 2006, the BCF Core Officer Group has day to day responsibility for monitoring activity and spend against the funding streams in the BCF and the agreed plan. The Board is asked to reaffirm that the information it wishes to receive is the high level messages arising from activity as well as reporting by exception where its intervention is required to address blockages. It is suggested to the Board that this not exclude successes and achievements of partners in meeting the needs of residents and addressing the priorities within the Joint Health and Wellbeing Strategy. The intention is that the reporting route for Board consideration will be integrated performance report, which is a standing agenda item. 10. For the Board’s information, the membership of the BCF Core Officer Group currently includes the Corporate Director of Adult Social Care and Health, the Managing Director of HHCP (and Board Co-chair), the ICB Borough Director and the BCF Programme Manager. Membership of the Core Officer Group is currently under review. Hospital Activity 11. Table 1 below illustrates the Q1 position. Table 1: Hospital Activity Dashboard Metric Target Apr - July 2024 Average Rating Emergency admissions (weekday) - Average daily adms 54 35 Green Emergency admissions (weekend) - Average daily adms 23 30 Amber Discharges (weekday) - Average daily discharges 59 49 Amber Discharges (weekend) - Average daily discharges 25 24 Amber No criteria to reside 34 43 Amber Health and Wellbeing Board report 10 September 2024 B. Workstream Highlights and Key Performance Indicator Updates This section provides the Board with progress updates for the five workstreams, where there have been developments. Workstream 1: Integrated Neighbourhood Working. Workstream Highlights Key Performance Indicator Updates Workstream 1 performance indicators include:  People with severe mental illness (SMI) receiving a full physical health check: Exceeded (Green) – The 2023/24 ICB target is 60% and the Hillingdon position during the review period was 77.2%  People over age of 14 on a doctor's learning disability register who have had an annual health check: Exceeded (Green) - The 2023/24 ICB target is 50% and Hillingdon achieved 73% during the review period.  People with diabetes who have received nine care processes in the last 15 months: Exceeded (Green) – The 2023/24 ICB target was 50% and Hillingdon achieved 67.8% during the review period.  Eligible female patients who have received a Cervical Cancer Screening within the last 3.5 years for ages 25-49 (Core20Plus5 measure): Slippage (Amber) - The 2023/24 ICB target was 80% but 64.5% was achieved during the review period. Hillingdon’s performance in May 2024 was 65% which is 6.5% higher than the NWL average. Key actions to improve performance include RM Partners (one of the 21 Cancer Alliances established by NHS England to lead on the delivery of the cancer care recommendations in the NHS Long-term Plan) meeting with all six PCNs to share performance data and provide instruction on accessing data on screening dashboards. There has been targeted 1:1 support for the two practices with the lowest to discuss actions for improvement.  Eligible female patients who have received a Cervical Cancer Screening within the last 5.5 years for aged 50 and over (Core20Plus5 measure): Slippage (Amber) - The 2023/24 ICB target was 80% but 76.9% was achieved during the review period. The Board is reminded that action to improve performance against this measure and the equivalent above for the 25 to 49 age group includes 1:1 meetings between the cervical cancer clinical lead and lower performing practices to identify issues and offer support; through proactive signposting and text message reminders to patients across our neighbourhoods; and through the clinical lead attending upcoming PCN meetings to present on performance to date and discuss further ideas for overcoming barriers to attending for cancer screening.  Patients aged 79 years or under with hypertension who have a blood pressure reading of 140/90 mmHg or less: Exceeded (Green) – The 2023/24 outturn was 60.2% against a NWL target of 44.7%. However, the Board may wish to note that this is rated as amber in the Transformation Workstreams Health and Wellbeing Board report 10 September 2024 Joint Health and Wellbeing Strategy update as Hillingdon has the second highest hypertension rates of NWL borough, and cardiovascular mortality is higher than London and England.  Patients aged 80 years and over with hypertension who have a blood pressure reading of 150/90 mmHg or less: Exceeded (Green) – The 2023/24 outturn was 76.8% against a NWL target of 59.7%  Admission rate for people aged 65 and older by severe frailty index per 1,000: Exceeded (Green) – The ceiling rate for 2023/24 was 719 and the outturn was 643. Workstream 2: Reactive Care The Board is reminded that the priorities for this workstream are:  Implementation of a new end of life operating model.  Implementation of an integrated active recovery service.  Implementation of a ‘Maximising Homefirst’ programme to reduce length of stay of residents in hospital. Workstream Highlights Key Performance Indicator Updates The following is an update on workstream 2 indicators where data is available:  % of deaths of people that occurred at home in the last twelve months: A higher proportion of deaths of people occurring at home is desirable and the data in chart 1 below shows that in 2023/24 Hillingdon’s performance was just above the NWL average and performance over the last three years has been close to the NWL average, although there has been a slight drop in the average for 2024/25 to date.  % of deaths of people that occurred in hospital in last twelve month period: The objective is that the percentage of deaths that occurred in hospital should be at a minimum Health and Wellbeing Board report 10 September 2024 and reflect the last place of care choice of residents. Chart 2 below shows that for the 2023/24 period Hillingdon’s performance was better than our direct comparators within the NWL sector. So far to date in 2024/25 Hillingdon’s performance is also lower than the NWL average.  A & E Attendances and Emergency Admissions: Between April 2023 and March 2024 there were 68,836 attendances, which is lower than in the two previous years. There were 28,367 emergency admissions during 2023/24, which exceeds the figures for each of the two preceding years and the conversion rate of attendances to admissions of 41% was slightly higher than the previous two years (37%). So far in 2024/25 the A&E attendances have continued to come down with 5,463 (Apr 24 – Jun 24) although the emergency admissions have remained higher with 2,930 so far to date in 2024/25. Charts 3 and 4 below show the attendances and admissions trends over the last three financial years. Health and Wellbeing Board report 10 September 2024 A & E Attendances and Emergency Admissions 65 +: There were 18,216 attendances of people aged 65 and over during 2023/24 review period, which is higher than 2022/23 but lower than 2021/22. The conversion rate of attendances to admissions of 60% was higher than in 2022/23 but lower than 2021/22. So far, in 2024/25 the attendances have remained lower than the previous year with Jun 24 being lower than the last 3 years attendances. Charts 5 and 6 below show the attendances and admissions trends over the last three financial years.  Hillingdon Hospital bed occupancy: Slippage (Amber) – The target occupancy level over the winter period was 92% but the average for the period 1 September 2023 to 31 March 2024 was 99%. Moving into 2024/25 the bed occupancy average has remained at 99% from April 2024 through to July 2024. Health and Wellbeing Board report 10 September 2024 Workstream 3: Planned Care Key Performance Indicator Updates The following is an update on workstream 3 indicators where data is available:  Patients waiting 52 weeks or more for surgery: In March 2024 there were 479 people waiting 52 weeks or longer for surgery, which is a reduction of 749 (61%) on the same period in 2023. This is attributed to contracts that the ICB has established with the private sector.  % Patients receiving tests within 6 weeks of referral: For the period April 2023 to March 2024 the average was 79.5%, which compares to 70% in 2022/23. So far in 2024/25 the average has increased to 90%.  % Urgent cancer referrals receiving diagnosis within 28 days: For the period April 2023 to March 2024 the average was 71%, which is equal to the performance in 2022/23 and an improvement on 2021/22 (66%). So far in 2024/25 the average has increased to 81%.  Average waiting times in days for outpatients: The average waiting time in days for 2023/24 was 140 days compared with 159 days in 2022/23 and 117 days in 2021/22, which indicates improvement but some distance to travel to get to Workstream 4: Children and Young People Workstream Highlights Stronger Families Hub: The Council’s Stronger Families Hub is the single point of contact for children, young people, and families in Hillingdon to access a wide range of support services 24/7. The model combines a social work led service, adult mental health service and the Hillingdon Multi-agency Safeguarding Hub (MASH). During the review period there were 5,868 enquiries with a wide range of reasons for the contact but the majority were socially unacceptable behaviour (10%), domestic Incident (8%), child's mental health (7%) and neglect (7%). The main outcomes arising from the contact were information and advice (36%), statutory social care (27%) and referrals to other agencies (10%). Key Performance Indicator Updates 34. The following is an update on workstream 4 indicators where data is available:  Education, Health, and Care Plan (EHCP): Slippage (Amber) - The national target for the completion of EHCPs is 20 weeks from referral. The local target is to achieve this in 80% of cases. The percentage of plans completed within 20 weeks between April – June 2024 was 52%. This is a 19% decrease over the same time period in 2023/24, which was 71%. Keith/Sean – I haven’t been able to get explanation for the performance, which I suspect is down to staffing issues but don’t know for certain. Suggest removing. Health and Wellbeing Board report 10 September 2024 Workstream 5: Care and support for adults with mental health challenges and/or people with learning disabilities and/or autism.  Estimated diagnosis rate for people aged 65 and over with dementia: Slippage (Amber) – An outturn of 66.2% was achieved in 2023/24 against a target of 66.7%. The England average was 62.2%. The main reason for not meeting the target during this period, was due to temporary gaps in permanent staffing in the Memory Service. Locum support was in place but still impacted on diagnosis delivery at times. The learning from this is that some pathway changes are being developed to ensure there is sufficient workforce to cover during any staff absences. Finance There are no direct financial implications arising from this report. BACKGROUND PAPERS Joint Health and Wellbeing Strategy, 2022 – 2025 Health and Wellbeing Board report 10 September 2024 Appendix 1 Discharge Fund Spending Plan 2024/25 Table 1: 2024/25 Discharge Fund Allocation LBH Direct s31 Allocation 1,744,957 Total Provisional ICB DF Allocation to Hillingdon 2024/25: 2,590,881 TOTAL PROVISIONAL HILLINGDON HWB DF ALLOCATION 2024/25 4,335,838 Table 2: Updated Spending Plan LBH Direct Funding: s31 Grant Allocation Discharge-related residential 220,780 Discharge-related nursing 613,775 Discharge-related homecare 726,000 Block nursing dementia step-down 44,314 Deep clean & house clearance contract 8,000 Social Work 7-day Discharge 57,658 Additional Brokerage Capacity 63,960 Admin 10,470 LBH DIRECT FUNDING TOTAL: 1,744,957 ICB Contribution Allocation Additional Bridging Care Capacity 135,200 5 x Nursing Dementia step-down beds 278,128 P3 Block Nursing Step-down 56,235 Homefirst/D2A Rehabilitation (Therapy Bridging) 785,213 Rehab beds in Furness Ward, Willesden. 120,575 Supporting patients where there is unclear commissioning (non-CHC) 220,584 Central ICB Support for Borough based teams 50,500 Health funding for complex care patients in P3 beds/other settings. For conditions including dementia and challenging behaviour 934,446 Admin 10,000 ICB ALLOCATION TOTAL 2,590,881 TOTAL HILLINGDON 2024/25 DISCHARGE FUND ALLOCATION 4,335,838

Health and Wellbeing Board report 10 September 2024 BOARD PLANNER & FUTURE AGENDA ITEMS Relevant Board Member(s) Councillor Jane Palmer Keith Spencer Organisation London Borough of Hillingdon Hillingdon Health and Care Partners Report author Nikki O’Halloran, Democratic Services Papers with report Appendix 1 - Board Planner 2024/2025 1. HEADLINE INFORMATION Summary To consider the Board’s business for the forthcoming cycle of meetings. Contribution to plans and strategies Joint Health & Wellbeing Strategy Financial Cost None Relevant Select Committee N/A Ward(s) affected N/A 2. RECOMMENDATION That the Health and Wellbeing Board considers and provide s input on the 2024/2025 Board Planner, attached at Appendix 1. 3. INFORMATION Supporting Information Reporting to the Board The draft Board Planner for 2024/2025, attached at Appendix 1, is presented for consideration and development in order to schedule future reports to be considered by the Board. Members may also wish to consider any standing items (regul ar reports) and on what frequency they are presented. The Board Planner is flexible so it can be updated at each meeting or between meetings, subject to the Co-Chairs’ approval. Board agendas and reports will follow legal rules around their publication . As such, they can usually only be considered if they are received by the deadlines set. Any late report (issued after the agenda has been published) can only be considered if a valid reason for its urgency is agreed by the Co-Chairs. Health and Wellbeing Board report 10 September 2024 Advance reminders for reports will be issued by Democratic Services but report authors should note the report deadlines detailed within the attached Board Planner . Reports should be presented in the name of the relevant Board member. With the Co-Chairs, Democratic Servic es will review the nature of reports presented to the Board in order to ensure consistency and adequate consideration of legal, financial and other implications. It is proposed that all reports follow the in -house “cabinet style” with cl ear recommendations as well as the inclusion of corporate finance and legal comments. The agenda and minutes for the Board will be published on the Council's website , alongside other Council Committees. Board meeting dates The Board meeting dates for 2024/2025 were considered and ratified by Council at its meeting on 18 January 2024 as part of the authority’s Programme of Meeti ngs for the new municipal year. The proposed dates and report deadlines for the 20 24/2025 meetings have been attached to this report as Appendix 1. Financial Implications There are no financial implications arising from the recommendations in this report. 4. EFFECT ON RESIDENTS, SERVICE USERS & COMMUNITIES Consultation Carried Out or Required Consultation with the Chairs of the Board and relevant officers. 5. CORPORATE IMPLICATIONS Hillingdon Council Corporate Finance comments There are no financial implications arising from the recommendations in this report. Hillingdon Council Legal comments Consideration of business by the Board supports its responsibilities under the Health and Social Care Act 2012. 6. BACKGROUND PAPERS NIL. Health and Wellbeing Board report 10 September 2024 APPENDIX 1 BOARD PLANNER 2024/2025 26 Nov 2024 2.30pm Committee Room 6 Business / Reports Lead Timings Reports referred from Cabinet / Policy Overview & Scrutiny (SI) LBH Report deadline: 3pm Thursday 14 November 2024 Agenda Published: 18 November 2024 Hillingdon Joint Health and Wellbeing Strategy 2022-2025 LBH Integrated Health and Care Performance Report and BCF Progress LBH/HHCP Board Planner & Future Agenda Items LBH PART II - Update on current and emerging issues and any other business the Co- Chair considers to be urgent All 4 Mar 2025 2.30pm Committee Room 6 Business / Reports Lead Timings Reports referred from Cabinet / Policy Overview & Scrutiny (SI) LBH Report deadline: 3pm Thursday 20 February 2025 Agenda Published: 24 February 2025 Hillingdon Joint Health and Wellbeing Strategy 2022-2025 LBH Integrated Health and Care Performance Report and BCF Progress LBH/HHCP PART II - Update on current and emerging issues and any other business the Co- Chair considers to be urgent All 11