Health & Wellbeing Board

Minutes HEALTH AND WELLBEING BOARD 18 March 2025 Meeting held at Committee Room 5 - Civic Centre Board Members Present: Councillors Jane Palmer, Keith Spencer, Susan O'Brien (Vice-Chair), Professor Ian Goodman, Lynn Hill, Ed Jahn, Sue Jeffers, Derval Russell, Sandra Taylor, Lesley Watts and Tony Zaman Officers Present: Sean Bidewell (Assistant Director – Integration & Delivery / Acting Joint Borough Director), Gary Collier (Health and Social Care Integration Manager), Gavin Fernandez (Head of Service - Hospital, Localities, Sensory & Review), Faiysal Patel (Head of Strategy) and Nikki O'Halloran (Democratic, Civic and Ceremonial Manager) 24. APOLOGIES FOR ABSENCE (Agenda Item 1) It was noted that the Vice Chair, Councillor Sue O’Brien, would be arriving a little late to the meeting. 25. DECLARATIONS OF INTEREST IN MATTERS COMING BEFORE THIS MEETING (Agenda Item 2) There were no declarations of interest in matters coming before this meeting. 26. TO APPROVE THE MINUTES OF THE MEETING ON 10 SEPTEMBER 2024 (Agenda Item 3) RESOLVED: That the minutes of the meeting held on 1 September 2024 be agreed as a correct record. 27. 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 5 to 9 would be considered in public and Agenda Items 10 to 11 would be considered in private. 28. PHARMACEUTICAL NEEDS ASSESSMENT UPDATE (Agenda Item 5) Ms Kelly O’Neill, the Council’s Director of Public Health, advised that the authority had been given responsibility in 2013 for publishing the Pharmaceutical Needs Assessment (PNA) every three years. The PNA was used by NHS England to look at the needs of the local population and establish whether or not there was sufficient access. It was on track for meeting the 1 October 2025 publication deadline. Members were advised that the PNA had been developed by the Council’s Business Intelligence Team. Questionnaires had been sent out to the pharmacies in Hillingdon to establish what services they provided so that these could be mapped across the Borough. This included questions in relation to opening hours and the additional services that they provided (such as stop smoking services). There were also links to the North West London Integrated Care Board (NWL ICB) shared needs assessment. It was noted that residents should not have to travel more than 20 minutes to access a pharmacy. Ms O’Neill advised that five pharmacies had recently closed down which would need to be reflected in the PNA. A statutory 60+ day public consultation would be undertaken to determine the positives and negatives around local access. An informal steering group had been set up which looked at updating the demographics. The group included representation from the Local Pharmaceutical Committee. Members were advised that the neighbourhoods would be able to use the PNA to review the services that were provided in each area. Each neighbourhood had been mapped and linked to local pharmacies but there was a lot more work that would need to be undertaken. Ms O’Neill advised that the PNA aligned with the Joint Strategic Needs Assessment but was not embedded therein. These documents needed to be considered together but were distinct documents. It was queried whether the information collected could be broken down, for example, to identify the number of vaccinations undertaken by GPs and pharmacies. Ms O’Neill advised that this data was amalgamated at a NWL level but should be able to be broken down. Although vaccinations received by young people were not usually done by GPs, Hillingdon had the highest MMR vaccination rate in NWL. Pharmacies had started giving more vaccinations during the pandemic and it had increased since then. Pharmacies had become more entrepreneurial and were now able to deal with a number of common minor illnesses as well give out emergency prescriptions. Primary Care Networks were also employing pharmacies now to undertake medicines checks and NWL ICB had been planning for winter by asking GP practices whether or not they wanted to be involved in the vaccination programme. It was queried whether services were delivered well. Professor Goodman advised that data had been collected in relation to Pharmacy First but that further investigations were needed to determine whether there had been a causal reduction at ED and GPs. RESOLVED: That it be noted that: 1. work on the 2025 PNA was on track for publication by 1 October 2025; 2. since the last PNA (published in 2022), five pharmacies had closed; 3. data analysis of Borough demographics, health and pharmacy/prescribing data was underway; 4. all pharmacies within the Borough had been issued with a questionnaire; and 5. the discussion be noted. 29. DRAFT JOINT HILLINGDON HEALTH AND WELLBEING PRIORITIES 2025-2028 (Agenda Item 6) Mr Keith Spencer, Managing Director at Hillingdon Health and Care Partners and Co- Chair, advised that, following on from the workshop held in November 2024, it had been clear that partners needed to be able to hold each other to account on delivering objectives. Although a work in progress, the report had been drafted providing a synthesis of priorities derived from five documents. Once agreed, partners would need to agree what ‘good’ looked like (and establish how they would know when this had been achieved) and a dashboard would be created for the priorities. It would be essential to identify who was responsible for each action (and the associated deadline) else it was unlikely that action would be taken. There were a number of challenges which included rising health inequalities (particularly in Yiewsley and West Drayton, but also in Harefield), increasing levels of chronic disease, hypertension and anxiety and depression. Referrals to adult social care had increased by around 40% and issues such as poor air quality were compounding the challenges. As such, it would be important to take a more focused approach around three themes: early intervention and prevention (there was currently no credible strategy for dealing with early intervention); enhanced programmes; and targeted interventions. Work was underway in relation to environmental health initiatives but more needed to be done around digital innovation. This would be key in terms of getting a handle on the metrics and what needed to be measured rather than just measuring what was available. Ms Kelly O’Neill, the Council’s Director of Public Health, advised that people were living longer but were living unhealthy lives for longer. There had been a significant increase in the demand for adult social care which would just get worse if it was not addressed. Preventative action would be key and should be underpinned by the residents’ needs. It was suggested that demand could be tackled by looking at the short and long term actions that could be undertaken with a focus of children and families. Social and economic determinants were driving ill health so this would need to be seen as a long term mission. The plan would need to be updated every three years but it was unlikely that much would really change in three years. Significant change could be initiated but there would need to be a real drive for action. Mr Tony Zaman, the Council’s Chief Executive, advised that partners needed to identify tangible material actions for which they could be held to account. Consideration would need to be given to identifying the top five or six issues that needed to be prioritised because they would make the biggest material difference in five years. Thought would also need to be given to how residents ‘consumed’ health and wellbeing services in Hillingdon and how this could be changed (would digital access be a way of helping those that needed the services the most?). It was agreed that partners needed to identify a small number of priorities. Councillor Jane Palmer, Cabinet Member for Health and Social Care and Co-Chair, noted that it would be important for residents to be included on this journey as they did not seem to know that the Council had a role in keeping them healthy. Residents could mistakenly think that the Council only dealt with things like things like moving the library to the Civic Centre. It would be important to showcase what action had already been taken and the difference that this had made. She suggested that obesity should be included as one of the priorities. Councillor Sue O’Brien, Cabinet Member for Children, Families and Education and Vice Chair, noted that the key challenges would be in relation to engagement with residents. There were issues in relation to access to information, language, etc. Ms O’Neill advised that inequalities should form the foundation of all action taken by partners. Action was needed to look at how engagement was undertaken because there had been some concerns about upsetting people. Core20PLUS5 was a national NHS England and NHS Improvement approach to support the reduction of health inequalities at both a national and a system level. The approach defined a target population cohort (the ‘Core20PLUS’) and identified ‘5’ focus clinical areas requiring accelerated improvement. Ms O’Neill believed that this approach would help contribute towards improvements in residents’ health. Ms Sue Jeffers, Borough Director at North West London Integrated Care Board (NWL ICB), advised that the ICB had a responsibility to focus on the Core20PLUS groups most impacted by health inequalities but that they needed to identify ways of engaging with these communities. There had been a 15% increase in homelessness between December 2024 and January 2025. Targeted groups would include people who were homeless, asylum seekers, Looked After Children, the transgender community and those with learning disabilities. Ms Lesley Watts, Chief Executive at The Hillingdon Hospitals NHS Foundation Trust, noted that the report included more than a small number of priorities and that these needed to be reduced. Consideration would need to be given to identifying what ‘normal’ behaviour looked like because things like obesity and anxiety seemed to have been medicalised. She also believed that more needed to be done in relation to children and to ensuring that those who needed it were seen in a therapeutic environment. Thought would need to be given to what the acute unit was there to do for the population. Currently, it didn’t seem to be providing the best care as it was having to take action in relation to things that it shouldn’t have to. Concern was expressed that partners tended to identify the same issues repeatedly but that progress never seemed to be made. It would be important to put responsibilities back onto individuals. Professor Ian Goodman, NWL ICB, believed that obesity was more important that hypertension in Hillingdon as obesity had been underrepresented and hypertension had been overrepresented. Inactivity was a key driver of obesity and falls were caused by inactivity. The Board was advised that GLP-1s had become popular amongst celebrities to treat diabetes and obesity but GPs were only allowed to prescribe them if the patient was diabetic and obese. As well as being able to help reduce weight, the drugs had also been shown to reduce the likelihood of dementia and heart attacks. Many of the residents who were overweight did not exercise and then found it difficult to exercise because they were overweight – it became a cycle. It was anticipated that GLP-1s would eventually become commonplace (like statins) and that partners needed to plan for this. Ms O’Neill advised that GLP-1s would not provide a quick systemwide change as there would only be a small number of people who would have access to the drugs over the next three years (220,000 doses across the whole country). As such, the focus should be on preventing residents from becoming obese in the first place. Mr Edmund Jahn, Chief Executive Officer at the Hillingdon GP Consortium, advised that integrated neighbourhood teams were now up and running and working with the acute trust. There were different versions of the strategy with neighbourhood level priorities that were adjusted to meet the needs of specific neighbourhood populations. The information included in the report dovetailed with the neighbourhood work. Ms Watts noted that it would be important to ensure that basic services were provided to the most deprived areas. Ms Zaman suggested that the partners needed time to think about setting the priorities. Some of them would be health related but some might be financial. Either way, consideration would need to be given to setting smart criteria for choosing priority areas that would make the biggest difference. In summary, the Board would need to: 1. identify five or six priorities which would make the most significant difference; 2. focus effort in the most deprived areas; and 3. look at engagement and what would be different this time. Mr Spencer noted that things needed to change to be able to cope with the increasing demand for services. It was agreed that Mr Spencer would work with Mr Zaman, Ms O’Neill, Ms Watts, Ms Taylor, Mr Jahn and others to identify the priorities. RESOLVED: That the Board’s comments on the draft joint Hillingdon Health and Wellbeing priorities for 2025-2028 be noted. 30. NORTH WEST LONDON FORWARD PLAN (Agenda Item 7) Mr Faiysal Patel, Head of Strategy at NHS North West London (NWL), advised that he would circulate the document that he had prepared to Board members after the meeting. It was noted that NWL Integrated Care Board (ICB), had been facing significant financial and operational challenges but that action was being taken to respond to those challenges. Providers were moving towards more joined up working through the development of provider collaboratives and staff were being provided with strategic direction and being asked to do fewer things well (rather than doing everything at once or some things more than once). Progress would be tracked over the next five years. The forward plan looked to tackle six key challenges within NWL: 1. the nature of the care the local population required had shifted from acute episodic, to chronic; 2. improvements in life exp ectancy had stalled in 2012 and life expectancy was now decreasing year-on-year; 3. the shift in the local population’s needs had been demonstrated in the ICB’s recent activity trends; 4. there was significant variation across NWL in service availability, acces s in a timely fashion and population health outcomes; 5. the pressure on the NWL system would continue as the population continued to grow and age; and 6. to deliver care more sustainably, three key shifts had been identified as part of the national 10 -year plan work: sickness to prevention; hospital to community; and analogue to digital. Nine long term priorities had been refreshed and carried forward from the ICB’s previous forward plan. Actions had been prioritised within each of the priorities and had been tied to the NWL needs assessment through three key themes:  Integrated Neighbourhood Teams;  Community and mental health services - particularly with regard to increasing capacity for young people; and  Transforming specific services – particularly in re lation to maternity, cancer screening and planned care services. The document set out the NWL ICB strategic ambition for the next five years. It included the actions and aims for each of these years and would be used by NHS providers and the ICB. Professor Ian Goodman, NWL ICB, noted that the NWL ICB outcomes from the previous year had not been published to be able to gauge progress to date on the priorities. Mr Patel advised that, in Hillingdon, there were similarities in the overarching plan and optimising the system flow. The next steps would be to update the forward plan to reflect the latest urgent care, planned care and neighbourhood health strategy work. The document would be refined following the Board’s comments and then submitted to NHS England. Ms Lesley Watts, Chief Executive at The Hillingdon Hospitals NHS Foundation Trust, suggested that, when mentioning children’s mental health and community services, the document needed to be more specific about things like dentistry. If the document was to be circulated more widely, it would be useful to include information about the ageing population. Mr Tony Zaman, the Council’s Chief Executive, noted that the NWL ICB Forward Plan appeared to be at odds with the previous item (Draft Joint Hillingdon Health and Wellbeing Priorities 2025-2028). It was queried whether the biggest drivers for the Forward Plan had been cost or ill health and whether it was the top or bottom of the system that should determine where resources should be focussed. Mr Patel advised that there were currently residents in NWL who did not have access to services in their area. The Forward Plan aimed to reduce the variation across NWL and produce a common offer – the plan would be to add services where required in year 2. The outcomes and milestones had been included in the document. Mr Edmund Jahn, Chief Executive Officer at Hillingdon GP Consortium, suggested that a core common offer would not be the right way of delivering services as the system should be trying to achieve equality of outcomes. The problem with the ICB’s approach was that a common specification might fit one community somewhere in NWL but not the majority of communities. The forward plan had been over specified in terms of input. In Hillingdon, partners were trying to do something specific and the forward plan would disrupt what they were doing at ‘place’. Mr Keith Spencer, Managing Director of Hillingdon Health and Care Partners and Co- Chair, noted that the neighbourhood specification was able to use a flexible workforce but this was not what was being proposed in the forward plan. Ms Kelly O’Neill, the Council’s Director of Public Health, noted that the forward plan appeared to be a document that was for NHS consumption. Clinical care access was only 20% of health so the NHS needed to recognise the importance of involving social care. Preventative measures were not done very well, so consideration needed to be given to early intervention and every contact should be preventative. End of life care had not been included and too often became an emergency because it hadn’t been planned. Councillor Palmer noted that partners had worked hard to create a joint Health and Wellbeing Board but it seemed that social care was still not being included at a NWL level. All of the partners wanted what was best for residents and it was recognised that the changes needed to start somewhere but it would be important to stop talking about changes and start taking action. Members of the Board were asked to pass on any additional comments to the Democratic, Civic and Ceremonial Manager to collate and forward on to Mr Patel. RESOLVED: That: 1. Board members pass any additional comments to the Democratic, Civic and Ceremonial Manager to collate and forward on to Mr Patel; and 2. the discussion be noted. 31. 2025/26 BETTER CARE FUND PLAN (Agenda Item 8) Mr Gary Collier, the Council’s Health and Social Care Integration Manager, advised that the Board was being asked to delegate sign off of the 2025/26 Better Care Fund Plan, including proposed financial arrangements and targets for the national metrics, to the Corporate Director of Adult Social Care and Health in consultation with the Co- Chairs, the NHS North West London Borough Director and Healthwatch Hillingdon. Two key objectives had been identified which were similar to those highlighted in the past. However, the recent NWL BCF review had not considered other BCF funding steams such as adult social care and Disabled Facilities Grant allocation. It was also noted that hospital discharge funds would no longer be ringfenced so work would need to be focussed on admission avoidance. Ms Lesley Watts, Chief Executive at The Hillingdon Hospitals NHS Foundation Trist, advised that she was the NHS England lead for discharge and flow. It was noted that there had been an expectation that fewer patients would be going to hospital and that discharge would be quicker – the plan looked good but the outcomes would be judged in due course. Mr Keith Spencer, Managing Director of Hillingdon Health and Care Partners and Co- Chair, noted that a demand and capacity review was underway and should be completed by the end of March 2025. This would be included in the BCF Plan. RESOLVED: That: 1. authority to sign off the 2025/26 Better Care Fund Plan, including proposed financial arrangements and targets for the national metrics, be delegated to the Corporate Director of Adult Social Care and Health in consultation with the Co -Chairs, the NHS North West London Borough Director and Healthwatch Hillingdon; and 2. the content of the report be noted. 32. BOARD PLANNER & FUTURE AGENDA ITEMS (Agenda Item 9) Consideration was given to the Board Planner and future agenda items. It was agreed that reports on the following issues be considered at the meeting on 10 June 2025: 1. the formal outcome of the BCF Plan; 2. combatting drugs and alcohol; 3. smoking cessation; 4. oral health – supervised brushing; 5. new joint health and wellbeing priorities and the associated dashboard; 6. impact and effect of the NHS reorganisation on the health economy; 7. revised place based governance (perhaps for the September meeting); and 8. new community offer and how it built on how residents were looked after in a new setting (and the impact on neighbourhoods). RESOLVED: That the Board Planner, as amended, be agreed. 33. TO APPROVE PART II MINUTES OF THE MEETING ON 10 SEPTEMBER 2024 (Agenda Item 10) Consideration was given to the confidential minutes of the meeting held on 10 September 2024. RESOLVED: That the PART II minutes of the meeting held on 10 September 2024 be agreed as a correct record. 34. UPDATE ON CURRENT AND EMERGING ISSUES AND ANY OTHER BUSINESS THE CHAIRMAN CONSIDERS TO BE URGENT (Agenda Item 11) The Board discussed a number of issues including the Better Care Fund review, the abolition of NHS England and the 50% reduction in funding for Integrated Care Boards. RESOLVED: That the discussion be noted. The meeting, which commenced at 2.30 pm, closed at 5.03 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 Health and Wellbeing Strategic Priorities, Progress Update and Draft Dashboard June 2025 Keith Spencer Managing Director For discussion and approval Purpose The Hillingdon Health and Wellbeing Board has a small number of strategic priorities for 2025–2028 developed at its meeting in March 2025. These aim to integrate current strategic plans and respond to worsening population health trends, increasing system health and social care pressures, and health inequalities. The Board are asked to review the proposed priorities and amend this draft performance update and dashboard Strategic Context • Demographic Pressure: Hillingdon’s adult population has grown 16% in seven years, with a rapidly ageing population; the 65+ group represents 14% of the population but accounts for 40% of health and social care usage. • Chronic Conditions Rising: 48% of adults have one or more long-term conditions (LTCs), with hypertension, obesity, anxiety, depression, and diabetes the most common. • High-Intensity Users: A small group of 4,400 adults (1.6%) account for 50% of all non-elective admissions and admissions to long term care • Health Inequalities: Deprivation in areas such as Hayes, Yiewsley, and West Drayton drives high levels of LTCs, emergency demand, and social care usage. Key Challenges • Socioeconomic Risk: High child poverty (31%), food insecurity, overcrowding, and low post-housing income. • Environmental Risk: Air pollution, particularly from Heathrow, increases cardiovascular and respiratory illness risk. • Service Access Gaps: Inequalities in access to maternity care, mental health services, cancer screening, and hypertension management. We have therefore developed a set of 5 strategic priorities. These are aligned with Core20PLUS5, NWL ICS priorities, HHCP strategic plan, and LBH’s broader policy framework and are focused on prevention, reducing unplanned care, and addressing inequality at neighbourhood level. The Proposed Priorities are: 1. Start Well: Improve early years outcomes, reduce child obesity, and promote readiness for school and life. 2. Live Well: Prevent and/or delay the onset of Long Term Conditions particularly hypertension, improve mental wellbeing, and enhance access to early intervention and support for carers 3. Age Well: Implement ‘at scale’ proactive frailty management, and better end-of-life care that enable people with multi morbidity to maintain independence for as long as possible in order to avoid non elective presentations, admission to long term care and to promote early discharge 4. Healthy Places: Tackle housing, environment, employment, and social isolation. 5. Equity and Inclusion: Target resources and interventions where inequalities are greatest using Core20PLUS5: specifically Hayes, Yiewsley, and West Drayton For Years 1 and 2 our priorities will be focused on ‘Live Well’, ‘Age Well’ and ‘Equity and Inclusion’ (priorities 2, 3 and 5 italicised and set out above) in order to manage delivery risk 2 Health and Wellbeing Priorities Summary 1. Integrated Services focused on Preventing Crisis (Live Well/Equity): Implement 3 co-located multi agency Integrated Neighbourhood Teams with 3 core functions: • Same Day Urgent Primary Care through 3 Neighbourhood Super hubs for people with non complex needs to reduce demand pressure on Primary Care and the THH Urgent Treatment Centre and Emergency Department • Proactive Care through risk stratification, case finding and enhanced case management to prevent the onset of non elective crises for people with severe frailty (9,840) through enhanced multi disciplinary Care Connection Teams and the mobilisation of Neighbourhood assets • A Preventative and Anticipatory Care Programme for those people with mild to moderate hypertension (the major cause of population ill health across Hillingdon) to delay or prevent the onset of severe frailty and the associated increased risk of non elective presentation and/or long term care 2. Integrated Services focused on Responding to Crisis (Age Well/Equity) Implement a new Borough wide Integrated Reactive Care Service to prevent unnecessary non elective episodes for patients with complex needs (moderate and severe Frailty) and to promote rapid recovery and prompt discharge after acute inpatient stay: • Implement a new Urgent Response Service: a coordinated, community based urgent response service designed to support people who experience sudden deterioration in their health or social care needs close to their own home (frail elderly, people with acute functional decline, some mental health crises, and palliative (End of life) episodes) • Implement a new Active Recovery Service to promote rapid recovery and discharge after acute inpatient stay reducing delays across all D2A pathways. 3 To deliver the Strategic Priorities, we are implementing a new 7 day Place Operating Model through 2 key transformation programmes for 25/26 (See Appendix 1 for full Place Operating Model) In order to : Tackle the short and long term root cause of population ill health, challenged UEC operational performance and ensure that we deliver the activity assumptions set out in the new hospital redevelopment plan. The success of the proposed interventions set out opposite will be measured by the following key ‘lead’ metrics: 1. Reduce UTC Attendances to a daily average of <= 180 by 2025 2. Reduce ED attendances to a daily average of <= 164 by 2025 3. Reduce non elective admissions to hospital by 10% over 2019/20 baseline 4. Increase the percentage of people on the carers register over 2021 census 5. Increase the proportion of people who use Reablement and who require no ongoing support over the 2024/25 baseline 6. Flatline permanent admissions to care homes based on 2025/26 baseline. 7. Enable THH to operate within a target bed base of <= 412 beds by reducing patients without criteria to reside to a daily average of <= 34 by 2025 and reducing discharge delays across all pathways to national norms by 2025 8. Deliver a 30% reduction in associated non elective admissions/long term care for (hypertension) over the 2019/20 baseline by 2028 by: I. Increasing prevalence rates for hypertension amongst adults to 24% by 2028 II. Ensuring that at least 80% of patients with diagnosed hypertension have their Blood Pressure under control by 2028 We have made the following Progress in Neighbourhood Development ü 3 Integrated Neighbourhood Teams Implemented: North, South East and South West ü Service alignment agreed: Community and Mental Health Services now integrated at Neighbourhood Team level. Adult Social Care aligned. ü A Neighbourhood Leadership Team for each INT formed composed of jointly appointed Neighbourhood Director, Clinical Director (PCN CD) , Community Manager (CNWL) and Public Health Consultant (LBH) ü Each Neighbourhood is currently rolling out a series of Preventative/Anticipatory Care Programmes designed to increase prevalence and optimisation of Hypertension – the principal cause of population ill health in Hillingdon and designed to progressively impact over the next 36 months ü Care Connection Teams are now aligned to Neighbourhoods and are successfully case managing the top 2% (5,000) of people with severe frailty (multi morbidity) against a target of 9,700. We need to progressively roll out Enhanced Case Management to the remaining Severe Frailty cohort (2%) by March 2026 through the greater identification and mobilisation of Neighbourhood assets ü 2 out of 3 Interim Same Day Urgent Care hubs have been established. Roll out of the third is contingent on sourcing appropriate estate in the South West Neighbourhood. We anticipate having an interim arrangement in place by September 2025 to increase daily SDUC capacity to 230 from 180. Current ICB proposals in relation to Access, however, pose a risk to this development. Taken together with the proposals set out overleaf in relation to Reactive Care, this will enable us to further tackle the ED under performance against target set out opposite ü Estates Super Hub Option Appraisal Report completed and Neighbourhood Estates Business case in processes of development led by Archus and Northmores. This will provide alignment with hospital redevelopment programme. This will be completed and then progress through appropriate Place and NWL ICB governance in the next 3-6 months ü Proposals are being developed between THH and the Confederation to enable the incremental ‘left shift’ of appropriate transformed Outpatient services from Hospital to Neighbourhood Based care commencing from September 2025 onwards 4 Our Current Performance against Key Metrics: (see slides 6 & 7 for detail) ü GP attendances have increased by 9% since 2022/23 (current average 3,500 per day) with same day GP attendances growing by an equivalent percentage ü Same Day Urgent Care Hubs have delivered a daily average of 180 attendances per day over the last 12 months against a target of 230. Full establishment of the third Super Hub (Hayes and Harlington) is required to reach the full target ü UTC daily average attendances are now below the new hospital target of 180 (12 month moving average of 167). Type 1 performance is challenged. ED attendances are significantly above their target <=164 average daily attendances by 32 attendances per day (an average 196 per day). Plans to tackle this are set out opposite and overleaf ü NEL Activity for patients under enhanced case management through Care Connection Teams has reduced by 36% post referral. ED attendances reduced by 41% for this cohort. The service, however, only currently covers 50% of people with severe frailty (9,840) ü Hillingdon has the second lowest admission rate in NWL for severe frailty: 643 per 1,000 pop The current prevalence rate for hypertension in Hillingdon is 13.8% against a target of 24% (It is estimated that about 30% of the population nationally have hypertension). This has improved from 10% since the start of roll out of the Hypertension Anticipatory Care Programme in Neighbourhoods. The percentage (of the 13.8%) with their Blood pressure under control is 85% -which is above target. Prevalence Rates will increase as the Programme progressively rolls out . Progress against the Health and Wellbeing Implementation Plan Priorities: Neighbourhood Development… We have made the following Progress in Reactive Care Services focused on Responding to Crisis: Admission and ED Avoidance • We have undertaken a Demand, Capacity and Pathway Review in relation to our Urgent Community Response Services. This includes services such as Rapid Response, Community Palliative Care, Emergency Social Care, Therapy Services, Mental Health. These services are intended to provide an urgent 2 hour crisis response in the event of a rapid deterioration in a persons physical and/or mental health to avoid a hospital episode. • The Review has demonstrated that current services have neither the capacity (3,500 referrals annually against a requirement for 5,500 to 7,500), the skill base or the exit pathways back to Neighbourhood Care to deliver the level of response required in terms of ED/Admission avoidance. • We will therefore implement a new Urgent Response Service from September 2025. It will bring together the existing Rapid Response Team, OTs, Respiratory Physiotherapists, Your Lifeline (EoL), and Social workers. It will deliver 21 new referrals per day compared to 7 new referrals per day for the existing service reducing ED attendance accordingly for this cohort • It will have access to GP clinical supervision via Same Day Urgent Primary Care Hubs and consultant support through the Frailty Assessment Unit. There will be a single co-ordination Centre. This will enable us to tackle the current over use of ED by this cohort (+34 appointments above target per day). We are working with the ICB to access additional funding. • In the meantime, we will fast track the implementation of a new mobile IV Antibiotics Service (a key component of the future service) by the end of June 2025 using funding from the Better Care Fund. This will benefit ED avoidance, free up Medical SDEC capacity and improve discharge. • We have implemented an End of Life Integrated Co-ordination hub to better integrate out of hospital end of life care between Harlington Hospice and CNWL. Initial results are positive with our hospital admission rate now below the North West London average. • We have implemented a diversion scheme at THH for MH patients attending ED (average 9 per day) called the Lighthouse. The impact has been disappointing (an average of 1 patient per day being seen). As a result, we have decided to rethink the model and plan to move to a model akin to a Mental Health ED from the end of June 2025. 5 Current Performance against Key Metrics: (see slides 6 & 7) Type 1 performance is challenged. ED attendances are significantly above their target <=164 average daily attendances by 32 attendances per day (an average 196 per day) Urgent Community Response: New Referrals per annum 3,635 (24/25), Demand 7,500 referrals per annum. Lighthouse ED Diversion Attendances: April Average Actual 1 per day, Target 7 per day ü Hillingdon has the lowest hospital Admission Rate across North West London for people at the End of their Life: 2.03 admissions per 1,000 list size Progress against the Health and Wellbeing Implementation Plan Priorities: Reactive Care Urgent and Emergency Care Flow In : Monthly Summary Performance Charts Urgent and Emergency Care Flow Out (Discharge): Monthly Summary Performance Charts We have made the following Progress in Reactive Care Services focused on Responding to Crisis: Discharge • The average number of patients without Criteria to reside at THH has steadily fallen over the last 12 months from an average of 54 in August 2024 to an average of 38 in April 2025. This is still above our target of 34, however. • Similarly, discharge delays across all D2A pathways (P0, P1, P2 and P3) are below the NWL average and the targets set by the ICB . In particular, P1 pathway delays in Hillingdon and our total delay days, are the lowest in North West London. • Nevertheless, THH has spent a significant period of time in ‘black escalation’ over recent months. There remain 2 significant interlinked challenges to be tackled in order to deliver better flow and hospital redevelopment targets: the growing number of P2 patients (awaiting in patient rehabilitation) with NCR and the low number of weekend discharges. • We have seen a gradual increase in the number of patients with NCR for Pathway 2 since February 2025. On some days this amounts to 60% of the total number of Patients with NCR. We have therefore recently undertaken a root cause analysis. • As a result of the P2 Deep dive, we have set a target to reduce the daily average number of P2 with NCR to <=14 from the current average of 22 by the end of June 2025 through: • Tackling overprescribing of care particularly IP Rehabilitation • Applying greater grip and control of existing processes and through more creative use of existing available resources • Increasing step down capacity where this is required • These steps, properly executed, will take us below the target of 34 patients with NCR. • In terms of discharge, slide 7 shows that on average, over the last 12 months, we have had a surplus of weekday discharges over admissions. This surplus is offset, however, by a significant deficit of discharges compared to admissions at weekends. Over the next 4 months (by end of September 2025), we will work with the Trust to develop a clear and coherent plan to rectify this in the context of the roll out of our new 7 day place model 8 Current Performance against Key Metrics: (see slides 5 & 6) The average daily 'No Criteria to Reside' target is set at 34. Over the past few months, there have been significant reductions, with the average steadily decreasing. Aprils average was 38. ü Pathway Delay Days for Hillingdon compared to the NWL average are set out in the table below: ü The growth in the daily average number of P2 with NCR is set out clearly in the chart below Progress against the Health and Wellbeing Implementation Plan : Reactive Care Pathway Hillingdon Average NWL Average P0 0.23 0.26 P1 1.63 2.38 P2 4.43 4.65 P3 7.62 8.68 Total 0.18 0.26 18/11/2425/11/2402/12/2409/12/2416/12/2423/12/2430/12/2406/01/2513/01/2520/01/2527/01/2503/02/2510/02/2517/02/2524/02/2503/03/2510/03/2517/03/2524/03/25 0 5 10 15 20 25 30 P2 No C2R for Hillingdon Hospital Measure Mean UCL LCL Appendix 1 Our New Place Target Operating Model looks like this…. 10 Urgent & Emergency Care Planned Care Cancer Acute Medical Care Diagnostics Acute Surgical Care Paediatrics Critical Care Reactive Care Co-ordination Hub THH Active Recovery Service • Bed Based Active Recovery • Home Based Active Recovery Palliative Integrated Care Service • Co-ordination Hub • Integrated Palliative Care Service (acute, Community, 3rd sector) • EoL Beds Mental Health Services • OPMH Beds • Memory Services • The COVE • MH CAS • Psychiatric Liaison Integrated Nursing • Community Nursing • Care Connection Teams • Specialist Nursing • Care Home Support Primary Care Networks Same Day Urgent Primary Care • Planned Care • Diagnostics (U/S) • Phlebotomy) • OPAT (IVA) Community Mental Health Hubs • CMHT, PCMH • Psychology • Psychotherapy • Employment 3 x Integrated co- located Neighbourhood Hubs Voluntary and Community Services Community Adult Social Care Pharmacy, Dentistry & Optometry Integrated Therapies (Acute, Community & Primary care) Integrated Reactive Care Services

Health and Wellbeing Board report 10 June 2025 2025/26 BETTER CARE FUND PLAN Relevant Board Member(s) Councillor Jane Palmer – Co-Chair Keith Spencer – Co-Chair Sandra Taylor – Corporate Director, Adult Social Care and Health Organisation London Borough of Hillingdon Report author Gary Collier - Adult Social Care and Health Directorate, LBH Sean Bidewell – Integration and Delivery, Northwest London ICB Papers with report Appendix 1 – Discharge Funding Breakdown 2025/26 HEADLINE INFORMATION Summary The Better Care Fund (BCF) is a national initiative that has been in place since 2015. Its vision is to support the national policy objectives of supporting the shift from sickness to prevention and supporting people to live independently and the shift from hospital to home. This report explains how the plan meets national requirements. Approval by the Health and Wellbeing Board is a one of the national requirements. Contribution to plans and strategies The Better Care Fund plan contributes to the delivery of Hillingdon’s Joint Health and Wellbeing Strategy and ensures compliance with requirements under the 2006 National Health Service Act. Financial Cost The proposed value of the BCF for 2025/26 is £74,160,938 comprising of a Council contribution of £44,729,879 and an ICB contribution of £29,431,059. Ward(s) affected All RECOMMENDATIONS That the Health and Wellbeing Board: 1. approves the 2025/26 Better Care Fund Plan as described in the report, including the proposed financial arrangements and proposed targets for the national metrics. 2. notes the position regarding Equality and Health Impact Assessments as set out in the report. INFORMATION Strategic Context 1. The policy framework that set out broad principles to be followed for the 2025/26 Better Care Fund (BCF) plan was published on 30 January 2025. The detailed planning requirements for 2025/26 were also published on the same date. Health and Wellbeing Board report 10 June 2025 2. The submission date for the 2025/26 plan set out in the January 2025 planning requirements was 31 March 2025. In-year changes to NHS additional contribution funding arrangements announced by the Northwest London Integrated Care Board (ICB) on 20 March 2025 meant that it was not possible for Hillingdon Place to be compliant with the national requirement and our local plan was submitted on 6 May 2025. The planning documents were submitted as drafts pending the Board’s formal approval. 3. The Board may wish to note that the decision to reduce the NHS additional contribution to the BCF in-year followed the national announcement of the requirement for ICBs to reduce their overheads by 50% by December 2025. 4. The 2025/26 BCF plan submission comprises of the following documents:  Narrative plan  Planning template  Intermediate care demand and capacity template 5. The narrative plan and key aspects of the planning template, i.e., income and expenditure, targets for metrics and supporting rationale, and the intermediate care demand and capacity template can be accessed using the following link https://www.hillingdon.gov.uk/bcf. 6. The Board is advised that, following the general election in July 2024, there has been a slight change of emphasis with the BCF in that plans must show how they are contributing to the delivery of two national policy objectives, and these are:  National BCF Policy Objective 1: To support the shift from sickness to prevention – including timely, proactive and joined-up support for people with more complex health and care needs; use of home adaptations and technology; and support for unpaid carers.  National BCF Policy Objective 2: To support people living independently and the shift from hospital to home – including help prevent avoidable hospital admissions; achieve more timely and effective discharge from acute, community and mental health hospital settings; support people to recover in their own homes (or other usual place of residence); and reduce the proportion of people who need long-term residential or nursing home care. 7. The Board may wish to note that, in 2024/25, there were two discharge funding grants, one of which came directly to local authorities and the other via ICBs. These were ring- fenced grants that could only be used to the support discharge. The ring-fence has been removed in 2025/26 and the ICB Discharge Fund has been included within the NHS minimum contribution to health. The local authority discharge fund has been included within the Local Authority Better Care Grant, which is paid directly to councils. The latter also includes the Improved Better Care Fund (iBCF) grant also previously received by councils as a separate grant. The value of this funding remains at the 2024/25 level. To avoid confusion, in this report funding previously identified as discharge funding will continue to be referred to as such, although it is important to emphasise that the removal of the ring-fence increases flexibility as to how this income can be deployed. ICB Review of BCF Schemes 8. As a result of the ICB instigated review of BCF schemes undertaken during 2024/25, Health and Wellbeing Board report 10 June 2025 Hillingdon has amalgamated schemes using common definitions agreed across the sector. BCF funded services have been aligned to four ‘buckets’ that have aims linked to the national BCF objectives. There has also been an attempt to simplify funding arrangements by reducing the number of different BCF income streams supporting services included in the plan. 9. The buckets and related aims are shown below:  Scheme 1: Living Well. Aim: Maximising independence and preventing unnecessary admission to hospital and residential care - Adults of working age.  Scheme 2: Ageing Well. Aim: Maximising independence and preventing unnecessary admission to hospital and residential care - People aged 65 +.  Scheme 3: Active Recovery. Aim: Promoting recovery and independence after acute illness.  Scheme 4: Infrastructure Enablers. Aim: Providing effective foundations for operational service delivery. Key Changes from 2024/25 Plan 10. The ICB’s decision to reduce its additional contribution to the BCF in 2025/26 by 50% has resulted in savings of £796,619. The expectation is that the NHS additional contribution to the BCF will reduce by a further £718,608 from 2026/27 making a full year saving for 2026/27 of £1,515,227. Within this changed financial context the approach taken has included:  Deletion of posts that have not been recruited to or where functions can be delivered outside of the BCF, e.g. P2/3 Bed Coordinator and Online Services Coordinator posts.  Moving things out of the BCF that could be funded elsewhere, e.g., Marketplace online directory software licence.  Not continuing contracts due to expire in-year or where it is difficult to demonstrate impact.  Reducing capacity of services following an eligibility review, e.g. Reablement. 11. As part of the process of streamlining the BCF to focus on mandated funded streams and additional that is aligned to them, £26,210k of additional local authority contribution has been removed from the 2025/26 plan (the additional local authority contribution was £55,385k in 2024/25). This mainly applies to community services for people with learning disabilities, e.g., supported living, outreach, direct payments, etc. It is important to emphasise that these services continue to be funded but outside of the BCF. 12. Linked to the outcome of the NWL BCF are changes to the risk share arrangements for the community equipment service. In 2024/25, this was 76% NHS and 24% local authority. This will change to 71% NHS and 29% local authority in 2025/26 as part of a transition to a uniform 65% NHS and 35% local authority, which it is proposed to fully implement in 2026/27. 2025/26 Priorities 13. The main priorities reflected in the 2025/26 BCF plan include:  Continuing to embed a Population Health Management (PHM) approach across the health and care system.  Further developing three Integrated Neighbourhood Teams (INTs) and the neighbourhood working approach to deliver care and support closer to home. Health and Wellbeing Board report 10 June 2025  Establishing fewer, larger integrated teams aligned to the INTs that cover seven days and have a single leader.  Expanding a targeted care coordination programme within the INTs that utilises digital innovation and focuses on risk stratification and early intervention, particularly for the 4,400 people who are high users of health services.  Reviewing the technology enabled care (TEC) offer and exploring alignment with the INTs to maximise opportunities for need escalation prevention.  Implementing a single Borough-wide Reactive Care Service that maximises the ‘Homefirst’ approach and delivers community-based urgent responses.  Implementing the outcomes of competitive tenders for third sector provided preventative services, e.g., information, advice and guidance, support for carers, and early intervention support for adults with mental health needs.  Implementing the outcomes of the Northwest London Integrated Care System (ICS) BCF review to achieve greater alignment of approaches across the sector. This is intended to ensure that national BCF objectives are met within an equitable and sustainable joint system approach, except where divergence is appropriate to address place-based needs. 2025/26 BCF Plan National Requirements National Conditions Compliance 14. There are four national conditions that roll forward into 2024/25 and these are summarised below. 15. National Condition 1: There is a jointly agreed plan. 16. National Condition 2: Implementing the objectives of the BCF. There are four components of this condition and these are:  Setting out a joint approach for meeting the two national priorities.  Setting goals for the three national metrics.  Demonstrating a ‘homefirst’ approach and shift away from avoidable use of care home placements.  Explaining any changes in the use of discharge funding compared to 2024/25. 16. National Condition 3: Complying with grant and funding conditions, including maintaining the NHS minimum contribution to Adult Social Care. Commentary: Hillingdon will be compliant with this condition if the Board agrees the report recommendation. Commentary: Key lines of enquiry in the narrative template have been addressed and the metrics tab in the planning template completed. This means that there is compliance with this requirement. Commentary: This is addressed within the expenditure tab of the planning template and demonstrates compliance. Health and Wellbeing Board report 10 June 2025 17. National Condition 4: Complying with oversight and support processes. There are two components to this requirement and these are:  Confirmation that HWBs will engage with the BCF oversight and support process if necessary.  Demonstrating that effective governance is in place. 21. Commentary: National Metrics 18. There are three national metrics in 2025/26 and these concern emergency admissions to hospital, discharge delays and permanent admissions to care homes. Following previous Board direction, in drafting the plan targets have been set that are achievable. The detailed rationale supporting the targets, including the services funded via the BCF supporting them can be found by using the link shown in paragraph 5. This section summarises some key points. 19. Emergency admissions to hospital for people aged 65 + per 100,000: Guidance supporting completion of plans encourages the use of supporting indicators concerning unplanned admissions for ambulatory care sensitive conditions and falls for people aged 65 and above. Poor data quality for the former means that this it was not possible to take this population group into consideration. Consideration was given to falls-related admissions, the outturn for 2024/25 for which was above plan. 20. Discharge delays, i.e., average length of discharge delay for all acute adult patients: The 2024/25 projected outturn has been used as a baseline to create base lines for the 2025/26 plans and a 1% improvement applied. Supporting indicators for patients not discharged on a range of delayed days, e.g., 1 day, 2 – 3 days, 7 – 13 days, etc., as well as local data on average length of delay by discharge pathway, have been taken into consideration when setting this target. 21. Long-term support needs of older people (aged 65+) met by admission to residential and nursing care homes, per 100,000 population: The target set is based on the projected 2024/25 outturn with a 10% reduction applied. Supporting indicators of the percentage of people discharged to their normal place of residence and the proportion of people who received reablement where no further request was made for ongoing support were also considered. Intermediate Care Demand and Capacity Analysis 22. Intermediate care services (IMC) are a range of short-term services provided to people to enable them to return home more quickly after a hospital stay or avoid going into hospital unnecessarily. The range of services include reablement, crisis response, i.e., Rapid Response, home-based rehabilitation and short-term bed-based services. 23. A local IMC demand and capacity exercise is in progress the outcome of which will be reported in the Quarter 1 (Q1) BCF reporting template and an update provided to the meeting of the Board in September. This will include any implications for the funding Commentary: Hillingdon’s commitment to engage with BCF oversight is confirmed in the cover tab of the planning template and the joint system governance is described in the narrative document. Hillingdon is therefore compliant with the requirements of this condition. Health and Wellbeing Board report 10 June 2025 alignment set out in the expenditure tab of the planning template and use of the discharge funding as outlined in Appendix 1. 24. The Board is asked to note that this includes flexibility to target funding at admission prevention or discharge support schemes in response to conclusions from the demand and capacity exercise. The Board is also advised that changes have not been made to the BCF IMC demand and capacity template to reflect the reduction in hours for the Reablement Service. This assumes that demand can be met by the under-utilisation, but this will be kept under review. 25. Community demand and capacity: The focus of intermediate care resource in Hillingdon is more on supporting people out of hospital than preventing them from getting there in the first instance, hence the drive to move towards the new operating model discussed at previous Board meetings that is intended to support our residents to stay healthier and fitter in the community. However, the conclusion from the data included in the IMC demand and capacity template is that there should be sufficient capacity to support demand from the community in 2025/26, although this is subject to the conclusion of the local exercise referred to in paragraph 23 above. 26. For the Board’s information, the 2025/26 BCF IMC demand and capacity template reports short-term placements from the community as demand for bed-based step-up provision. This addresses feedback from NHS England’s Better Care Support Team about the absence of bed-based step-up provision in our 2024/25 BCF plan. Short-term placements for respite to support unpaid carers has been excluded. 27. Hospital discharge demand and capacity: The template is constructed using the Home First/Discharge to assess (D2A) categories explained below. These categories reflect revisions in the updated statutory Hospital Discharge and Community Support guidance published in January 2024. As a result of clarification provided by NHS England P3 will only refer to placements of self-funders. This will necessitate some changes to how placements within block contracts reported and this will be undertaken during Q1. 28. The template also demonstrates an expectation that there should be sufficient capacity to Home First/Discharge to Assess 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 June 2025 support discharges by pathway, although a key caveat that needs to be applied to this assumption is the accuracy of the data. This issue has now been addressed, and the Place-based IMC demand and capacity analysis will be working with more accurate data. Any resultant changes to assumptions will be reflected in the Q1 2025/26 BCF reporting template. Hospital Discharge Fund 29. The Discharge Fund comprises of a local authority aspect, which is funding paid directly to the Council via a grant under section 31 of the Local Government Act, 2003, as part of the Local Authority Better Care Grant and an ICB aspect. The ICB aspect is distributed on a Health and Wellbeing Board basis and the Board is reminded that this is included within the NHS minimum contribution. A detailed breakdown of this funding for 2025/26 can be found, for ease of reference, in Appendix 1. The key points for the Board’s attention are explained below:  Local Authority Discharge Fund: Nearly 93% (£1,615k) of the Council’s allocation is committed to discharge-related homecare and placement costs that support the financial implications of the Home First model and ensuring that assessment of long- term care needs primarily take place in the community and not in hospital. The remaining 7% is funding additional social work and brokerage capacity to ensure weekend and bank holiday coverage as well as a contract to address requirements for deep cleans.  ICB Discharge Fund: Nearly 49% (£1,258k) of the funding is intended to support P1 and nearly 24% (£615k) to support P2. Nearly 14% (£361k) has been allocated to admission prevention schemes and 12% (£314k) to discharge support schemes, which will primarily be to support additional capacity to address increased need during the winter months. Each Health and Wellbeing Board contributes £33.7k to central ICB business intelligence support for borough-based teams, which is 1.3% of Hillingdon’s allocation. Equality Impact Assessments 30. Despite structural changes to Hillingdon’s BCF plan to reflect the outcomes of the 2024/25 NWL review, much of the content of the 2025/26 plan is a roll forward from the previous year. There are some changes that will have a neutral impact because they are intended to improve performance from the current position rather than reduce what is currently in place, e.g., where it is proposed not to proceed with the creation of new posts. However, there are proposals that could have a negative impact on people with protected characteristics and specific impact assessments will be undertaken to support decisions about whether to proceed with them. Next Steps 31. The result of the assurance process is now awaited. Once assured status is confirmed, it will be possible for the Council and ICB to enter into an agreement under section 75 (s75) of the NHS Act, 2006, to give legal effect to the financial and partnership arrangements under the BCF. Plans are in place to secure agreement between the ICB and the Council on the content of the s75 subject to confirmation of assured status. The national target for s75 agreements to be in place is 30 September 2025. Health and Wellbeing Board report 10 June 2025 Risk Share Arrangements 32. The arrangement for previous iterations of the plan has been that each organisation manage its own risks, and it is proposed that this will continue for 2025/26, except for community equipment as mentioned in paragraph 12. The detail of risk share arrangements will also be reflected in the s75 agreement referred to previously. Financial Implications Financial Uplift 33. Tables 1 and 2 below provide a comparison of NHS and Council contributions in 2025/26 compared with 2024/25. Table 1: Financial Contributions by Organisation 2024/25 and 2025/26 Organisation 2024/25 2025/26 NHS 29,851,857 29.431,059 LBH 70,173,307 44,729,879 TOTAL 100,025,164 74,160,938 34. Table 3 below provides a comparison of NHS and Council contributions by funding stream in 2025/26 compared with 2024/25. The decrease in the Council’s additional contribution is explained in paragraph 11. Table 3: Financial Contributions by Funding Stream 2024/26 FUNDING SOURCE FUNDING 2024/25 2025/26 Minimum NHS Contribution 26,754,890 24,554,228 Additional NHS Contribution 3,096,967 2,285,950 NHS TOTAL 29,851,857 29,431,059 Minimum LBH Contribution 14,787,649 15,554,753 Additional LBH Contribution 55,385,658 29,175,125 LBH TOTAL 70,173,307 44,729,878 TOTAL BCF VALUE 100,025,164 74,160,937 35. Table 4 below provides a comparison in value of the mandated BCF income streams in 2024/25 and 2025/26. Table 4: BCF Minimum Contributions Summary 2024/26 Funding Breakdown 2024/25 2025/26 NHS MINIMUM CONTRIBUTION BREAKDOWN  Minimum to Adult Social Care 8,811,589 9,157,453  Minimum to Health 15,352,420 15,396,775  ICB Discharge Fund 2,590,881 2,590,881 TOTAL 26,754,890 27,145,109 Health and Wellbeing Board report 10 June 2025 LBH MINIMUM CONTRIBUTION BREAKDOWN  Disabled Facilities Grant (DFG) 5,574,889 6,341,993  Improved Better Care Fund (iBCF) 7,467,803 7,467,803  LA Discharge Fund 1,744,957 1,744,957 TOTAL 14,787,649 15,554,753 MINIMUM BCF VALUE 41,787,649 42,699,862 36. Table 5 below summarises the Council and NHS funding contributions for the 2025/26 plan by scheme. Table 5: Funding Breakdown by Bucket Scheme NHS LBH TOTAL 1: Living Well 2,720,577 11,973,563 14,694,140 2: Ageing Well 11,166,206 30,872,950 42,039,156 3: Active Recovery 15,013,481 1,744,957 16,758,438 4: Infrastructure Enablers 530,795 138,409 669,204 TOTAL 29,431,059 44,729,879 74,160,938 Local Authority Better Care Grant 37. The Board is reminded that the above grant combines what were two separate grants in 2024/25, i.e., Local Authority Discharge Grant and the Improved Better Care Grant. The funding received in 2025/26 reflects the combined value of the two grants in 2024/25, which was £9,212,760. The grant conditions for the Local Authority Better Care Grant are that it must be used to: ● Meet adult social care needs; ● Reduce pressures on the NHS, including supporting more people to be discharged from hospital when they are ready (including supporting the principles of ‘Discharge to Assess’); and/or ● Ensure that the local social care provider market is supported. 38. It is intended that £7,467,803 of this grant that in 2024/25 was the Improved Better Care Grant be used to support the provider market. This includes funding commissioning capacity to ensure greater effectiveness in delivering the Council’s responsibilities under section 5 of the Care Act, 2014, which was identified as an area for development during the assurance process undertaken by the Care Quality Commission in 2024. BACKGROUND PAPERS Hospital discharge and community support guidance (DHSC updated January 2024) Hospital discharge and community support guidance - GOV.UK (www.gov.uk) Health and Wellbeing Board report 10 June 2025 Discharge Funding Breakdown 2025/26 LOCAL AUTHORITY BETTER CARE GRANT (DISCHARGE) SPEND 2025/26 Spend Item 2025/26 Allocation 1,744,957 Discharge-related placements 1,040,000 Discharge-related homecare 435,485 Additional Reablement capacity 96,000 Block nursing dementia step-down 44,314 Deep clean & house clearance contract 16,000 Social Work 7-day Discharge 57,658 Additional Brokerage Capacity 55,500 TOTAL 1,744,957 NHS MINIMUM CONTRIBUTION (DISCHARGE) Spend Item 2025/26 Allocation 2,590,881 Bridging Care Service 256,380 Block step-down beds 406,597 Home-based Active Recovery Service 785,213 Home-based Recovery Service - Additional weekend capacity 37,642 Additional admission prevention schemes 360,631 Additional discharge support schemes 313,510 Central ICB support for borough-based teams 33,750 Gap commissioning 139,834 Mildmay HIV Rehab Unit 87,500 Personal Health Budget (PHB) purchase cards 10,000 Rehab beds, Furness Ward, Willesden 120,574 Reablement Physio 39,250 TOTAL 2,590,881 Appendix 1

Health and Wellbeing Board report 10 June 2025 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 2025/2026 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 2025/2026 Board Planner, attached at Appendix 1. 3. INFORMATION Supporting Information Reporting to the Board The draft Board Planner for 2025/2026, 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 June 2025 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 2025/2026 were considered and ratified by Council at its meeting on 16 January 2025 as part of the authority’s Programme of Meeti ngs for the new municipal year. The proposed dates and report deadlines for the 20 25/2026 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 June 2025 APPENDIX 1 BOARD PLANNER 2025/2026 9 Sep 2025 2.30pm Committee Room TBA Business / Reports Lead Timings Reports referred from Cabinet / Policy Overview & Scrutiny (SI) LBH Report deadline: 3pm Thursday 28 August 2025 Agenda Published: 1 September 2025 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 2 Dec 2025 2.30pm Committee Room TBA Business / Reports Lead Timings Reports referred from Cabinet / Policy Overview & Scrutiny (SI) LBH Report deadline: 3pm Thursday 20 November 2025 Agenda Published: 24 November 2025 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 3 Mar 2026 2.30pm Committee Room TBA Business / Reports Lead Timings Reports referred from Cabinet / Policy Overview & Scrutiny (SI) LBH Report deadline: 3pm Thursday 19 February 2026 Agenda Published: 23 February 2026 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 11