Health & Wellbeing Board

Minutes HEALTH AND WELLBEING BOARD 10 June 2025 Meeting held at Committee Room 6 - Civic Centre, High Street, Uxbridge UB8 1UW Board Members Present: Councillor Jane Palmer, Keith Spencer, Sean Bidewell (In place of Sue Jeffers), Amanda Carey-McDermott (In place of Ed Jahn), Professor Ian Goodman, Lynn Hill, Vanessa Odlin, Derval Russell, Shikha Sharma (In place of O'Neill), Sandra Taylor and Lesley Watts Officers Present: Gary Collier (Health and Social Care Integration Manager), Ryan Dell (Democratic Services Officer) and Nikki O'Halloran (Democratic, Civic and Ceremonial Manager) 35. APOLOGIES FOR ABSENCE (Agenda Item 1) Apologies for absence had been received from Councillor Susan O’Brien, Mr Edmund Jahn (Ms Amanda Carey-McDermott was present as his substitute), Ms Sue Jeffers (Mr Sean Bidewell was present as her substitute), Ms Julie Kelly, Ms Kelly O’Neill (Ms Shikha Sharma was present as her substitute) and Mr Tony Zaman. 36. DECLARATIONS OF INTEREST IN MATTERS COMING BEFORE THIS MEETING (Agenda Item 2) There were no declarations of interest in matters coming before this meeting. 37. TO APPROVE THE MINUTES OF THE MEETING ON 18 MARCH 2025 (Agenda Item 3) RESOLVED: That the minutes of the meeting held on 18 March 2025 be agreed as a correct record. 38. 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 8 would be considered in public and Agenda Items 9 to 11 would be considered in private. 39. HILLINGDON'S JOINT HEALTH & WELLBEING STRATEGIC PRIORITIES, DASHBOARD AND PROGRESS UPDATE (Agenda Item 5) Mr Keith Spencer, Co-Chair and Managing Director of Hillingdon Health and Care Partners, advised that this item would also cover the discussion that would have taken place under Agenda Item 7: Proactive Care Developments Update / Neighbourhood Health. He noted that a discussion had taken place at the last Health and Wellbeing Board meeting in relation to the need to identify a smaller number of priorities. The report provided more detail on: 1. five proposed health and wellbeing priorities: i. start well - improve early years outcomes, reduce child obesity and promote readiness for school and life. ii. live well - prevent and / or delay the onset of Long Term Conditions, particularly hypertension, improving mental wellbeing and enhancing access to early intervention and support for carers. iii. age well - implement ‘at scale’ proactive frailty management and better end-of- life care that enabled people with multi morbidity to maintain independence for as long as possible in order to: avoid non elective presentations; avoid admission to long term care; and promote early discharge. iv. healthy places - tackle housing, environment, employment and social isolation. v. equity and inclusion - target resources and interventions where inequalities were greatest using Core20PLUS5: specifically Hayes, Yiewsley, and West Drayton. 2. progress to implement these priorities; and 3. a series of metrics and diagrams to quantify progress. It had been proposed that the first two years would focus on the ‘ii. live well’, ‘iii. age well’ and ‘v. equity and inclusion’ priorities, whereby resources would be targeted on areas with the greatest inequity. Work would still also be undertaken in relation to the ‘i. start well’ and ‘iv. healthy places’ priorities, but to a lesser degree. Professor Ian Goodman, North West London Integrated Care Board (NWL ICB), suggested that, if effort was going to be focussed on priorities ii, iii and iv, this would need to be discussed outside of the medical model and moved away from acute medical care. Mr Spencer advised that the priorities would be delivered through a new seven-day place operating model and two key transformation programmes in 2025/26: integrated services focused on preventing crisis (live well/equity); and integrated services focused on responding to crisis (age well/equity). Preventing crisis would involve the neighbourhood teams which had progressed well with three strands: 1. access to primary care to prevent overspill into acute care; 2. proactive care for those with multi morbidity; and 3. preventing long term conditions. Consideration needed to be given to the place-based offer available to help people live at home for longer and prevent them from going into hospital. It was suggested that the key metrics needed to be clear and should be built from the hospital redevelopment programme, national targets (for example in relation to Better Care Fund and reablement) and hypertension. Board members were asked if they would be happy to adopt these as the initial metrics which could then be built upon or changed at a later date (progress on these had been highlighted in the report). Hillingdon performed well with regard to neighbourhood health and proactive care but had faced challenges in relation to greater case management. Although the Borough did well against the NWL benchmark, more could be done to improve reactive care. For example, the Care Connections Team was currently case managing around 5,000 patients, yet there were around 10,000 Hillingdon residents that were living with severe frailty, which meant that only half of those that needed help were being supported by the Team. Action would also be needed to reduce non-elective admissions / long term care for hypertension and to endure that at least 80% of patients with diagnosed hypertension had their blood pressure under control by 2028. Metrics would also include a reduction in the number of patients without criteria to reside to no more than 34 by 2025. Progress had also been made in relation to services focused on responding to crisis (admission and Emergency Department (ED) avoidance). A new Urgent Response Service would be implemented from September 2025 which would have access to GP clinical supervision via Same Day Urgent Primary Care Hubs and consultant support through the Frailty Assessment Unit. There would be a single co-ordination Centre which would enable partners to tackle the current overuse of ED by this cohort (34 appointments above target per day). Hillingdon had been working with the NWL ICB to access additional funding. The Lighthouse had been set up as a diversion scheme for mental health patients attending the ED (averaging nine patients per day). However, as only an average of one patient per day was being seen at the Lighthouse, the model and plan had been rethought and would move to a model akin to a mental health ED from the end of June 2025. Ms Vanessa Odlin, Managing Director - Goodall Division at Central and North West London NHS Foundation Trust (CNWL), advised that the Lighthouse numbers were far too low and that the Trust had been working with Dr Ritu Prasad, Chair of the Hillingdon GP Confederation, to increase usage. Service users had also been involved in identifying improvements and it appeared that the Lighthouse was sometimes not used because people were unaware of the crisis alternatives. It was suggested that consideration needed to be given to same day emergency care for individuals with mental health needs and what this would look like. Ms Odlin had been looking at a model whereby patients did not need to present at the ED before they went to the Lighthouse and therefore only had to tell their story once (the Lighthouse was located approximately 100 yards from the ED). System partners would be meeting to discuss this at the end of June / beginning of July 2025. A demand, capacity and pathway review had been undertaken in relation to Urgent Community Response Services. This multi-agency work had involved primary care and community services and had highlighted that the capacity was not available to meet the patient numbers (capacity would need to double to about 7,500 annual referrals). As such, consideration was being given to bringing services together with a new model and the implementation of a new mobile Intravenous Antibiotics Service (a key component of the future service) which would be implemented by the end of June 2025 using funding from the Better Care Fund. Ms Sandra Taylor, the Council’s Corporate Director of Adult Social Care and Health, advised that she supported the five priorities as they dovetailed with the adult social care perspective, particularly in relation to issues such as hypertension which would need to be aligned with Public Health. Even though the Council was also having good outcomes from its work with CNWL, she also supported the targeted and universal work in relation to early help and young people. Ms Lesley Watts, Chief Executive at The Hillingdon Hospitals NHS Foundation Trust, advised that she did not have any issues with the priorities but that the timescales for delivery needed to be realistic. Clarity would also be needed in terms of identifying who would be responsible for delivering which actions. The new hospital would not be big enough to meet residents’ needs if the priorities were not delivered. As there was a tendency to want to boil the ocean, it would be important to focus on a small number of issues and do them well. To this end, focussed work had been undertaken in relation to mental health, reactive care and children’s services but clear numbers were needed. It was noted that Roy Lilley had reported that children under the age of one year were the greatest users of the ED but not all of these children needed to go to hospital. Further work was needed to educate new parents on the most appropriate alternative pathways for common issues. The issue of vaccinations had also been raised following the recent media coverage of the increasing prevalence of measles (particularly in London). Consideration would need to be given to increasing vaccination rates through the 0-19 service, GPs and screening. Ms Odlin agreed with the proposed five priorities. CNWL continued to work with the local authority on the Family Hub and the Urgent Crisis Response for physical health had been prioritised. Partners had been delivering some good services but had not been very good at publicising their successes. Concern was expressed at how partners were going to be able to deal with demand and capacity. It was noted that the current spend would need to go further by, for example, bringing resources together. Additional resources had also been sought through a bid for £20m funding (by September 2025). Following the discussion, Mr Spencer agreed to update the priorities to include responsibilities and timescales for the vaccination update. Insofar as discharge was concerned, Hillingdon faced two challenges: 1. the Borough had a target of 34 for ‘no criteria to reside’ but the figure hovered around 40. Work had been undertaken in relation to P2 patients (who needed rehabilitation) but it was still being oversubscribed; and 2. the Borough faced a deficit of discharges at the weekend and a surplus during the week. A seven-day model of care was needed. With these changes, the priorities would provide a single version of the truth. Ms Amanda Carey-McDermott, Hillingdon GP Confederation, advised that there were risks associated with same day urgent care capacity. Although HHCP had identified additional funding to support this, the GP Confederation was only able to contribute 60% of the funding that it had done in the previous year. It was hoped that the gap would be mitigated by the success of other funding bids. RESOLVED: That: 1. the priorities, as amended, be agreed; and 2. the discussion be noted. 40. 2025/26 BETTER CARE FUND PLAN (Agenda Item 6) Mr Gary Collier, the Council’s Health and Social Care Integration Manager, advised that the 2025/26 Better Care Fund (BCF) Plan had been submitted and was compliant with national requirements. There had been a 3.93% increase in the NHS contribution to adult social care and a 13% increase in Disabled Facilities Grant (DFG) funding. The North West London Integrated Care Board (NWL ICB) discharge fund had been ringfenced, but the value was the same as it had been for 2024/25. The Board was advised that the BCF Plan had been restructured to make it simpler and more streamlined. The submission had included the Plan template with details of three metrics and financials. The overall value of the Plan had reduced from £100m to around £74m due to a reduction in the contributions from the local authority and NWL ICB. The ICB had reduced its additional contribution to the BCF in 2025/26 by 50% which had resulted in savings of £796,619. The expectation was that the NHS additional contribution to the BCF would reduce by a further £718,608 from 2026/27 making a full year saving for 2026/27 of £1,515,227. Whilst some of these savings would be quite straight forward, others would need an equalities impact assessment undertaken. Ms Sandra Taylor, the Council’s Corporate Director of Adult Social Care and Health, advised that this £1.5m reduction meant that it would not be possible to just roll over what had been done in previous years. Everything had had to be realigned and would need to be constantly reviewed. With regard to mental health, Mr Collier confirmed that there was nothing that had been included in the 2024/25 Plan that would be coming out of the 2025/26 Plan. In response to a query about whether the overall funding had gone up, down or stayed the same, the Board was advised that funding for mandated schemes had increased and that there had been a reduction in the NWL ICB contribution. However, although the local authority contribution had decreased, there had been no change to the services provided which were funded outside of the BCF. There were three national metrics in 2025/26 in relation to emergency admissions to hospital, discharge delays and permanent admissions to care homes. These improved NHS targets had been based on the data that had been available but there had been some issues with the data available in relation to discharge to the usual place of residence. The 2024/25 projected outturn had been used as a baseline to create base lines for the 2025/26 plans and a 1% improvement applied. Ms Lesley Watts, Chief Executive at The Hillingdon Hospitals NHS Foundation Trust, noted that this 1% did not just sit here and consideration needed to be given to what more could be done with the funding that was available. There would be an opportunity to review the targets when the Q1 update was undertaken next month. The Whole System Integrated Care (WSIC) dashboards linked provider data from four acute, two mental health and two community Trusts across NWL, 380 GP practices and social care data from eight boroughs to generate one of the largest integrated care records in the country. Ms Amanda Carey-McDermott, Hillingdon GP Confederation, noted that WSIC did not provide live or up to date data. Partners would be able to do more but only if these data sharing issues were resolved. The report set out the priorities. Mr Keith Spencer, Co-Chair and Managing Director of Hillingdon Health and Care Partners, advised that partners needed to be more radical and ambitious in using the BCF to drive the priorities identified (this had been discussed in detail under the previous agenda item). Professor Ian Goodman, NWL ICB, noted that Hillingdon had been at the front with regard to digital interventions. He queried how much digital innovation could be used to stretch the BCF money further. Ms Taylor advised that the digital strategy had provided some good solutions for staff to use (some of these had been in place for 18 months). However, the technology in social care had not really moved on and residents were instead being encouraged to use normalised technology to help themselves (for example, bed sensors, door sensors, etc) which would help to keep them out of care placements. About ten years ago, no one was discharged from hospital without having Telecareline in place first (this might have involved having to have a new line installed at the residents’ home so could be time consuming). Today’s technology was quicker and easier to install without the need for major works which meant that it was also quicker to remove when it was no longer needed. Councillor Jane Palmer, Co-Chair and Cabinet Member for Health and Social Care, noted that not all residents were at ease with technology. As such, consideration needed to be given to how partners communicated and delivered technological solutions to them. Mr Spencer noted that there were almost 10k residents in Hillingdon with severe frailty. As it was currently unknown, effort was being made to identify where these patients were right now. The answer had not been readily available. Consideration would need to be given to how such information could be more easily obtainable in future. Ms Carey-McDermott noted that the Confederation was in discussions about mobile diagnostics that would be small enough to be transported on a moped but that they needed a bigger cohort to work with than just care homes. She suggested that these 10k frail residents be included in the cohort. RESOLVED: That: 1. the 2025/26 Better Care Fund Plan as described in the report, including the proposed financial arrangements and proposed targets for the national metrics, be approved; and 2. the position regarding Equality and Health Impact Assessments, as set out in the report, be noted. 41. PROACTIVE CARE DEVELOPMENTS UPDATE / NEIGHBOURHOOD HEALTH (Agenda Item 7) The Board discussed this item as part of Agenda Item 5 - Hillingdon's Joint Health & Wellbeing Strategic Priorities, Dashboard and Progress Update. 42. BOARD PLANNER & FUTURE AGENDA ITEMS (Agenda Item 8) Consideration was given to the Board Planner and future agenda items. RESOLVED: That the Board Planner be agreed. 43. TO APPROVE PART II MINUTES OF THE MEETING ON 18 MARCH 2025 (Agenda Item 9) Consideration was given to the confidential minutes of the meeting held on 18 March 2025. RESOLVED: That the PART II minutes of the meeting held on 18 March 2025 be agreed as a correct record. 44. NHS STRATEGIC CHANGES UPDATE (Agenda Item 10) Consideration was given to the confidential report and it was agreed that further information be considered at the Board’s next meeting on 9 September 2025. RESOLVED: That the discussion be noted. 45. UPDATE ON CURRENT AND EMERGING ISSUES AND ANY OTHER BUSINESS THE CHAIRMAN CONSIDERS TO BE URGENT (Agenda Item 11) Consideration was given to issues at Mount Vernon Hospital. RESOLVED: That the discussion be noted. The meeting, which commenced at 2.30 pm, closed at 4.03 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.

Hillingdon Health and Well-being Board Integrated Health and Wellbeing Performance Report and  Service Update Report for Hillingdon Health and Well-being Board – 09th September 2025 Health and Wellbeing Board Priorities Background and Overview  1. Purpose, Background and Overview This paper provides an update on progress against the Health and Wellbeing Board’s key priorities, Place transformation programmes, and wider system goals in Hillingdon. It focuses on  delivery progress, performance outcomes, and next steps. The report consolidates the latest developments across three core areas: • Health and Wellbeing Board Metrics – A summary of performance against agreed strategic indicators, highlighting areas of improvement and flagging metrics requiring further  attention. • Integrated Neighbourhood Teams (INTs) – Update on mobilisation across Hillingdon, covering infrastructure, workforce, and governance. Next steps include finalising operating  models, embedding enabling workstreams, and aligning INT delivery with borough priorities. • Reactive Care Programme – Current status and forward plan, including: Ø Development and phased launch of the Community Coordination Hub Ø Expansion of Urgent Community Response (UCR) services Ø Integration of rehabilitation and reablement services Ø Actions to reduce “No Criteria to Reside” delays and improve hospital discharge flow In response to growing health needs, inequalities, and system pressures, we have established five strategic priorities, aligned with Core20PLUS5, NWL ICS priorities, the HHCP strategic  plan, and the Council’s wider policy framework. These are designed to strengthen prevention, reduce unplanned care, and target inequality at neighbourhood level: 1. Start Well – Improve early years outcomes, reduce childhood obesity, and promote school and life readiness. 2. Live Well – Prevent and delay long-term conditions (particularly hypertension), improve mental wellbeing, and strengthen early intervention and carer support. 3. Age Well – Scale proactive frailty management and improve end-of-life care to help people live independently for longer, avoiding unnecessary admissions and enabling earlier  discharge. 4. Healthy Places – Address housing, environment, employment, and social isolation. 5. Equity and Inclusion – Focus resources where inequalities are greatest (Hayes, Yiewsley, West Drayton) through the Core20PLUS5 framework. 6. For Years 1–2, delivery will focus on Live Well, Age Well, and Equity and Inclusion, balancing ambition with manageable delivery risk. 1. Integrated Neighbourhoods : Implement 3 co-located multi agency Integrated Neighbourhood Teams with 3 core functions: • Same Day Urgent Primary Care through 3 Neighbourhood Super hubs 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) • A Preventative and Anticipatory Care Programme for those people with mild to  moderate hypertension ( 2. Reactive Care: Implement a new Borough wide Integrated Reactive Care Service to prevent unnecessary non elective episodes for patients with complex needs 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 5 Strategic Priorities, we are implementing a new 7 day Place Operating Model through 2 key  transformation programmes for 25/26 Key Metrics : 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. 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 • P1: <=2 days delay • P2: <=5 days delay • P3: <=7 days delay 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 2. High-Level Progress Summary (as of July 2025) • Neighbourhood Integration: All three Integrated Neighbourhood Teams (INTs) now live, covering the borough; 50% of the severe frailty cohort already case managed, delivering  a 36% reduction in non-elective admissions. Remaining 50% by April 2026. • Prevention: Hypertension prevalence recording increased to 13.8% (up from 10% baseline), with 85% of diagnosed cases under control – exceeding target. Short term target is  16% by March 2026. Flu and COVID immunisation uptake improved following provider changes and targeted outreach. • Reactive Care: Design and mobilisation of the Reactive Care Coordination Hub underway for Dec 2025 go-live; Lighthouse Mental Health Crisis model expanded capacity and  live from Sept 2025; Take-Home-and-Settle service launched in July supporting safer discharges. • Hospital Flow: Weekday discharges improved (55/day vs 51 in June); weekend discharges rising modestly but still below requirement. Patients with No Criteria to Reside remains  high (46 vs target ≤34), with a system taskforce and 8 week delivery plan now in place. New Choice Policy due Nov 2025. • Challenges: • ED attendances remain significantly above target (196/day vs ≤164). • UTC activity at 189/day, above target (≤180). • Patients with No Criteria to Reside still too high with Discharge Pathway 2 delays (42% of all Patients with NC2R)  above norm (6.5 days vs ≤5). • Estates and funding constraints risks delaying Neighbourhood Super Hubs and full SDUC rollout. • Next Steps: • Launch Coordination Hub (Dec 2025). • Pilot Mobile Diagnostics for Care Home Residents and Frailty elderly cohort in Q3 2025/26 • Implement NCR reduction taskforce and 8 week delivery plan  (Sept 2025) and Choice Policy (Nov 2025). • Scale hypertension outreach to reach 16% prevalence by Mar 2026. • Archus appointed to develop Neighbourhood Estates Business Case  for Super Hubs • Embed integrated INT leadership by end 2025. • A summary of metrics, actions and accountability is given overleaf:  4 Executive Summary   5 Health and Wellbeing Priorities: Summary Progress to Date (July 2025)  Metric Target Actual (Jul ’25) RAG Likely Cause Summary Action to Remedy Timeline to Resolution Accountability ED Attendances ≤164/day 196/day High demand, limited UCR capacity,  mental health crises at Front Door Expand UCR including launch of Co- ordination hub, mobile diagnostics,  Implement new Lighthouse diversion   from Sept Phased rollout from   Q3 25/26 SRO Reactive Care  UTC Attendances ≤180/day 189/day Reduction in SDUC funding , demand  spill over into UTC Revised Delivery Plan incorporating  stronger front door diversion and  capacity improvement Phased rollout from   Q3 25/26 SRO Neighbourhoods Patients with No Criteria to Reside (NCR) ≤34/day 46/day Discharge bottlenecks particularly  P2, referral process delays across all  Pathways, Family choice Delays 8 Week Delivery Plan developed  running Sept through end Oct Choice policy live Nov  25, 8 Week Delivery  Plan Sept - Oct SRO Reactive Care NEL Admissions: Moderate Frailty ≤285/1,000 273/1,000 INT case management effective Sustain INT scaling, expand  anticipatory care Full coverage by Apr  26 SRO Neighbourhoods NEL Admissions: Severe Frailty ≤694/1,000 674/1,000 Early impact of frailty programme Full rollout to 100% severe frailty  cohort By Apr 26 SRO Neighbourhoods  Unplanned Admissions from Care Homes ≤688/1,000 688/1,000 Variable care home capability, lack of  community alternatives for Falls and  Infection Care Home Champion forum, UCP  training, Expand UCR, access to  mobile diagnostics including IVA Phased rollout from   Q3 25/26 SRO Reactive Care  Discharge Pathway Delays (P1) ≤2 days 1.23 • Discharge Process Bottlenecks esp  time to Placement in P2 • Referral Process Delays across all  Pathways: D2A, District Nursing • Family Choice Delays  • Capacity Constraints  8 Week Delivery Plan developed  running Sept through end Oct Integration of Rehabilitation and  Reablement Jan 2026  Choice policy live Nov  25, 8 Week Delivery  Plan Sept - Oct SRO Reactive Care  Discharge Pathway Delays (P2) ≤5 days 6.53 Discharge Pathway Delays (P3) ≤7 days 6.1 Hypertension Prevalence 16% (Mar ’26) 13.8% Outreach scaling slower than  required Accelerate pharmacy/GP/INT  outreach, Borough campaign 16% by Mar 26 SRO Neighbourhoods  Hypertension Control ≥80% 85% Strong primary care management Maintain and spread learning Ongoing SRO Neighbourhoods  Integrated Neighbourhood Teams – Proactive Care 3. Integrated Neighbourhood Teams – Proactive Care Integrated Neighbourhood Teams (INTs) drive  Hillingdon’s preventative and personalised care agenda at  the community level.  These teams unite GPs, community nurses, social care,  mental health, therapists, and voluntary sector partners  within three locality-based “neighbourhoods.”  The proactive care program focuses on keeping people healthy and independent, managing long-term conditions  (like frailty and hypertension) to prevent crises and hospital admissions.  Key Achievements to Date ✓ 3 INTs launched, covering the whole borough, with co-located teams ✓ Severe frailty case management for ~50% of identified cohort –  achieved a 36% drop in emergency admissions for those patients ✓ Hypertension case-finding drive: raised recorded prevalence  from 10% to 13.8% (highest in NWL), with 85% of known hypertensives under control (above 80% target) ✓ Community outreach pilot (“Living Well”): 25% of attendees had  undiagnosed high BP and were escalated for treatment ✓ Infrastructure progress: Business case drafted for 3 locality hubs; joint  INT leadership roles being created across organisations Proactive Care – Strategic Intent Establish three Integrated Neighbourhood Teams and hubs providing joined-up care closer to  home. Focus on frailty management and preventative interventions (e.g.  hypertension case finding) to reduce  avoidable hospital use. Each INT  coordinates GPs, community  services, soial care, and VCS support  to keep residents healthy and  independent. Upcoming Priorities  Roll out INT care hubs (subject to funding) – expand same-day urgent care and diagnostics in communities by mid- 2026  Enrol 100% of severe frailty patients in Enhanced Case Management by Apr 2026 (up from ~50% now)  Merge community teams (District Nursing, Care Home team) by Nov 2025 to boost proactive capacity  Hypertension outreach: monthly health check invites and borough-wide BP awareness events (starting Sept 2025)  to reach 16% prevalence by 2026  Strengthen patient engagement via new Neighbourhood PPI forums (launch in early 2026) Integrated Neighbourhood T eams – Proactive Care Next 6–12 Months – Priorities Frailty Case Management By Q4 2025/26 (March–April 2026), every patient with severe frailty will have a care coordinator  and a multidisciplinary plan. This will require recruiting extra matrons and therapists (enabled by  the planned Care Home & CCT team integration by Nov 2025) and using the WSIC frailty data to  identify and enrol patients. A new digital frailty dashboard is due early 2026, enabling INTs to  track and support high-risk patients more effectively. •Neighbourhood Care Hubs (pending funding) Securing ICB capital funding through the Archus led business case is critical to progress. Interim  South Hub sites will be identified by Sept 2025 to expand access ahead of full development.  Once funding is approved (expected by end 2025), design and phased implementation will  follow: All hubs will offer 7-day urgent primary care, diagnostics (ultrasound, X-ray), and  outpatient clinics, improving local access. •Hypertension & Prevention A borough-wide campaign (“Know Your Numbers” week) launches Sept 2025 to promote blood  pressure checks, supported by pharmacies, GP Confederation clinics, and community events. The  target is to increase recorded prevalence from 13.8% to 16% by March 2026, on the way to 20%+  by 2027, while maintaining high levels of BP control (>80%). INTs will also expand anticipatory  care for other conditions, such as a COPD case-finding pilot in early 2026 and embedding mental  health practitioners in each INT to intervene early in anxiety/depression. Reactive Care 4. Reactive Care Programme – Hillingdon The Reactive Care programme is redesigning urgent and crisis care so residents  receive the right care, in the right place, at the right time when health or  social care needs escalate. It brings together our Integrated Urgent Response, hospital avoidance services,  and discharge support – creating a single pathway for unplanned care outside  of the acute hospital. The goal is a 24/7 community-based urgent care system able to respond to  crises within two hours, deliver short-term treatment and monitoring at home,  and coordinate a smooth return to routine or planned care. This transformation is vital to: •Reduce pressure on A&E and 999 •Prevent unnecessary admissions •Enable timely discharges •Improve patient outcomes and system flow Hillingdon’s Reactive Care model has three components: 1.Integrated Urgent Community Response 2.Supporting Discharge 3.Proactive support for reactive care (bridging prevention with urgent  response) The intended outcome is a single borough-wide Integrated Reactive Care Service, consolidating previously separate teams (rapid response nursing,  admission avoidance, discharge, and reablement) into one coordinated system. Reactive Care – Strategic Intent Integrate and strengthen urgent & emergency community services to manage crises outside hospital and support safe discharges. Establish a single Community Coordination Hub for 2-hour urgent response, linking rapid response, mental health crisis, and social care teams. Expand same-day urgent primary care capacity and implement 7-day services to improve hospital flow. Key Achievements to Date ✓ Coordination Hub model designed: Multi-agency taskforce set high- level operating model, staff workshops begun ✓ New “Lighthouse” mental health pathway approved: Increase crisis alternative capacity from 4 to 8–10 patients, direct from A&E (Phase 1 live Sept 2025) ✓ Community IV Antibiotics service launched (July 2025): Providing 6–8 daily IV therapy slots in the community, reducing hospital visits ✓ Direct GP-to-SDEC referrals implemented: GPs can now refer patients straight to same-day emergency care without ED, adding ~5 extra cases/day ✓ Hospital discharge improvements: Weekday discharges up from 51 to 55 per day (July 25) after new initiatives; weekend discharge up modestly. “Home First” discharge teams restructured and Take-Home-and-Settle service in place. Upcoming Priorities Launch Hillingdon Coordination Hub pilot by Dec 2025: single point for urgent community referrals, operating 8am–8pm, integrating health & social care rapid response Winter resilience (Oct 2025–Mar 2026): Execute surge plan – extend community urgent care hours, extra virtual ward capacity, close monitoring of admissions and discharges Lighthouse Phase 2 (Q3 25/26): pending evaluation, expand mental health hub to GP referrals further relieving ED Embed 7-day discharge model: By Q4 2025/26, fully implement weekend in-reach services (therapy, social care) to sustain higher discharge rates Integrated rehab & reablement service: Design by early 2026 a merged community rehab pathway (Health & Social Care) to reduce post-acute lengths of stay. Reactive Care Next 6–12 Months – Key Priorities •Launch the Integrated Coordination Hub (Dec 2025): Phase 1 will co-locate the Urgent Community Response, Rapid Response nursing, and therapy  triage teams. Preparatory work is underway, with SOPs due in October, end-to-end testing in  November, and go-live on 1 December . Phase 2 (by March 2026) will extend the Hub to include  mental health and social care staff, enabling a 2-hour response for at least 70% of appropriate  community crisis referrals. •Strengthen Discharge and Flow (from Sept 2025): A new multi-agency “NCR reduction taskforce” will review stranded patients daily to bring  medically-fit numbers down towards the target of 34. The Council and Age UK have deployed  staff to support families of self-funding patients with care home placements. The revised  Choice Policy will be rolled out by November to speed up discharge decisions. •Intermediate Care Integration (Q4 2025): Finalise the joint operating model for rehabilitation and reablement, with pilot implementation  planned for early 2026 and governance sign-off by year-end.

Health and Wellbeing Board report 9 September 2025 COMMUNITY EQUIPMENT SERVICE UPDATE Relevant Board Member(s) 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 Papers with report None HEADLINE INFORMATION Summary This report is to brief the Board on the changes to the provider of the Community Equipment Service from NRS Healthcare to Medequip Assistive Technology Limited. The change has arisen due to the liquidation of NRS Healthcare. The report also explains that the Council has left the London Community Equipment Consortium and made alternative arrangements to ensure the health and safety of residents. Contribution to plans and strategies The Community Equipment Service (CES) contributes to the delivery of the 2025/26 Better Care Fund Plan and ensures compliance with local authority duties under the Chronically Sick and Disabled Persons Act, 1970, and the Care Act, 2014. It also ensures compliance with NHS responsibilities under the National Health Service Act, 2006. Financial Cost The CES contract budget reflected in the 2025/26 BCF plan is £2,136k. Ward(s) affected All RECOMMENDATION That the Health and Wellbeing Board notes the content of the report and questions officers to address any queries or concerns it may have. INFORMATION 1. This report concerns arrangements to ensure continuation of the Community Equipment Service (CES) following the liquidation of the contracted provider, NRS Healthcare Limited (NRS). The report summarises actions taken and provides an update on the current position. 2. The Health and Wellbeing Board would not ordinarily be asked to consider a service specific report, but this matter is being brought to the Board’s attention because of the critical importance of the service to the health and safety of Hillingdon’s residents and its impact on the local health and care system. Health and Wellbeing Board report 9 September 2025 Strategic Context 3. The CES supplies equipment ranging from raised toilet seats to electric profiling beds and hoists, key safes and handrails to support residents of all ages, although most users are people aged 65 and above. The scope of the contract with NRS included the supply, delivery, fitting and installation, adjustment, servicing and testing, collection, refurbishment, recycling and disposal of items of equipment. 4. The service has a critical part in supporting the continued independence of Hillingdon's residents who are living with a physical disability and/or a sensory impairment, which is predominantly people aged 65 and over. The provision of this service also supports the local health and care system by:  Supporting the independence, safety and quality of life of Hillingdon's residents of all ages.  Preventing A & E attendances and emergency admissions.  Facilitating earlier hospital discharge and reducing length of stay.  Reducing care costs by avoiding or delaying admission to residential care. It also supports unpaid carers and reduces the need for additional care workers.  Facilitating people at end of life being able to die at home when this is their preferred choice. 5. The Council acts as lead commissioner for the CES on behalf of the Integrated Care Board (ICB) and the NHS prescribers make the greatest use of the service, which is reflected in local risk share arrangements, i.e., 71% NHS and 29% local authority in 2025/26. NRS were awarded a five-year contract in June 2023, which was a call-off from a London borough consortium framework led by the Royal Borough of Kensington & Chelsea (RBKC). As of 30 June 2025, there were 21 London boroughs and associated Integrated Care Boards that were members of the consortium. 6. As of 30 June 2025, there were 23,400 residents being supported by 206,872 items of equipment. In 2024/25, there were 10,400 residents referred by the NHS or social care (children and adults) prescribers for new equipment and/or who received repairs and planned preventative maintenance to existing equipment supplied to them. NRS Liquidation and Service Provider Change 7. NRS went into liquidation on 1 August 2025 when the court appointed the Official Receiver (OR) as the liquidator. The OR offered a managed wind-down of the service rather than an immediate cessation of trading. 8. Medequip Assistive Technology Limited was able to offer both Hillingdon and Ealing a service based on geography as they have a depot already located at Heathrow. In response to alerts by NRS about their financial position, the Council’s July 2025 Cabinet meeting agreed to award Medequip a contract for two years from 1 August 2025 with the option to extend for one further year. This is intended to give sufficient time for the detail of the longer-term service model to be determined and any required procurement activity to take place. 9. Hillingdon and Ealing represent one of the six groupings of boroughs and associated ICBs that have replaced the London consortium referred to in paragraph 5. 10. The Board is asked to note that the market for community equipment nationally is under- developed and has been dominated by three companies, Millbrook, Medequip Assistive Technology Limited and NRS. Before 1 August 2025, in London provision was split Health and Wellbeing Board report 9 September 2025 between Medequip and NRS, with only three boroughs having alternative provision arrangements, such as a local authority trading company. Interim Service Arrangements 11. The support offer from Medequip was to initially provide a limited service focused on equipment deliveries and installations intended to avoid admission to hospital and support discharge as well as to undertake repairs to equipment already supplied to residents in the community. These restrictions were introduced pending Medequip being able to increase its staffing capacity. The limited service started on 1 August 2025. 12. To support the limited service, a temporary reduced equipment catalogue was introduced with advice from senior leads from prescribing teams. The senior leads also provided nominations for a reduced list of authorised prescribers. 13. During the transition phase, the collection by Medequip of equipment no longer required by residents has been limited to the most urgent cases, e.g., end of life. Full Service Implementation 14. Plans are in place for a full service that includes equipment supply, installation, collection, recycling and servicing (also known as planned preventative maintenance) to be in place from 8 September 2025. This will include expanding the catalogue of equipment available and incrementally increasing the number of people authorised to prescribe equipment. Communication with Stakeholders Northwest London ICB 15. Officers are liaising with the ICB’s Programme Director, Integrated Care. The Board may wish to note that ICB emergency planning arrangements have now been stood down. These initially entailed twice weekly meetings with senior NHS provider leads across Hillingdon and other trusts supporting Hillingdon patients. Prescribing Teams 16. Updates to prescribing teams going forward will be managed through an operational advisory group that has been established. This group will also coproduce the development of the catalogue, manage the list of authorised prescribers and oversee the budget and prescribing practice. Equipment Users 17. Equipment users are informed of the changes via multiple channels including direct contact for servicing, care agencies and other home visiting teams, and an article in the Council magazine called Hillingdon People that goes to every household in the Borough. Resident support services such as the Hillingdon Advice Partnership have also been made aware of the new arrangements. Contract Management 18. The Council is responsible for contract management and feedback from the operational leads group referred to previously will be used as part of the contract management process, as will service user experience.

Health and Wellbeing Board report 9 September 2025 PHARMACEUTICAL NEEDS ASSESSMENT UPDATE Relevant Board Member(s) Sandra Taylor Organisation London Borough of Hillingdon Report author Kim Overy Papers with report Draft PNA 1. HEADLINE INFORMATION Summary From 1 April 2013, the statutory responsibility to publish and keep up to date a statement of the need for pharmaceutical services for the population in its area transferred to Health and Wellbeing Boards from Primary Care Trusts. This statement is known as the ‘Pharmaceutical Needs Assessment’ (PNA). The PNA assists in the commissioning of pharmaceutical services to meet local priorities. NHS England also use the PNA when making decisions on applications to open new pharmacies. A revised PNA should be published by 1 October 2025. This paper presents an update on progress to the Health and Wellbeing Board. Contribution to plans and strategies The PNA sets analysis of provision of pharmacy services within Hillingdon and contributes to the Hillingdon Joint Health and Wellbeing Strategy (JHWBS). Financial Cost There are no direct financial costs arising from this report. Ward(s) affected All 2. RECOMMENDATIONS The Health and Wellbeing Board is asked to note that: 1- work on the 2025 PNA is on track for publication by 1 October 2025. 2- the Draft PNA was signed off for consultation in early June 2025 (a 60-day consultation was hosted on the Council website between 20 June and 19 August 2025). 3- two pieces of feedback were received during the consultation period (one piece from a member of the public and one piece from a Boots branch), alongside feedback from: a. the Borough Lead Inequalities Pharmacist; b. the London Region Pharmaceutical Services Regulations Committee; and c. the Harmondsworth & Sipson Residents Association (following June’s Older People’s Assembly). Health and Wellbeing Board report 9 September 2025 4- feedback is currently being reviewed and integrated accordingly into the draft PNA; this includes: - changes to opening hours and trading names - more detail on future housing developments within the localities - further details on current and future provision, and any gaps - the need to reiterate that many pharmacies who responded to the survey said they are willing to provide services if commissioned 5- the verbal update on changes tabled at this meeting. 6- the Board is asked to provide delegated responsibility to the Public Health and Business Intelligence teams to make the amendments and sign off the document for publication by 1 October 2025. 3. NEXT STEPS The Board is asked to agree that the PNA be published by 1 October 2025 and agree to delegate further amendments of the PNA prior to publication to the Public Health team and Business Intelligence team.

Pharmaceutical Needs Assessment 2025 DRAFT September 2025 Contents List of tables ......................................................................................................................................... 4 List of graphs and figures ...................................................................................................................... 5 List of maps .......................................................................................................................................... 8 1. Summary ............................................................................................................................................. 9 1.1. Overview of the London Borough of Hillingdon ........................................................................... 10 1.2. Community Pharmacies in Hillingdon ........................................................................................ 11 1.3. Conclusions ............................................................................................................................. 12 2. Introduction ....................................................................................................................................... 14 2.1. Purpose of the PNA ................................................................................................................... 14 2.2. Scope of the PNA ...................................................................................................................... 15 Process for developing the PNA: ...................................................................................................... 18 3. Hillingdon population demographics ................................................................................................... 20 3.1. Population Projections: ............................................................................................................. 22 3.3. Ethnicity: .................................................................................................................................. 23 3.4. Languages: ............................................................................................................................... 25 3.5. Religion .................................................................................................................................... 27 3.6. Homelessness ......................................................................................................................... 28 3.7. Patient Group Demographics .................................................................................................... 28 3.8. Deprivation .............................................................................................................................. 29 3.8.1. CORE20 (PLUS5) ................................................................................................................... 32 3.10. Economic activity (employment and unemployment): .............................................................. 33 3.11. Benefit claimants: .................................................................................................................. 35 3.12. Access to transport: Public and Private transport: .................................................................... 37 4. The Health of Hillingdon’s Residents ................................................................................................... 38 4.2. Mortality ................................................................................................................................... 39 4.3. Disease Prevalence: ................................................................................................................. 40 4.3.1. Cardiovascular Disease: ........................................................................................................ 42 4.3.2. Respiratory Disease: .............................................................................................................. 45 4.4. Excess Weight and Obesity ....................................................................................................... 46 4.5. Mental Health & Neurological Conditions .................................................................................. 47 4.7. Learning Disabilities and SEND: ................................................................................................ 51 4.8. Smoking: .................................................................................................................................. 51 4.9. Seasonal influenza: .................................................................................................................. 51 4.11. All-age Vaccinations: .............................................................................................................. 53 4.12. Under 18s conceptions ........................................................................................................... 53 4.13. Substance misuse: Drugs & Alcohol ........................................................................................ 54 5. Pharmacy provision within Hillingdon .................................................................................................. 56 5.1. Access to a pharmacy ............................................................................................................... 64 5.2. Travel times to a pharmacy: ....................................................................................................... 66 5.4: Other NHS providers that affect pharmaceutical services .......................................................... 74 5.3. Pharmacy Services: .................................................................................................................. 76 5.3.2 Advanced Services: ................................................................................................................ 79 5.4. Enhanced Services: .................................................................................................................. 82 5.5. Analysis of the Pharmacy Questionnaire ........................................................................................... 84 5.6. Essential Services: ................................................................................................................... 85 37 of those who responded dispense some form of appliance. ......................................................... 85 5.6.1. Gaps in provision: Essential Services: ..................................................................................... 87 5.6.3. Gaps in provision: Advanced Services: ................................................................................... 90 5.7. Enhanced / Other services ........................................................................................................ 91 5.11. Gaps in provision: Enhanced / Other Services: ......................................................................... 97 5.13. Delivery services & non-commissioned services: ..................................................................... 98 5.14. Bank-holiday access ............................................................................................................... 99 5.16. Dispensing GP practices ......................................................................................................... 99 5.17. PhAS pharmacies: .................................................................................................................. 99 6. Patient Survey Outcome: ................................................................................................................... 100 6.2. PNA Localities: ........................................................................................................................... 107 6.2.1. North Locality: ...................................................................................................................... 108 6.2.2. Southeast Locality: ............................................................................................................... 110 6.2.3. Southwest Locality: .............................................................................................................. 112 7. Conclusions: ..................................................................................................................................... 114 8. Data Sources: ................................................................................................................................... 115 8.1 Glossary ......................................................................................................................................... 117 9. Pharmacy opening hours ................................................................................................................... 118 List of tables Table Page Table 1: Hillingdon age breakdown, 2022/23 22 Table 2: Community pharmacies in Hillingdon by ward and locality 56 Table 3 Pharmacies that have closed since 2022 57 Table 4: Drive Times to local pharmacies 65 Table 5: Opening hours overview (borough) 87 Table 6: Enhanced / other services 91 Table 7: Screening services 94 Table 8: Vaccinations 94 Table 9: Delivery and non-commissioned services 97 Tables 10 to 16: patient survey equalities monitoring 106 Table 17: North locality opening hours overview 108 Table 18: Southeast locality opening hours overview 110 Table 19: Southwest locality opening hours overview 112 Table 20: North locality detailed opening hours 118 Table 21: Southwest locality detailed opening hours 120 Table 22: Southeast locality detailed opening hours 122 List of graphs and figures Graph or Figure Page Figure 1: Hillingdon population density 20 Figure 2: Household size 21 Figure 3: Population Pyramid 22 Figure 4: Census changes between 2011 and 2021 23 Figure 5: Broad ethnic groups 24 Figure 6: Percentage of population ethnicity 24 Figure 7: Ethnicity by age 25 Figure 8: Country of birth 26 Figure 9: Religion 27 Figure 10: Religion by ward 27 Figure 11: Homelessness trend 28 Figure 12: Deprivation deciles 30 Figure 13: Income 33 Figure 14: Economic activity 34 Figure 15: Employment rate 34 Figure 16: Benefits claimant count 35 Figure 17: Universal credit overview 36 Figure 18: Universal credit, Oct 2024 37 Figure 19: Life expectancy 38 Figure 20: Healthy life expectancy 38 Figure 21: Disability-free Life Expectancy 39 Figure 22: Mortality trend 39 Figure 23: Premature deaths 40 Figure 24: Disease prevalence spine chart 40 Figure 25: Atrial Fibrillation prevalence 42 Figure 26: Coronary Heart Disease prevalence 42 Figure 27: Heart Failure prevalence 43 Figure 28: Hypertension prevalence 43 Figure 29: Peripheral Arterial Disease prevalence 44 Figure 30: Stroke and Transient Ischaemic Attack prevalence 44 Figure 31: Asthma prevalence 45 Figure 32: COPD prevalence 45 Figure 33: Obesity prevalence, adults 46 Figure 34: Obesity trend, adults 46 Figure 35: Obesity (Reception) NCMP trend 47 Figure 36: Obesity (Year 6) NCMP trend 47 Figure 37: Dementia prevalence 48 Figure 38: Depression prevalence 48 Figure 39: Mental health prevalence 49 Figure 40: Cancer prevalence 49 Figure 41: Chronic Kidney Disease prevalence 50 Figure 42: Diabetes Mellitus prevalence 50 Figure 43: Non-diabetic hyperglycaemia prevalence 51 Figure 44: Influenza vaccinations 52 Figure 45: STI spine chart 52 Figure 46: Vaccinations spine chart 53 Figure 47: Under 18s conception trend 54 Figure 48: Drug treatment completions 54 Figure 49: Alcohol admissions spine chart 54 Figure 50: Essential Services: Dispensing by locality 76 Figure 51: BNF high volume 77 Figure 52: BNF medium volume 77 Figure 53: BNF low volume 77 Figure 54: Dispensing flows, North locality 78 Figure 55: Dispensing flows, Southwest locality 78 Figure 56: Dispensing flows, Southeast locality 78 Figure 57: Discharge Medicine Service 79 Figure 58: Advanced Services: Pharmacy First performance 80 Figure 59: Lateral Flow Device 80 Figure 60: Flu vaccination provision 81 Figure 61: Community Pharmacy Consultation Service provision 81 Figure 62: Contraception provision 81 Figure 63: Blood Pressure checks 82 Figure 64: New Medicine Service 82 Figure 65: Pharmacy Survey: pharmacy responses 84 Figure 66: Consultation rooms 84 Figure 67: Languages 85 Figure 68: Appliance provision 85 Figure 69: DMS provision 86 Figure 70: Advanced Services provisions 90 Figure 71: Influenza vaccination provision 92 Figure 72: Enhanced services provision 93 Figure 73: Enhance service provision continued 94 Figure 74: Vaccination provision 96 Figure 75: Delivery and non-commissioned service provision 97 Figure 76: Patient survey respondents 100 Figure 77 - 85: Patient survey responses 100 List of maps Map Page Map 1: Indices of Multiple Deprivation 30 Map 2: IDACI deprivation 31 Map 3: IDAOPI deprivation 31 Map 4: CORE20 (PLUS5) 32 Map 5: Primary Care Networks 41 Map 6: Pharmacies in Hillingdon and those outside the boundary 60 Maps 7 to 9 – Hillingdon pharmacies by locality 61 Map 10: One mile distance around each pharmacy 64 Map 11: Walking by time 66 Map 12: Walking by distance 67 Map 13: Travel by car, by distance 68 Map 14: Travel by car, non-rush hour 69 Map 15: Travel by car, rush hour 70 Map 16: Public transport, weekday morning 71 Map 17: Public transport, weekday afternoon 71 Map 18: Public transport, weekday evening 72 Map 19: Public transport, weekend morning 72 Map 20: Weekend afternoon 73 Map 21: Weekend evening 73 Map 22: Hospitals with a 5-mile radius 74 Map 23: A&E hospitals within a 30-minute drive time 75 Map 24: North locality pharmacies 108 Map 25: Southeast locality pharmacies 110 Map 26: Southwest locality pharmacies 112 1. Summary Every Health and Wellbeing Board (HWB) has a statutory duty to carry out a Pharmaceutical Needs Assessment (PNA) every three years. The PNA provides Hillingdon’s Health & Wellbeing Board (HWB) with a framework that supports the local health and care system to: − understand the demographics of the local population − understand current provision of pharmaceutical services, including - the range of providers and choice - their premises (including facilities), the location and geographical spread across the area - the range of services provided − make appropriate decisions on applications for inclusion in a pharmaceutical list − commission appropriate and accessible services from pharmacies and dispensing appliance contractors − identify and address any local gaps in pharmaceutical services − target services to reduce health inequalities within local health communities. Pharmaceutical services are provided by pharmacy and dispensing appliance contractors from premises that are registered on a pharmaceutical list within each HWB area. In addition, some GP surgeries provide a dispensing service to eligible patients registered to their practice, and some pharmacy contractors provide services under a local pharmaceutical services contract. Pharmacy contractors provide services under the national Community Pharmacy Contractual Framework (CPCF) which sets out three levels of service: 1. Essential Services: these are the services that every community pharmacy providing NHS pharmaceutical services must provide and includes the dispensing of medicines and appliances, disposal of unwanted medicines, clinical governance, and promotion of healthy lifestyles 2. Advanced Services: there are nine services that Community Pharmacy Contractors and Dispensing Appliance Contactors (DACs) can choose to provide. Provision of these services are subject to accreditation as set out in the Secretary of State Directions 3. Enhanced Services: these are nationally commissioned services (commissioned directly by NHS England) that have been introduced to assist the NHS in improving and delivering a better level of care in the community. Pharmacy contractors can choose to provide any of these services Locally commissioned services can also be commissioned by the Local Authority (LA) or the Integrated Care Board (ICB). These are services that community pharmacy contractors could choose to provide and are included in the PNA. For this PNA, Essential Services and the dispensing service provided by some GP surgeries are defined as ‘necessary services’, while Advanced and Enhanced Services are defined as ‘other relevant services.’ Other locally commissioned providers may also provide specific services that impact the need for local community pharmacy services. These specific services include sexual health services, stop-smoking support and needle exchange services. The geographical location of pharmaceutical providers determines access to services in terms of distance from a resident's home or work (either within Hillingdon or neighbouring boroughs). The surrounding location is included in the access criteria, and whether the service is accessible via public transport, whether there is the ability of service users to drive and park and the access to services for residents with a disability. Locating a service within or near to other services (for example within a supermarket) may influence choice by reducing travel. However, access is determined by more than just location; opening times are also an important aspect of access and service availability. Pharmaceutical services need to be available during ‘normal’ day-time hours (e.g. weekdays 9 am to 5- 6pm) when many other professional services might be expected to be available. The needs of specific groups of residents also need to be considered, for example: - workers being able to access pharmacy services after 6 pm or during lunchtime hours - those who access general practice in extended hours, e.g. up to 8pm on weekdays - those with more urgent self-care, unplanned care needs or for end-of-life care needs, at non- routine times, including weekends and in the evening. The Hillingdon Council Business Intelligence Team has completed the PNA in collaboration with the LA Public Health Team, Customer Engagement, the Council Communications Team, the Local Pharmaceutical Committee for Hillingdon and Healthwatch Hillingdon. The PNA has been overseen by the Hillingdon Health & Wellbeing Board to ensure it is fit for purpose as per the NHS Regulations. The process of developing this PNA has consisted of: - gathering and analysing data and information of population demographics, public health data, prescribing and service use data - mapping and evaluating existing pharmacy services - assessing service gaps based on population growth and access issues - a 60-day public consultation to gather feedback from stakeholders and the public running between June and August Lastly, reviewing feedback from the resident and pharmacy provider consultation to finalise the PNA, ahead of publication on the Council website within the national timeframe. Data presented throughout the PNA are accurate as of May 2025, unless stated otherwise. Any subsequent changes to pharmacy service provision in Hillingdon will be monitored, including any changes to the availability of pharmaceutical services reflected through supplementary statements (published alongside the PNA document), as and when appropriate. 1.1. Overview of the London Borough of Hillingdon Hillingdon is the second largest of London’s 32 boroughs and shares its borders with Hertfordshire, Buckinghamshire, Surrey, and the London boroughs of Hounslow, Ealing and Harrow. Hillingdon has 21 electoral wards within three localities: North (8 wards), Southeast (7 wards) and Southwest (6 wards). The borough has been split into these localities based on the 2022 ward structures and data is widely available at ward or LSOA level for analysis to support the information used in the PNA. These localities align with the Primary Care Network structures and the Integrated Neighbourhood Teams (INT) that are the local vehicles of primary and community care delivery. Each locality shares several socio-economic characteristics which makes analysis easier. The current population of Hillingdon is 319,018 (ONS Mid-year Estimate, 2023). This represents growth of 8,337 residents from 2022 (2.6%). At locality level, 33.6% of the borough live in the North INT area, 30.6% in the Southwest and 35.7% in the Southeast. Over the course of this three-year PNA duration we can expect to see an average increase of 1,200 new dwellings per year, with most of the growth in population associated with new homes in the southern localities, specifically the Southeast. 48.2% of residents in Hillingdon are White. This is lower percentage than London and England. 33.3% of Hillingdon residents are Asian/Asian British; higher than London and England. There is a higher proportion of White and older residents in the North and Southwest localities, and southern localities, especially the Southeast locality have higher proportions of younger Asian and Black residents (Census 2021). Population at ward level ranges from 5,640 residents in Harefield Village to 19,701 residents in Wood End ward. The south of the borough is more densely populated with approximately two thirds of residents living in the southern wards. Wards in the south have higher levels of overcrowding and higher proportions of households with six or more residents. Hillingdon has a mixed socio-economic profile. The 2019 English Index of Deprivation ranks Hillingdon as 21st most deprived out of the 33 London boroughs. The boroughs average deprivation score masks the differences at ward level where northern wards are the least deprived and wards in the south have higher levels of deprivation than the Hillingdon average. Hillingdon has no LSOAs in decile 1 (the 10% most deprived areas) on the overall national indices. The long-term London Shared Needs Assessment (2024) and the Core20Plus 5 framework highlights that Hillingdon’s long term population health is deteriorating, with: - significant socio economic and environmental deprivation factors are driving the increasing prevalence of long-term conditions particularly in our most deprived communities (Yiewsley, Hayes, and West Drayton). This includes a high child poverty rate (31%), low mean income post housing costs, food insecurity and higher than NWL average rates of overcrowding and homelessness - 48% (127,264) of the Hillingdon registered Adult (18+) population are currently living with 1 or more Long Term Conditions (LTCs); making Hillingdon joint highest with Harrow in NWL for the highest weighted average % of patients with LTCs. The top five LTC’s within the Borough are: Hypertension, Anxiety, Depression, Obesity & Diabetes. This is double the number of people recorded as living with one or more LTC compared to 2017 1.2. Community Pharmacies in Hillingdon There are 59 pharmacies in Hillingdon that provide pharmaceutical services, a rate of 19.0 per 100,000 residents. Since the 2022 PNA was published, five Hillingdon pharmacies have closed; Lloyd's pharmacy in both Sainsburys (Hayes and South Ruislip) and three Boots pharmacies (Uxbridge, Eastcote and Northwood Hills). Hillingdon has better coverage of pharmaceutical services per 100,000 population than England, but slightly less than London. The rate is higher in the boroughs North locality (20.1) compared with the other two localities (Southwest 18.9/100,000 population and Southeast 18.0/100,000 population). There is variation in pharmacy coverage at ward level, with more pharmacies located in town centre areas within the localities (i.e. Ruislip and Hayes Town). There are good public transport links to town centres within Hillingdon and across the borough boundary in neighbouring boroughs. Three of the five pharmacies that have closed since 2022 were located on existing high streets with other pharmacies close by. This enabled residents to maintain access to local pharmacy services. Data indicates that dispensing services from the closed pharmacies in Northwood Hills, South Ruislip and Uxbridge have transferred to pharmacies nearby. In Hayes this appears to differ due to the increased choice of provision in very close proximity along the Uxbridge Road and Coldharbour Lane. The national framework for pharmaceutical services requires every pharmacy to open fora minimum of 40 hours a week to provide essential services (necessary services). Although the south of the borough has less pharmacies than the north, some of these pharmacies have longer opening hours, and more are open on Sundays. There is a good spread of pharmacies that open early, remain open late and at weekends, all with good accessibility. There is an even spread of pharmacies in areas of deprivation in the south of the borough, and in areas with higher proportions of older people and people with long term conditions. During certain days and times of the week, community pharmacies are often the only healthcare facility available. Pharmacy provision is good across all three localities in Hillingdon. In the pharmacy survey pharmacists stated their willingness to provide services that may be required in the future. This flexibility and adaptability of pharmacists indicates that there are opportunities to develop services and that the scope of services and the number of pharmacies is sufficient to manage the need of the population over the course of this PNA. 1.3. Conclusions For this PNA, Essential Services for Hillingdon are defined as Necessary Services. Advanced and Enhanced Services are considered relevant as they contribute toward improvement in provision and access to pharmaceutical services. Locally Commissioned Services are those that secure improvements or better access to or that have contributed towards meeting the need for pharmaceutical services in Hillingdon. These services are commissioned by the ICB or the local authority, rather than NHSE. The Hillingdon HWB considered the number, distribution, access and choice of providers of pharmaceutical services covering each of the three localities in Hillingdon and conclude that the evidence reviewed to inform this PNA based on the national criteria indicates that residents are adequately served by providers of pharmaceutical services in the borough. No current or future gaps have been identified in the provision of necessary and other relevant services across Hillingdon. Changes affecting pharmaceutical services provision such as substantial changes in current provision through business closure and/or changed population demographics will be monitored and reviewed by the HWB. The PNA will be updated with supplementary statements where necessary to explain the impact of any changes and what this means for the availability and accessibility of pharmaceutical services in Hillingdon. 2. Introduction Since the 2022 PNA, five pharmacies have closed. The following changes have also occurred: - There has been an update to the Pharmaceutical Regulations 2013 in May 2023 in response to the number of requests for temporary pharmacy closures with changes made to the: - Notification procedures for changes in core and supplementary opening hours - Notification procedures for 100-hour pharmacies to be able to reduce their hours to no less than 72 hours per week - Local arrangements with ICBs for the temporary reduction in hours - requirement for all pharmacies to have a business continuity plan that allows them to deal with temporary closures - Integrated Care Boards (ICB) have replaced Clinical Commissioning Groups (CCGs) as part of Integrated Care Systems (ICS). In an ICS, NHS organisations in partnership with local councils and other public sector and voluntary and community sector organisations take collective responsibility for managing resources, delivering NHS standards of care and improving the health of the population they serve. ICBs took on the delegated responsibility for the commissioning of pharmacy services from NHS England from 1 April 2023. - The Pharmacy First Service builds on the Community Pharmacist Consultation Services (CPCS) and was launched at the end of January 2024. Pharmacy First allows patients to obtain treatment for their health conditions directly from community pharmacies without needing a GP appointment. The conditions that are included in Pharmacy First are sinusitis, sore throat, earache, infected insect bites, impetigo, shingles, and uncomplicated urinary tract infections in women. - Hypertension Case-Finding Service requirements were updated from 1 December 2023. This service can be provided by suitably trained and competent pharmacy staff (previously, only pharmacists and pharmacy technicians could provide the service). - The Hepatitis C testing service was decommissioned at the beginning of April 2023. 2.1. Purpose of the PNA The purpose of the PNA is to assess and set out how the provision of pharmaceutical services can meet the health needs of the population of Hillingdon for the next three years. The PNA links closely to other strategies and needs assessment, notably the Joint Local Health & Wellbeing Strategy (JLHWS) and the Joint Strategic Needs Assessment (JSNA). The PNA sets out how health needs can be met by pharmaceutical services commissioned by the ICB on behalf of the NHS in England. If a pharmacy or a dispensing appliance contractor wants to provide pharmaceutical services, they are required to apply to the ICB to be included in the pharmaceutical list for the HWB area in which they wish to have premises. Their application must demonstrate how they will meet a need that is set out in the HWB’s PNA, or to secure improvements or close an access to service gap identified in the areas PNA. There are however some exceptions to this, for example, applications offering benefits that were not foreseen when the PNA was published (‘unforeseen benefits applications’). As well as identifying if there is a need for additional premises, the PNA will also identify whether there is a need for an additional service or services, or whether improvements or better access to existing services are required. Identified needs, improvements or better access may be needed or will arise within the three-year lifetime of the PNA. Whilst the PNA is primarily a document for the ICBs to use to make commissioning decisions, it may also be used by local authorities. A robust PNA will ensure those who commission services from pharmacies and Dispensing Appliance Contractors (DACs) where to target services to areas of health need and reduce the risk of overprovision in areas of less need. 2.2. Scope of the PNA The Pharmaceutical Regulations 2013 detail the information required to be contained within a PNA. A PNA is required to measure the adequacy of pharmaceutical services in the HWB area under five key themes: • Necessary services: current provision • Necessary services: gaps in provision • Other relevant services: current provision • Improvements and better access: gaps in provision • Other NHS services In addition, the PNA details how the assessment was carried out. This includes: • How the localities were determined • The different needs of the different localities • The different needs of people who share a particular characteristic • A report on the PNA consultation To comprehend the definition of 'pharmaceutical services' as used in this PNA, it is important to understand the types of NHS pharmaceutical providers in the pharmaceutical list maintained by NHSE. The types of NHS pharmaceutical providers are: • Pharmacy contractors • DACs • LPS providers • Dispensing GP surgeries Pharmaceutical services provided by community pharmacies, dispensing GP surgeries and appliance contractors are defined by the Pharmaceutical Regulations 2013 and consist of services that are/may be commissioned under the provider’s contract with NHSE. For this PNA, ‘necessary services’ are understood to be equivalent to Essential Services, while ‘other relevant services’ are equivalent to Advanced and Enhanced Services. Pharmacy contractors operate under the NHS Community Pharmacy Contractual Framework (CPCF) which sets out three levels of service under which pharmacy contractors operate: Essential Services: These are nationally negotiated and must be provided by all pharmacies: • Dispensing Medicines • Dispensing Appliances • Repeat Dispensing • Discharge Medicine Service (DMS) • Public Health and Health Promotion • Signposting • Support for Self-Care • Disposal of Unwanted Medicines • Clinical Governance Advanced Services: These services are nationally negotiated, and any contractor may provide any of these services if they meet the requirements of the Pharmaceutical Regulations 2013 and service specification associated with each service. They are: • Appliance Use Reviews (AURs) • Pharmacy First • Seasonal Influenza Vaccination Service • Hypertension Case-Finding Service • New Medicine Service (NMS) • Stoma Appliance Customisation (SAC) • Smoking Cessation Service Enhanced Services (national and local): In December 2021 provisions were made within the NHS Pharmaceutical and Local Pharmaceutical Services Regulations 2013 to provide a new type of enhanced pharmaceutical service. These are developed by NHS England and NHS Improvement and commissioned to meet specific health needs. Enhanced Services can include: • Care home service • Chlamydia Screening & Treatment • Emergency Hormonal Contraception (EHC) service • Minor ailment service • Needle and Syringe Programme (NSP) • Patient group direction (PGD) service • Smoking Cessation Service (SCS) • Pharmacy Based Supervised Administration Programme (PBSAP) National Enhanced Services (NES): Enhanced Services are all considered relevant for the purpose of this PNA. Under the pharmacy contract, Enhanced Services are those directly commissioned by NHSE. There is currently one National Enhanced Service commissioned in Hillingdon, the COVID-19 vaccination service. This service is provided from selected community pharmacies who have undergone an Expression of Interest Process, and the service is commissioned by NHSE. Pharmacy owners must also provide the Flu Vaccination Service for a selected cohort of patients. Pharmacy Access Scheme (PhAS) providers: The PhAS has been designed to capture the pharmacies that are most important for patient access, specifically those pharmacies where patient and public access would be materially affected should they close. The PhAS takes isolation and need levels into account. Pharmacies in areas with a dense provision of pharmacies remain excluded from the scheme. In areas with high numbers of pharmacies, public access to NHS pharmaceutical services is not at risk. The scheme is focused on areas that may be at risk of reduced access, for example, where a local population relies on a single pharmacy. DSPs, DACs, LPS contractors and dispensing GP practices are ineligible for the scheme. From 1 January 2022, the revised PhAS is to continue to support patient access to isolated, eligible pharmacies and ensure patient access to NHS community pharmaceutical services is protected. There are three PhAS in Hillingdon; Howletts (Ruislip) and Boots landside in Terminal 3 and Terminal 5 in Heathrow Airport. Dispensing Appliance Contractors (DACs): DACs operate under the Terms of Service for Appliance Contractors as set out in Schedule 5 of the Pharmaceutical Regulations 2013. They can supply appliances against an NHS prescription, are not required to have a pharmacist, do not have a regulatory body and their premises do not have to be registered with the General Pharmaceutical Council. There are no DACs in Hillingdon. Other providers of pharmaceutical services in neighbouring areas: There are six other neighbouring boroughs that border Hillingdon: • Ealing • Harrow • Hertfordshire • Hounslow • Spelthorne • South Buckinghamshire In determining the needs for pharmaceutical service provision to the population of Hillingdon, consideration has been made to the pharmaceutical service provision from the neighbouring HWB areas. Although these pharmacies have not been included in the survey of contractors this PNA includes maps showing their proximity to Hillingdon. Process for developing the PNA: Hillingdon HWB has statutory responsibilities under the Health and Social Care Act to produce and publicise a revised PNA at least every three years. Hillingdon’s last PNA was published in September 2022 and is due to be refreshed and published by the end of September 2025. Other strategies considered include: Joint Strategic Needs Assessment (JSNA): The aim of the JSNA is to improve the health and wellbeing of the local community and reduce health inequalities for residents of all ages, identifying those groups where health and care needs are not being met and those residents which are experiencing poorer health and wellbeing outcomes. Hillingdon’s JSNA is currently being refreshed and is in the process of being replaced by the Hillingdon Datahub; the Datahub has been used to populate many of the figures within the PNA. Health and Wellbeing Strategy (HWS): Hillingdon’s draft Joint Local Health & Wellbeing Strategy 2025-28 seeks to improve the health and wellbeing of all our residents and reduce disparities in health and care across our communities to achieve a vision shared by all health and care partners in the borough. The priorities and objectives include:  Thriving Healthy Households: - whole-population approaches to prevent ill health and promote wellbeing through self- management - tackling the social determinants of poor health - improving air quality and built environment  Early Intervention and Prevention: - optimising preventative care for people with LTCs with an emphasis on hypertension - maximising independence and choice - preventing reliance on health and care services  Targeted long-term care and community support for people with complex health and care needs: Provide proactive, personalised and integrated case management and care across primary, community, mental health, social care and voluntary services for high-need, high-utilisation patients to: - Maintain their independence for as long as possible - Reduce non-elective presentations - Reduce admissions to long term care A small number of high impact actions and key performance indicators (KPIs) have been created to monitor performance of the objectives. Included in the HWS is the Core20PLUS5 framework, an NHS England initiative aimed at reducing healthcare inequalities, which focuses on the most deprived 20% of the population (CORE20), additional marginalised groups (PLUS) and five (5) key clinical priority areas. Hillingdon’s draft Health & Wellbeing Strategy (2025-28) shows how these priorities relate to Hillingdon: Pharmaceutical service providers have the potential to play a greater role in identifying and helping address priority health needs as they are strategically placed in the community and have daily interactions with the local populations. To help understand local health needs and how pharmaceutical service providers can be involved in various interventions, the next sections look at Hillingdon’s population and major causes of ill health. 3. Hillingdon population demographics The current population of Hillingdon is 319,018 (ONS Mid-year Estimate 2023). This represents growth of 8,337 residents from 2022 (2.6%). The largest element of change between 2022 and 2023 was from international migration; natural change (births minus deaths) accounted for an additional 2,000 residents, internal migration accounted for a decrease of 3,950 residents and international migration accounted for a net change of 10,100 residents – giving overall growth of approx. 8,000 residents between 2022 and 2023. The current dataset of ward population estimates 310,681 residents (2022); population totals at borough and ward level vary as there is a lag in the publication of data at different geographies. Population between wards varies; Harefield Village has the smallest population (5,640) and Wood End the largest (19,701). The south of the borough is more densely populated with approximately two thirds of residents living in the southern wards; 8 of the top 10 most densely populated wards are in the south, with Belmore topping the ranks with the most residents per square km. Wards in the south have higher levels of overcrowding, with up to 20% of households having fewer bedrooms than required (1 or 2 or less than needed). Wards in the south have higher proportions of households with six or more residents. Figure 1: Hillingdon Population Density: Figure 2: Household size in Hillingdon (2021): The GP registered population in Hillingdon: This population is estimated at 346,632 (2023/24); the difference between this and the usual resident population is that some people registered with a Hillingdon GP will be non-Hillingdon residents. Similarly, some Hillingdon residents will be registered with GPs outside of the borough. Daytime / workday population: The population of an area changes as people move in and out of an area to work or study. Census 2011 indicated that the working age population increases by 17.3% during the workday (or 34,700 people); Census 2021 took place during the Covid pandemic when a nationwide lockdown was still in place, with many people working from home. Although the pandemic has now passed, applying the 2011 percentage to the current population estimates that we could have an additional 55,000 people potentially accessing services within Hillingdon during the working day, similarly just as a percentage of our residents will access services outside our boundary, i.e. a pharmacy near their place of work, study or end destination. Data from the NHS Business Services Authority shows that in September 2024 approximately 11% of prescriptions dispensed by pharmacies in the borough were from GPs outside the borough boundary. Gender by age range: The Hillingdon population is split 49.9% male (159,326) and 50.1% female (159,692), with variations by age range which can be seen in Figure 3 which also shows the age distribution in comparison to London and England. Hillingdon has higher proportions of younger residents aged 0-18 than London and England. Figure 3: Hillingdon Population by gender and age compared to London and England: 2023: The North locality has higher proportions of residents aged 65 years and older, with the Southeast and Southwest localities having higher proportions of younger residents aged under 19 years. Table 1: Hillingdon age breakdown, 2022/23 Age Band Hillingdon Persons Hillingdon % of population North locality Southeast locality Southwest locality London England Age: 0-3 16,731 5.2% 4.6% 5.4% 5.6% 4.7% 4.2% Age: 4-18 61,350 19.2% 17.6% 20.9% 19.5% 17.7% 17.8% Age: 19-64 198,420 62.2% 58.5% 63.5% 63.9% 65.4% 59.3% Age: 65-74 22,200 7.0% 9.2% 5.9% 6.2% 6.6% 9.5% Age: 75+ 20,317 6.4% 10.0% 4.4% 4.9% 5.6% 9.2% 3.1. Population Projections: At the current time (February 2025), no Sub-National Population Projections have been published since 2018; an updated data set is due in 2025. Using the growth data between the 2011 and 2021 Census (11.7%) we could expect the population in 2031 to be 342,000. Figure 4 shows the large growth in the older population since Census 2011, with some younger age cohorts seeing a decrease; the largest growth was in those aged 55 to 59, who between 2021 and the next census will further increase the older population. Figure 4: Since 2021 the North locality has seen a very small reduction in the number of residents (a net reduction of 157 residents overall). The Southeast has seen the largest growth (3,004 extra residents) and the Southwest saw growth of 1,917 residents. Over the course of this PNA we can expect to see an average increase of 1,200 new dwellings per year, with most of the growth of the associated new population in the southern localities, specifically the Southeast. 3.2. Births and Fertility: Births In Hillingdon have fallen from 4,500 in mid-2016 to 4,100 in mid-2023. Wards in the Southeast locality have seen the highest numbers of births (specifically Belmore, Wood End and Hayes Town) alongside Yiewsley in the Southwest locality. The Total Fertility Rate in Hillingdon has fallen to 1.72 in 2023 (from 1.79 in 2020) with rates also having fallen in London and England. 3.3. Ethnicity: 48.2% of residents are White, lower than London and England; 33.3% are Asian/Asian British, higher than London and England. Figures 5 and 6 show the borough data. Figure 5: Broad Ethnic Groups in Hillingdon: 2021 Figure 6: Percentage of Population by Ethnic Group (excluding white population): 2021: There is a higher proportion of White and older residents in the North and Southwest localities, and the southern localities have higher proportions of younger Asian and Black residents, as shown in Figure 7. Figure 7: Ethnicity by Age Range: Census 2021: 3.4. Languages: Census 2021 shows that 75% of borough residents aged 3 years and older have English as their main language. For residents who do not have English as their main language, 17.5% can speak it well or very well. There is variation at locality level, with Belmore ward (Southeast locality) having the lowest level of residents aged 3 years+ with English as the main language (58.3%), whereas Harefield Village ward (North locality) has 90.2% of residents with English as their main language. The top three main languages spoken by residents in Hillingdon (after English) is Panjabi (4.5%), Polish (1.6%) and Tamil (1.6%). Over 80 languages are spoken by Hillingdon residents. 3.5. Country of Birth: 62% of borough residents were born in the UK, with a further 19.8% from Middle & East Asia. Figure 8: Country of Birth by region of Hillingdon residents (excluding Europe): 2021: There is variation at locality level, with Hayes Town ward (Southeast locality) having the lowest level of residents born in the UK (43.8%), whereas Ruislip ward (North locality) has 77.9% of residents who were born in the UK. 3.5. Religion Census 2021 shows that the majority of residents in Hillingdon identify as having a Christian faith, followed by No Religion and Muslim; 6% chose not to answer the optional question. Figure 9 shows the borough proportions and Figure 10 shows the variation at ward level. Figure 9: Recorded religion in Hillingdon: Census 2021: Figure 10: Reported religion by ward: Hillingdon: 2021: 3.6. Homelessness Hillingdon has seen a large increase in households in temporary accommodation since 2021/22. Figure 11 shows Hillingdon’s trend data, which has shown larger increases than London and England. Figure 11: Homelessness: households in temporary accommodation: Rough Sleepers: monthly data from the Ministry of Housing, Communities & Local Government shows that in September 2024 there were - 86 people sleeping rough over the month - 47 new people sleeping rough over the month (an increase of 21% since September 2023. 3.7. Patient Group Demographics 3.7.1. Student population: Students studying and resident on campus during term times can impact on service needs. Hillingdon is home to Brunel University, Buckinghamshire New University’s Uxbridge campus and Uxbridge College (spread over two campuses - Uxbridge and Hayes): • The Brunel University campus includes a medical centre and pharmacy and is close to Uxbridge Town Centre • Buckinghamshire New University is close to Uxbridge Town centre • Uxbridge College campuses are close to Uxbridge or Hayes Town centres 3.7.2. Immigration Removal Centre: Within Hillingdon’s boundary is the Heathrow Immigration Removal Centre (HIRC); situated two miles away from Heathrow Airport comprising of two separate buildings (Harmondsworth IRC and Colnbrook IRC), it has a combined capacity of 965 residents. 3.7.3. Military Veterans: Data from Census 2021 shows that 3,443 residents have previously served in UK regular armed forces, a further 1,211 have served in the UK reserve armed forces and an additional 177 have served in both (a total of 4,831 residents aged 16+). 3.7.4. RAF base: Hillingdon is home to RAF Northolt in South Ruislip ward. 2,000 service personnel (from all three Armed Forces), civil servants, and contractors work at RAF Northolt, which has an onsite medical centre and dentist. 3.7.5. Immigration: Immigration statistics from the Home Office show that in December 2024 Hillingdon was supporting 3,816 people under three pathways; the Homes for Ukraine, Afghan Resettlement Programme and Supported Asylum that account for 1.2% of the borough population, the highest proportion of all local authorities in Great Britain. 3.7.6. Travellers: Census 2021 counted 472 Gypsy or Irish Travellers living in Hillingdon, 0.2% of the borough population. The majority live in the Southwest of the borough (60.4%, 285), 26.7% live in the Southeast (127) and 12.7% live in the North (60). There are 691 Roma residents, 0.2% of the population; 41.4% live in Southwest wards (286), 33% live in Southeast wards (228) and 25.6% live in the north of the borough (177). Census counted six residents who responded as ‘other traveller’, all live in Yiewsley ward. 3.7.7. Unpaid Carers: Census 2021 counted 22,464 residents (aged 5+) who provide unpaid care. The number of hours per week varies but 5,007 residents provide 20 to 49 hours per week, and 6,445 residents provide 50+ hours per week. Note that Census 2021 took place during the COVID pandemic, which may have affected how people responded. Some of these patient groups will be included within the normal resident population. 3.8. Deprivation Hillingdon is ranked 21st most deprived of the 33 London Boroughs (including City of London). The following 3 maps show the various versions of IMD ranking in Hillingdon: • Overall Indices of Multiple Deprivation (IMD): Hillingdon has no LSOAs among the 10 per cent most deprived nationally • Income Deprivation Affecting Children Index (IDACI) ranking: Hillingdon has two LSOAs in the south of the borough in the most deprived 10% of LSOAs in England • Income Deprivation Affecting Older People Index (IDAOPI): Hillingdon has six LSOAs in the south of the borough in the most deprived 10% of LSOAs in England Deprivation in older people is associated with poor health outcomes; this has implications for health and care services, including pharmacy services. Map 1: IMD by Hillingdon ward: 2019: Figure 12: Percentage of Hillingdon LSOA in each national deprivation decile: Map 2: Income Deprivation Affecting Children Index: Hillingdon: 2019 Map 3: Income Deprivation Affecting Older People Index, 2019: 3.8.1. CORE20 (PLUS5) On the overall Indices of Multiple Deprivation (Core20), 4% of the borough's population live within the most deprived 20% of LSOAs (12,541 residents) – Hillingdon’s has no LSOAs in the most deprived decile. All these LSOAs fall within southern wards. The population increases when looking at the indices affecting children and older people; all LSOAs are still in the south of the borough: - Indices affecting children – 5.9% of residents (18,401) - Indices affecting older people – 12.6% of residents (39,029) Map 4: The most deprived 20% of LSOAs in the overall indices: Source: SHAPE Atlas by the Department of Health & Social Care 3.9. Low Income Hillingdon has lower rates of children under 16 living in families with low income when compared to London and England, though there will be variation at ward level. Figure 13: Number of Children living in families with a low income: Hillingdon: 2014/15-2022/23 3.10. Economic activity (employment and unemployment): Economic activity relates to whether a person (aged between16 and 64 years) is working or looking for work. Residents who are unemployed, or who are in poorly paid occupations tend to have poorer health outcomes. In June 2024, Hillingdon had lower proportions of economically active males compared with London and England, and a higher proportion of economically active females. This is mirrored for employment rates in both genders. Figure 14: Economic Activity in Hillingdon compared to London and England, by gender (June 2024): Of residents economically inactive 43.9% are students and 14.1% are long term sick. Figure 15: Employment Rate n Hillingdon compared to London and England, by gender (June 2024): 3.11. Benefit claimants: The proportion of residents claiming out of work benefits is increasing, both in Hillingdon and across London. Figure 16: Benefit Claimants: Hillingdon compared with London and England: November 2024: 3.11.1. Universal Credit: Universal Credit (UC) is a single payment for households on low income or out of work to help with living costs. UC replaces six legacy benefits. Introduced in Hillingdon in October 2018, the data shows an increase in claims that could be a natural increase or the phased switchover of existing benefits. Figure 17: Universal Credit Claims: Hillingdon compared with London and England: October 2024: Figure 18: Proportion of people claiming UC by duration of claim: Hillingdon compared with London and England: October 2024: 38% of UC claimants are in employment. Wards in the south of the borough have higher claim rates of most benefits; 48% of people claiming Universal Credit live in the Southeast locality of Hillingdon. 3.11.2. Pension Credit: In May 2024 Hillingdon had 5,400 residents claiming pension credit (data from DWP on Stat-Xplore); 40.2% of claims were from the Southeast locality. Nationally, almost 90% of all prescription items are dispensed free of charge, with almost 63% of all prescription items dispensed free of charge to patients claiming age exemption (aged 60 years and over). 3.11.3. Carers Allowance: In May 2024 Hillingdon had 4,300 residents claiming pension credit (data from DWP on Stat-Xplore); 43.4% of claims were from the Southeast locality. 3.12. Access to transport: Public and Private transport: In 2024 there were 165,300 licensed vehicles registered within Hillingdon (cars, motorcycles and light and heavy goods vehicles). Hillingdon is well served by the London Underground; the Central, Metropolitan and Piccadilly Lines start and end within the borough and provide good links into London, alongside the Elizabeth Line that runs through the south of the borough. Hillingdon also has overground rail links and a good network of bus routes. Maps detailing distance to pharmacies are presented in Section 5. 4. The Health of Hillingdon’s Residents 4.1. Life Expectancy: Hillingdon’s male and female life expectancy at birth is 79.6 and 84.3 respectively (2022); both are higher than England and lower than London (Figure 3). However, there are inequalities at ward level; the latest data (2016-20) shows variation for males from 84.4 (north) to 76.5 (south) and for females 87.4 (north) to 80.5 (south) - as this is based on the old ward structures, no wards are named. Figure 19: Male and Female life expectancy at birth: Hillingdon compared with London and England: 2022: Figures 20 and 21 show Hillingdon’s Healthy life expectancy and disability-free life expectancy compared to London and England. Figure 20: Healthy Life Expectancy: Hillingdon compared with London and England: 2022: Figure 21: Disability-free Life Expectancy: Hillingdon compared with London and England: 2022: 4.2. Mortality Mortality from all causes has been falling in Hillingdon in line with national decreases. Figure 22 shows the trend in mortality rate from all causes, all ages (persons, 1 year range). Figure 22: All-age all-cause Mortality: Hillingdon compared with England 2001 – 2022: The average number of deaths per year in the period 2021-23 was 2,186; deaths because of circulatory diseases accounted for 18.9% of deaths in that period, cancer 20% and respiratory disease 20.2%. 34% of deaths in 2021-23 occurred in those aged under 75 (premature mortality) and 66% in those aged 75+, with variation at locality level – in the North of the borough 25.8% of deaths were in those aged under 75, with 42.9% in the Southeast locality and 38.2% in the Southwest. Figure 23: Proportions of borough premature deaths by identified diseases: Hillingdon compared with London and England: 2021-23: In 2021-23 the main cause of premature deaths in Hillingdon was attributable to cancer (28.1%), circulatory disease (20.6%) and respiratory disease (13.9%). Together, these causes accounted for 62.6% of all premature deaths in that period (source: Primary Care Mortality Dataset). 4.3. Disease Prevalence: More than one in four of the adult population in England lives with two or more conditions. People with multiple conditions are more likely to have poorer health, poorer quality of life and a higher risk of dying early than the overall general population (source: National Institute for Health Research, 2021). Figure 24: Hillingdon’s profile for certain diseases, with comparison to London and England: 2023/24 The following figures uses data from the Quality Outcomes Framework (QOF) on NHS Digital (2023/24) and shows prevalence levels of diseases from the GP registered population. It should be noted that thus is data based in GP registered populations which includes people that are registered with a Hillingdon GP and live in a neighbouring borough. Hillingdon has 42 GP surgeries organised into six Primary Care networks (PCNs), with two GP practices that have made the decision not to be allocated to a PCN. Graphs presented are at PCN level. Hillingdon has no GPs in Ruislip Manor or Hillingdon West wards. Map 5: Primary Care Networks in Hillingdon and aligned General Practices.

Health and Wellbeing Board report 9 September 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 9 September 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 9 September 2025 APPENDIX 1 BOARD PLANNER 2025/2026 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