Health & Wellbeing Board

Minutes HEALTH AND WELLBEING BOARD 18 March 2026 Meeting held at Committee Room 5 - Civic Centre Board Members Present: Councillors Keith Spencer, Susan O'Brien (Vice-Chair), Sean Bidewell, Amanda Carey- McDermott, Alex Coman (In place of Julie Kelly), Claire Eves (In place of Vanessa Odlin), Samreen Nawshin, Shikha Sharma (In place of Sharon Stoltz), Sandra Taylor, Lesley Watts and Tony Zaman Officers Present: Gary Collier (Health and Social Care Integration Manager) and Nikki O'Halloran (Democratic, Civic and Ceremonial Manager) 72. APOLOGIES FOR ABSENCE (Agenda Item 1) Apologies for absence had been received from Professor Ian Goodman, Dr Richard Grocott Mason, Julie Kelly (Alex Coman was present as her substitute), Vanessa Odlin (Claire Eves was present as her substitute), Councillor Jane Palmer and Sharon Stoltz (Shikha Sharma was present as her substitute). 73. DECLARATIONS OF INTEREST IN MATTERS COMING BEFORE THIS MEETING (Agenda Item 2) There were no declarations of interest in matters coming before this meeting. 74. TO APPROVE THE MINUTES OF THE MEETING ON 2 DECEMBER 2025 (Agenda Item 3) RESOLVED: That the minutes of the meeting held on 2 December 2025 be agreed as a correct record. 75. 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 10 would be considered in public and Agenda Items 11 to 13 would be considered in private. 76. INTEGRATED HEALTH AND WELLBEING PERFORMANCE REPORT AND SERVICE UPDATE (Agenda Item 5) Mr Sean Bidewell, Joint Borough Director at North West London Integrated Care Board (NWL ICB), advised that the report included definitions that it was hoped would make it easier to read. The report provided the Board with an overview of progress against its five strategic priorities and the major transformation programmes supporting them: Best Start in Life; Live Well; Age Well; Healthy Places; and Equity and Inclusion. The system had been stabilising and had shown measurable improvements, particularly with regard to discharge performance, frailty management and mental health crisis flow. However, operational targets for Emergency Department (ED) attendances and bed days / length of stay had not been met with ED attendance averaging at 176 per day against a target of 164 and bed days being impacted by length of stay >1 day activity. Insofar as winter pressures were concerned, the Board was advised that there had been a 4.6% reduction in the ED attendances at Hillingdon Hospital compared to the same period in the previous year. In addition, waits over twelve hours had reduced by over 35% and the four-hour wait had improved by 8.5%, making Hillingdon one of the highest performers in NWL. Mr Bidewell advised that there had been a material reduction in the number of patients with No Criteria to Reside (NC2R) from 50 per day to about 36 per day. The daily multi agenda grip meetings that had been taking place, and the weekly gold oversight meetings, had translated to improvements in bed availability and flow. Mr Keith Spencer, Managing Director of Hillingdon Health and Care Partners, suggested that it would be useful to have case studies to illustrate where things had not gone so well. Ms Lesley Watts, Chief Executive at The Hillingdon Hospitals NHS Foundation Trust, noted that the complexity of NC2R was often related to dementia but there were also challenges in relation to patients who were admitted but who had no recourse to public funds (this would require a national solution). Frailty case management now covered around 50% of the severe frailty cohort with early evidence of reduced early admissions with a linked 25% reduction in the number of care home residents going to hospital and a 33% reduction in admissions. This was a critical foundation for reducing future bed-day demand. The appendices to the report set out some of the changes and achievements that had taken place including reference to the Lighthouse and Best Start in Life. Over the next three months, effort would be made to consolidate and accelerate the initiatives that had already been initiated rather than start new projects. Measurable improvements were being seen across the system and action would now be needed to fully mobilise and embed reactive care initiatives (such as mobile diagnostics) and reduce variation. Mr Spencer advised that it would be important to track where partners were against the targets that had been set for the Hillingdon Hospital redevelopment. This information would be included in an update report to the Board at its next meeting on 9 June 2026. Ms Watts thanked partners for their support. There had been a significant improvement in performance at Hillingdon Hospital which meant that it was now the most improved in the country (moving from NHS Oversight Framework 4 (NOF4) to NOF2) and rated 27th out of 134 hospitals. Action was needed to build on the work in relation to the frail elderly so that the funding could be used to do more in the community. RESOLVED: That the report be noted. 77. DRAFT JOINT HEALTH & WELLBEING BOARD STRATEGY 2026-2031: UPDATE (Agenda Item 6) Mr Gary Collier, the Council’s Health and Social Care Integration Manager, noted that the Board had approved the Strategy at its meeting in December 2025 subject to the consultation being undertaken with residents and stakeholders. The report provided the Board with an update and Mr Collier advised that a plain English version of the Strategy had been made available for the consultation. It was agreed that the results of the consultation would be considered by the Board at its meeting on 9 June 2026. Mr Keith Spencer, Managing Director at Hillingdon Health and Care Partners, noted that the consultation was currently underway and was available online (children and adult social care staff had also been included in the consultation). RESOLVED: That the consultation and engagement and final strategy approval process approach, as described in the report, be noted and the results of the consultation be presented to the Board at its meeting on 9 June 2026. 78. 2026/27 BETTER CARE FUND PLAN UPDATE (Agenda Item 7) Mr Gary Collier, the Council’s Health and Social Care Integration Manager, advised that the report set out the requirements of the 2026/27 Better Care Fund (BCF). It was noted that the Government’s intention had been to reform the BCF so this had been an interim / staging year that aimed to align with neighbourhood targets (the framework had been published on 17 March 2026). The Board was advised that there had been a 4.4% increase in the NHS minimum contribution to Adult Social Care and 2.1% to other aspects of the NHS minimum contribution, including discharge (from £42.7m in 2025/26 to £43.48m in 2026/27). There had been no change to the local authority Better Care Grant and Disabled Facilities Grant and it was noted that the 4.4% increase would contribute towards (but not cover) the costs of inflation so would not provide additional capacity. The report set out the three mandated metrics which had been rolled forward from 2025/26: 1. To reduce emergency admissions to hospital for people aged 65 + per 100,000. 2. To reduce discharge delays, i.e., average length of discharge delay for all acute adult patients. 3. To reduce the number of older people (aged 65 +) whose long-term needs are met by admission to a care home, per 100,000 population. In addition to these metrics, there had been a requirement to demonstrate improving outcomes from reablement. This measure had been reflected in the Joint Health and Wellbeing Strategy and it was likely that it would be included as a national BCF metric from 2027/28. Ms Sandra Taylor, the Council’s Corporate Director of Adult Social Care and Health, advised that a twelve week reablement metric had been in place for a very long time and that Hillingdon performed very well against it as a system. Mr Collier noted that there were some slight positive differences between this and the new reablement metric. Ms Lesley Watts, Chief Executive at The Hillingdon Hospitals NHS Foundation Trust, noted that there were some parts of the country that were not making any progress with regard to the BCF metrics. If no improvements were being made, this then challenged the purpose of the BCF. Hillingdon had been identified as a good example of how the BCF should work to deliver improvements. Ms Taylor stated that Mr Spencer had undertaken a review of out of hospital services for NWL and that Hillingdon had performed well but needed to build on this progress. This work had dovetailed with the work of the Confederation to keep patients out of hospital through initiatives such as mobile diagnostics. It was agreed that the Board would receive an update at its meeting on 9 June 2026 and that it should reflect the priorities of place. RESOLVED: That the content of the report be noted and the plan approval arrangements described in the report be endorsed and that an update be brought to the Board’s meeting on 9 June 2026. 79. OCCUPATIONAL THERAPY SERVICE UPDATE (Agenda Item 8) Mr Alex Coman, the Council’s Director Children Safeguarding and Care, noted that the report provided an update on the 400 children who had not received their full number of statutory contact hours for occupational therapy (OT) during the last academic year (2024/25), although more than half of all contacts had been delivered as expected and only a handful had not received any contacts. Not all children had OT included in their Education Health Care Plans (EHCPs). Of those that did, some had personal budgets in place for therapy (or had a private provider due to specific needs). The rest had their therapy delivered by Central and North West London NHS Foundation Trust (CNWL) as part of the commissioning arrangements. The number of EHCPs had been increasing in many local authorities over the years (there had been an 90% increase over an eight year period) but had, more recently, been slowing down. The increase in demand was a national issue. Action had been taken to address the backlog, a joint recovery plan had been put in place to address needs and progress had been made which had reduced the pressure on caseloads. It was noted that funding had been put in place until the end of March 2026 to address the backlog and consideration would then need to be given to how this situation was not repeated. It was anticipated that appropriate OT provision would have been delivered by the end of March 2026 for the children impacted during the 2024/25 academic year. Ms Claire Eves, Service Director for Outer London Services at CNWL, advised that there had been a number of staff vacancies within the service which had impacted on performance. The money that had been saved through these vacancies had been used to pay for agency staff for the rest of the academic year but this would not provide a long term solution to meeting the ongoing level of demand (there had not been any additional budget). Funding had been approved for the service until the end of June 2026, a recruitment process had been undertaken and permanent job offers made. OT technician were now available in schools and each child was being reviewed and, if their needs were complex, they would be prioritised. Currently, the service was stable, but work was also underway with commissioner colleagues to see how demand could be funded going forward. Councillor Susan O’Brien, Cabinet Member for Children, Families and Education, noted that it had become clear at the end of the last academic year that there had been some issues as she had received a number of emails from residents expressing concern. It was hoped that the funding and workforce issues could be resolved before the start of the next academic term and that those children and young people who needed the service, received it. A 90% increase in demand was a huge jump and it was queried whether enough had been done to educate those that were involved, such as schools. Ms Eves advised that an EHCP would specify the number of OT contacts that needed to be made and that this was on a par with a prescription. This total number of contacts across EHCPs had been increasing. CNWL would continue to talk to North West London Integrated Care Board (ICB) and the local authority about the commissioning arrangements (currently a block contract rather than activity based payments). Ms Amanda Carey-McDermott, Chief Executive Officer at The Confederation Hillingdon CIC, advised that the new West and North London ICB had identified £134m for the next year to fill commissioning gaps and that this issue could possibly be considered as one of those gaps. SEND reforms had been published within the last four weeks and consideration was being given to how to respond within such a dynamic landscape. It had been hoped that the reforms would introduce thresholds as the current system did not provide any motivation for schools to change what they did. The reforms would not help with regard to changing the volumes coming through the system. It was noted that OT was in a holding position for the remainder of this academic year and that conversations were being undertaken which may (or may not) resolve the situation. It was agreed that the Board be provided with an update at its meeting on 9 June 2026. RESOLVED: That the content of the report be noted and that the Board receive an update at its meeting on 9 June 2026. 80. HEALTHWATCH HILLINGDON - VERBAL UPDATE (Agenda Item 9) Ms Samreen Nawshin, Operations Manager at Healthwatch Hillingdon (HH), advised that Healthwatch had recently been restructured and, although still commissioned by the local authority, since August 2025, HH now sat under Your Voice in Health and Social Care. Between October and December 2025, HH had visited several GP practices across the Borough and gathered 324 reviews through community events and outreach activities. The feedback received raised issues about appointment availability, getting through to the surgery on the telephone and online consultations. However, there had been some positive feedback about the callback times following a form submission, flexibility of appointments and the quality of staff. It seemed that patients needed a better understanding of the way that things worked, which could be addressed by GPs. Insofar as feedback on hospitals was concerned, during the same period, residents had said that improvements were needed in relation to waiting times (punctuality and queueing on arrival, especially in relation to the Emergency Department), appointment availability and staffing levels. However, respondents were more positive about staff attitudes, the quality of treatment and communication with patients (treatment explanation, verbal advice). Based on residents’ feedback, HH had made a number of recommendations in relation to GP practices and the hospital: GP Practices 1. Optimise existing telephone systems to reduce long waits. 2. Make online consultation systems easier to use and more inclusive. 3. Improve transparency of appointment pathways and reduce waiting times through small workflow changes. 4. Increase awareness and use of the wider clinical team. Hospital 1. Sustain and strengthen excellent staff attitudes, treatment quality, and patient communication. 2. Reduce waiting times in A&E by improving triage flow and communication with patients. 3. Improve appointment availability by using existing capacity more effectively and giving clearer timelines. Ms Amanda Carey-McDermott, Chief Executive Officer at The Confederation Hillingdon CIC, noted that the results had been entirely consistent with what she would have expected. Technology was not an issue (it was actually being used increasingly effectively), but the volume of telephone calls received was an issue as GPs did not have enough staff to answer the calls in a timely manner. This had been tracked into access metrics but the demand was significant so there was a need to manage patient expectations. Effort had been made to try to move patients to access services online but this was a difficult and possibly unresolvable challenge. Councillor Susan O’Brien, Cabinet Member for Children, Families and Education, noted that there had been some inconsistency of communication between different GP surgeries. Ms Carey-McDermott expressed concern of the report that there had been GP practices that would not take telephone calls for whole days at a time or would only allow appointments to be booked online (not over the telephone or in person). Councillor O’Brien would speak to Ms Carey-McDermott about this matter outside of the meeting. HH had visited three nursing homes or assisted living accommodation during 2025/26 under the Enter and View Programme to speak to residents and staff. Following the visits, reports had been drafted which included recommendations for improvement around the themes of: Accessibility; General environment and cleanliness; Activities, engagement and communication; and Staff support and wellbeing. Issues that had been raised included the odour and cleanliness of main hallways and a request for more outdoor activities and engagement with families. It had also become apparent that staff wanted more support in relation to palliative care days. This work had been fed back to the Councils’ Quality Assurance Team. Ms Nawshin advised that project topics had been suggested by a variety of sources and asked that partners put forward any suggestions that they might have. The Hospital Discharge project would be kicking off soon and would seek the patient’s perspective on their experience after they had been discharged from hospital. The project would evaluate the clarity of any discharge related communication (including letters) and talk to residents about their experience and the support they received once they were home. Ms Shikha Sharma, the Council’s Consultant in Public Health, would have a conversation with Ms Nawshin outside of the meeting to talk about where the needs in the Borough were. Ms Claire Eves, Service Director for Outer London Services at Central and North West London NHS Foundation Trust (CNWL), advised that she would speak to Ms Nawshin outside of the meeting to see how community services could feature in the feedback. As 80% of patients did not go through the discharge lounge (this was for complex cases only), Ms Lesley Watts, Chief Executive at The Hillingdon Hospitals NHS Foundation Trust (THH), suggested that Ms Nawshin work with the hospital to identify a representative sample of patients as well as mental health and community health patient discharge. Mr Gary Collier, the Council’s Health and Social Care Integration Manager, noted that part of the discharge process related to community services and that an information leaflet had been developed in relation to Discharge Pathway 1, the effectiveness of which could be tested as part of the HH project. It was agreed that conversations needed to take place outside of the Board meeting to ensure that the work was joined up. Mr Alex Coman, the Council’s Director Children Safeguarding and Care, advised that there were roughly 80k children and young people in Hillingdon and queried whether HH would consider looking at children’s homes in the Borough or having some focus on children and young people. Ms Nawshin advised that no topics had yet been finalised for 2026/27 and that a survey would be published to solicit feedback on possible topics for consideration. Concern was expressed that partners seemed to experience real challenges getting some parts of the community to engage. This was sometimes a cultural issue but might be because English was not their first language and/or they could not read or write. Mr Coman advised that Ms Nawshin would be welcome to use the engagement groups that had already been set up. Ms Carey-McDermott advised that she would welcome any feedback from the traditionally hard to reach groups, particularly in Hayes and West Drayton, as there was always a danger that respondents were always the same few people getting involved. RESOLVED: That: 1. Ms Samreen Nawshin liaise with the Council, CNWL, THH and The Confederation to progress issues raised at the meeting; and 2. the verbal update be noted. 81. BOARD PLANNER & FUTURE AGENDA ITEMS (Agenda Item 10) It was agreed that the following items be included for consideration by the Health and Wellbeing Board at its meeting on 9 June 2026: 1. the results of the consultation on the Joint Health and Wellbeing Strategy 2026- 2031; 2. an update on the 2026/27 Better Care Fund Plan reflecting the priorities of place; and 3. an update on the occupational therapy service. RESOLVED: That the Board Planner, as amended, be noted. 82. TO APPROVE PART II MINUTES OF THE MEETING ON 2 DECEMBER 2025 (Agenda Item 11) RESOLVED: That the confidential minutes of the Health and Wellbeing Board meeting held on 2 December 2025 be agreed as a correct record. 83. ICB FUTURE NEIGHBOURHOOD HEALTH OPERATING MODEL (Agenda Item 12) Consideration was given to the confidential report. RESOLVED: That the report and discussion be noted. 84. UPDATE ON CURRENT AND EMERGING ISSUES AND ANY OTHER BUSINESS THE CHAIRMAN CONSIDERS TO BE URGENT (Agenda Item 13) There were no current or emerging issues to discuss. The meeting, which commenced at 2.30 pm, closed at 4.42 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 Well-being Performance Report and Programme Update Report for Hillingdon Health and Well-being Board 17th June 2026 Executive Summary 2 1. Purpose, Background and Overview This report provides the Health and Wellbeing Board with an overview of progress against Hillingdon’s strategic priorities and the major transformation programmes supporting them. It summarises delivery  achievements, emerging performance trends, risks to outcomes, and the key areas where continued Board sponsorship is required. The report is structured in line with the Health and Wellbeing Board style and  focuses on those areas where the Board has a particular interest in both resident outcomes and system-wide impact. Hillingdon’s strategic priorities — Best Start in Life, Live Well, Age Well, Healthy Places, and Equity & Inclusion — remain aligned to Core20PLUS5, the priorities of the West and North London Integrated Care Board (W&NL ICB), and the Council’s wider policy framework. As in previous reports, the main emphasis remains on Live Well, Age Well and Equity & Inclusion, reflecting both the scale of current need and the  opportunity to reduce inequalities while easing pressure on urgent and unplanned care. This update covers progress/outcomes in five principal areas: I. Year end review, the report highlights some of the year on year changes to show more clearly the system-level outcomes that have been achieved over the past year . II. Integrated Neighbourhood Teams (INTs), continue to strengthen preventative, personalised & joined-up care, with particular progress in frailty, hypertension & community diagnostics.  III. Reactive Care, which is improving urgent community response, patient flow and discharge. IV. . Best Start in Life, where work is progressing to strengthen integrated provision for children and young people, including Child Health Hubs, school mental health support and neurodevelopmental pathways.  V. Beter Care Fund (BCF) end of year report. 2. Overall Position The overall position is that the Hillingdon system is showing clearer signs of stabilisation and measurable improvement, particularly in discharge performance, frailty management and mental health crisis flow.  This reflects the fact that place-based transformation is beginning to translate into operational benefits and emerging population impact. Progress made through the latter part of the year demonstrates that the  direction of travel is positive, with early evidence that integrated neighbourhood working, urgent community alternatives and stronger discharge grip are beginning to change patterns of demand and system  flow. However, performance remains above operational thresholds in a number of important areas. Emergency Department attendances remain above target, and bed days continue to sit materially above plan,  driven primarily by longer lengths of stay for non-elective patients. The system is therefore in a position where there are real gains to build on, but where the scale and pace of improvement still need to  increase if those gains are to become sustainable and translate into lasting recovery. The immediate priority is to consolidate what has improved, embed transformation as business-as-usual, and accelerate change where the largest gaps remain. This means sustaining discharge gains, converting  frailty delivery into measurable reductions in admissions and bed days, fully mobilising the reactive care model, and continuing the wider hospital-to-community shift required to meet both local ambitions and  W&NL ICB planning expectations. Executive Summary 3 3. What Has Improved • Flow and discharge: No Criteria to Reside (NC2R) has reduced materially from pre‑intervention levels (~50/day) to an average of ~38/day in April.  Daily multi‑agency grip and Gold oversight are now embedded, improving bed  availability and flow. • Frailty and preventative care: Frailty case management now covers approximately 50% of the severe frailty cohort, with early evidence of reduced emergency admissions. This is a critical foundation for reducing future bed‑day demand. • Mental health crisis response: The redesigned Lighthouse model has improved system flow, with 81% of patients now discharged within 24 hours (up from 55%). There has also been a substantial increase in diversion and discharge home  with support, rising from 31% to 71%, reducing reliance on acute mental health admissions • Community alternatives to hospital: The Reactive Care Coordination Hub is live improved pathways now operate with CCTs, X-ray Diagnostics and SDAH. UCR, SCDM, Adult Social Care, DNs, HIU Wellbeing is now embedded into  handovers/MDTs and strengthen links between the ICC Hub joining up care. • Strong uptake of mobile diagnostics: 285 referrals received since November 2025, with evidence that 196 patients avoided hospital conveyance or attendance. Estimated indicative system savings total  £389,760 against a £135,000 service cost. 4. Where Performance Remains Off‑Track • Emergency demand: ED attendances remain above the operational hospital target (April average ~174/day vs target 164/day), despite improvement against last year and the redevelopment baseline. • Bed days and Length of Stay: While Non‑Elective admissions volumes are trending down and remain below the redevelopment baseline, bed days remain materially above target, driven primarily by Length of Stay >1 day activity. This  remains the most significant gap. • Hypertension: The 16% Hypertension target remains off track, current delivery 14.2%. A delivery plan is in place to reach the 16% target by December 2026. 5. Key Risks ​ • Workforce fragility: Delivery remains dependent on scarce roles across UCR, discharge, therapy and Lighthouse services. Any slippage risks reduced responsiveness and throughput. • Scaling new models: Mobile diagnostics, the Coordination Hub and community IV antibiotics are early in implementation; their full impact depends on adoption, staffing stability and integration with  neighbourhood teams. Executive Summary 4 6. Priorities to Q2 (to September 2026) I. Sustain NC2R at ≤34/day Embed discharge processes as business‑as‑usual, maintain daily multi‑agency grip, and deliver a small but consistent surplus in P2 discharges, including improved management of out‑of‑borough  patients. II. Translate frailty into bed‑day reduction Scale the frailty operating model, formalise the SOP , and move from coverage to quantified impact on admissions and Length of Stay. III. Fully mobilise Reactive Care: Embed the Coordination Hub, align UCR with Virtual Wards frailty pathways, and mental health integration, moving towards a future 24/7 model. Complete the Lighthouse review to enable expansion  toward 10‑patient capacity at any given time, IV. Hospital to Community Transformation (Left Shift) We are currently working through the transformation delivery required to reduce outpatient activity by c48,000 appointments, known as Hospital to community (left Shift). This will provide support in  the community for patients/residents that would otherwise have required acute care. This will align with the plans for the new hospital requirements and the W&NL ICB neighbourhood delivery plans.  The initial specialties to begin with are: 1) Frailty, 2) Cardiology, 3) Respiratory, 4) Diabetes/Endocrinology, 5) Renal/CKD, 6) MSK/Rheumatology interface. 7. Board Oversight, Support and decisions: Continued Board‑level focus on the next phase of scaling the place operating model with sufficient pace and consistency to strengthen the core neighbourhood offer, mobilise community assets, close known  gaps, support neighbourhood health delivery across the whole Place. The Board is also asked to note the content of the report with respect to the BCF under section 13. Year-End Outcome Review – Activity Shift & System Impact 5 8. Year End Position Change: 2025/26 marks a shift from growth to early stabilisation across the system, following sustained increases in demand up to 2024/25. Improvements are evident  in front-door demand, targeted cohorts and short-stay activity, supported by continued  expansion of primary care and same-day pathways. Primary Care Within Primary Care, both GP availability and attended appointments have increased consistently  year-on-year . Total GP appointment capacity rose from approximately 3.7 million appointments  in 2022/23 to over 4.2 million in 2025/26. Despite the growth in activity, utilisation rates have  remained high and stable, demonstrating sustained demand across primary care services. When  weighted for population growth, appointment availability and attendance rates have also  improved, indicating that capacity growth has broadly kept pace with increasing population  demand. ➡️ Demand absorbed in primary care, limiting further escalation into acute services Urgent & Emergency Care Urgent and Emergency Care activity presents a more varied picture. Type 1 A&E attendances  have shown an overall downward trend across the review period, reducing from around 200  attendances per day in 2022/23 to approximately 180 per day in 2025/26. UTC attendances  similarly reduced overall despite some fluctuation during 2024/25. This may indicate a gradual  shift in activity away from traditional emergency settings towards alternative urgent care  pathways. ➡️ First clear reduction following prior growth trend Same-Day & Ambulatory Care Significant growth has been observed within Same Day Urgent Care (SDUC) and SDEC services.  SDUC booked appointments more than doubled between 2023/24 and 2024/25 before  moderating in 2025/26, although activity levels remain substantially above the original baseline.  SDEC activity has increased rapidly year-on-year, rising from approximately 6,700 attendances in  2022/23 to over 27,000 in 2024/25. This suggests increasing maturity and utilisation of  ambulatory and same-day emergency care models, supporting avoidance of unnecessary  admissions. ➡️ Joint lowest Non-elective (avoidable) admissions with ‘ambulatory conditions’ Year-End Outcome Review – Activity Shift & System Impact 6 Care Homes Care Home metrics demonstrate notable improvement during 2025/26 following  increases in previous years. Care Home Type 1 attendances and Non-Elective Admissions  both reduced significantly compared to 2024/25, returning close to 2022/23 levels. This  may indicate improved proactive management, strengthened community support, and  more effective intervention within care home settings. Average Length of Stay for Care  Home residents also reduced, suggesting improved discharge flow and more timely  management of admissions. ➡️ Clear year-on-year impact in a high-risk cohort Admissions & Flow Overall Non-Elective Admissions (NELs) increased steadily between 2022/23 and 2024/25  before plateauing slightly in 2025/26. However, Non-Elective Short Stay admissions  reduced substantially in 2025/26 following sustained growth in prior years. This reduction  may reflect improved streaming, enhanced same day emergency care pathways, and  stronger community-based alternatives preventing avoidable short-stay admissions. ➡️ Improved streaming and pathway effectiveness Year-End Outcome Review – By Core Programme Area 7 Neighbourhoods (Live Well & Age Well) Summary: Reactive Care (Urgent & Crisis Response, Hospital Discharge) Summary: Over the past year, Integrated Neighbourhood Teams have become established across all localities, embedding a proactive, population health approach focused on early intervention, multidisciplinary working, and reducing reliance on acute services. Initial delivery through frailty, diagnostics and PHM approaches is showing early benefit, though the programme remains in a scaling phase to drive consistent impact and reduce inequalities. Headlines • Integrated delivery model strengthened, with MDTs operational across all localities and supported by shared digital infrastructure • Frailty model mobilised, with proactive case-finding underway and a standardised model progressing to wider rollout • Mobile diagnostics delivering strong impact – 196 hospital attendances avoided and significant system savings Impact for Residents and the System • Shift toward proactive, preventative care, reducing reliance on acute services • Earlier identification and management of frailty and long-term conditions through MDTs and PHM • Improved access for housebound and care home residents via community diagnostics • Reduced avoidable hospital activity, with early evidence of admission avoidance • Stronger integration across primary, community, mental health and diagnostics • Foundations for reducing inequalities through targeted case-finding and outreach Over the past year, the Reactive Care programme has established a more coordinated, community ‑ based urgent & crisis response, bringing together UCR, mental health & discharge pathways to improve flow & reduce avoidable hospital use. Early delivery is demonstrating improved length of stay, increased diversion from acute settings and stronger system coordination, though the model remains in a maturing phase with further embedding and scaling required to deliver consistent impact. Headlines • Coordinated system-wide model in place, integrating UCR, Coordination Hub, discharge pathways and mental health crisis response • Coordination Hub (Phase 1 live) strengthening triage, MDT decision-making and system flow across health and social care • Lighthouse delivering impact – increased capacity, improved flow and reduction in admissions (40% → 14%) with <24hr stays rising to 81% • Discharge to Assess (Pathway 1) optimised, with strengthened MDT processes improving decision- making and throughput • System-wide discharge improvements reducing delays (NC2R 48 → 33) and improving bed flow • Enhanced community response capability through SCDM, diagnostics access and stronger links to social care Impact for Residents and System • Reduced avoidable hospital admissions and ED attendance, with more patients managed in the community • Improved patient flow and discharge performance, including reduced delays and increased throughput • Faster access to urgent and crisis care through same‑day coordinated response • More joined-up care across health and social care, improving MDT working and discharge coordination • Better patient experience, with more care delivered in appropriate, non-acute settings Programme Update: Neighbourhoods (Live Well & Age Well) 8 9.0. All INTs fully operational. Multidisciplinary teams are now active across all three localities, providing a consistent neighbourhood model for prevention and coordinated care. • Frailty programme mobilisation underway: Monthly mobilisation groups and workstreams established, first MDTs delivered in North INT practices, proactive case-finding commenced using WSIC, and standardised CGA/care planning development progressing. • Hypertension programme established: Strategic and operational governance groups mobilised, targeted support delivered to low prevalence practices, outreach campaigns completed, and prevalence increased to 14.2% with optimisation maintained at 82%. • Strong uptake of mobile diagnostics: 285 referrals received since November 2025, with evidence that 196 patients avoided hospital conveyance or attendance. Estimated indicative system savings total £389,760 against a £135,000 service cost. • Hospital to Community pathways progressing: Business cases, workforce modelling, and quality impact assessments underway for heart failure, cardiac rehabilitation, spirometry and direct access diagnostics pathways. Further discussions taking place with THH re the “left-shift” programme and agreeing a joint approach • Integrated delivery and digital development: HHCP digital workstream established to support integrated MDT workflows, shared documentation, proactive case-finding and neighbourhood performance reporting. • Integrated Neighbourhood Hubs: A new programme manager from Northmores has now been appointed to continue the Estates Business Case for the development of the 3 neighbourhood hubs 9.1. Forward Plan (Qtr. 1 2026/27) Over the next quarter, the Neighbourhoods programme will focus on consolidating early progress and expanding delivery to ensure consistent, preventative care across all localities: • Expand Frailty and Anticipatory Care Coverage o Define and implement a consistent neighbourhood frailty operating model, focusing on severe frailty and rising-risk cohorts. o Formalise the frailty model through a Standard Operating Procedure. Accelerate MDT working across all neighbourhoods, progressing towards 100% frailty coverage o Broaden anticipatory care beyond hypertension to include COPD, diabetes, falls prevention and multi-morbidity, prioritising residents at moderate risk. • Implement the Hillingdon Hypertension Strategy o Finalise and adopt the borough-wide Hypertension Strategy. o Finalise and implement the Hypertension Delivery Plan to sustain progress on prevalence, progress education and communications business cases, expand targeted outreach and implement a standardised practice approach to improve data coding to focus on high-risk cohorts, with targeted recalls and engagement events, including mosque outreach and support movement towards the 16% prevalence target. • Secure ongoing commissioning and funding arrangements for the Mobile Diagnostic Service and increase utilisation through wider referral engagement. • Finalise workforce, governance and pathway arrangements for Hospital to Community phase one services including cardiac rehabilitation, heart failure and community diagnostics. Programme Update: Neighbourhoods (Live Well & Age Well) 9 By Q1 2026/27, we  aim to have a consistent neighbourhood operating model across all localities, with full frailty coverage, expanded anticipatory care and clearer  outcome dashboards to track impact and  inequalities. Specifically:  Strengthen Mental Health Integration • Ensure each INT has a named mental health practitioner by Q4, improving early support for anxiety, depression and emerging cognitive issues. • Enhance links between INTs, primary care and community mental health teams to reduce escalation to crisis pathways and improve access to brief interventions in neighbourhood settings. Introduce Neighbourhood Performance Dashboards • Develop and implement INT-level performance dashboards to provide near real-time insight into activity, outcomes, inequalities and variation between localities. • Align with the emerging Children & Young People dashboard, enabling whole-life-course neighbourhood monitoring and supporting targeted resource allocation. • Progress digital solutions, integrated dashboards and neighbourhood reporting to support proactive care delivery, performance monitoring and inequalities reduction. Progress Neighbourhood Estates (Hubs) • Continue progressing the infrastructure required to support delivery of Hillingdon’s Neighbourhood Health Service model through the development of three integrated Neighbourhood Hubs at Nestlé (Hayes),  Pembroke and Uxbridge/Civic Centre • Finalise the Schedule of Accommodation and progress feasibility and design work for the three Neighbourhood Hubs. Advance the Outline Business Case, ensuring alignment with hospital redevelopment, left- shift priorities and wider system enablers including workforce and digital. 9.2. Key Issues & Risks (Neighbourhoods) Despite strong early progress, several risks could limit the scale and consistency of neighbourhood impact: Workforce Capacity & Capability: Scaling  preventative  and  proactive  care  depends  on  sufficient  clinical  and  non-clinical  workforce.  Gaps  remain  in  key  roles  (geriatricians,  pharmacists,  therapists,  care  coordinators). Without continued recruitment and skills development, INTs may struggle to expand frailty coverage, maintain quality, or keep pace with rising long-term condition demand. Variation in INT Maturity: Not all INTs are operating at the same level of integration, shared processes or MDT coordination. This creates inconsistent resident experience and uneven delivery of prevention and  anticipatory care. The Neighbourhoods Steering Board is addressing this through standardised operating models and planned investment in co-located Neighbourhood Hubs. Rising Demand Driven by Demographics & Long-Term Conditions: The ageing population and increasing prevalence of long-term conditions continue to drive demand. As frailty case-finding expands towards  100% coverage, INT caseloads will grow substantially. Without matched capacity, there is a risk that proactive care becomes diluted, reducing its impact on avoidable admissions. Inequalities Across Localities: Health outcomes vary significantly across Hillingdon, with areas such as Hayes & Harlington experiencing poorer health, lower life expectancy and higher prevalence of long-term  conditions. Neighbourhood improvements may not reach these communities at the same pace unless metrics are  monitored with an equity lens (e.g., frailty coverage, hypertension control, Health Checks).  Targeted outreach and tailored interventions will be essential to avoid widening gaps. Neighbourhoods (Live Well & Age Well) Dashboard 10 Narrative / Likely Cause Actions to Remedy Timeline Accountability The 10-week rolling average is currently at 218 attendances  per day with an April monthly average of 221, this is against  a target of 180 per day.  We continue to see lower levels of  Type 1 activity suggesting more redirections to UTC. Revised delivery plan incorporating stronger  front door diversion & capacity improvement.   SRO  Neighbourhoods Narrative / Likely Cause Actions to Remedy Timeline Accountability Hypertension prevalence continues to increase gradually  and is currently 14.21% as of April 26, against a target of  16%. At present, 14 practices within the Borough are  achieving the 16% prevalence target. Finalise and implement the Hypertension  Delivery Plan, progress education and  communications business cases, and expand  targeted outreach and high-impact  workstreams. To meet 16%  Prevalence  target by Dec-26 SRO  Neighbourhoods Narrative / Likely Cause Actions to Remedy Timeline Accountability Hypertension optimisation is currently 81% across the  Borough, meeting the target. Performance has  improved gradually over recent months, with a 5%  increase recorded since September 2025. Strengthen and standardise optimisation  approaches across all practices, including 24-hour  BP monitoring and pharmacist-led medication  reviews. Reinforce call-and-recall systems to  ensure regular follow-up for patients with  uncontrolled or borderline readings Ongoing SRO  Neighbourhoods Narrative / Likely Cause Actions to Remedy Timeline Accountability Hillingdon have one of the best outcomes within WNL.  Case management is effective. Launch of WSIC frailty radar  to support case finding and management of frail patients  First MDT interventions delivered in the  North Neighbourhood with proactive case  finding via WSIC underway Full coverage by  Apr 26 SRO  Neighbourhoods Narrative / Likely Cause Actions to Remedy Timeline Accountability Meeting the quarterly target and yearly average is almost  on target. Which shows the early impact of the frailty  programme. Currently supporting 50% case management to  patients with severe frailty.  Full rollout to 100% severe frailty cohort. Ongoing SRO  Neighbourhoods Programme Update: Reactive Care (Urgent & Crisis Response, Hospital Discharge) 11 10.0. Reactive Care Purpose & Model The Reactive Care Programme strengthens urgent and crisis response in the community so that residents receive the right care, at the right time, in the right place, while reducing avoidable hospital use and  supporting timely discharge. It brings together urgent community response, crisis support, and discharge pathways into a single, coordinated model with a simplified referral route via the new Coordination Hub.  The intended outcome is a joined-up reactive care system that reduces avoidable ED attendances, shortens hospital stays, improves the resident experience and strengthens resilience through winter . The programme has three core aims: • Rapid Urgent Community Response (UCR): Deliver fast, community-based interventions that stabilise health and social care crises and prevent avoidable A&E attendances or admissions. • Timely and Safe Discharge: Improve discharge planning and post-discharge support, ensuring residents who no longer meet criteria to reside (NC2R) leave hospital promptly and safely. • Bridging Preventative and Reactive Care: Strengthen the link between preventative care (INTs) and crisis response—ensuring early deterioration is managed proactively and repeat emergency use is reduced. 10.1. Components of Reactive Care (Progress Update) • Reactive Care Coordination Hub (Phase 1 – April 2026): Improved pathways now operate with CCTs, X-ray Diagnostics and SDAH. UCR, SCDM, Adult Social Care, DNs, HIU Wellbeing is  now embedded  into handovers/MDTs and strengthen links between the ICC Hub joining up care.   Phase 2 (now live) will expand to include frailty, mental health and end-of-life coordination with a pilot aligned to the North  INT Frailty MDTs. • Lighthouse : Having opened in August 2023, a new operating model went live in November 2025: adapting the staffing model, space utilisation, introduction of prescribing and increasing the patient capacity  from 4, to the current 6 and flexes up to 8-10 depending on patient risk profile/safe staffing. Referrals are from UTC, A&E and PLS. on average, a doubling in weekly average referrals, a reduction in length of  stay [81% now less than 24hrs, from 55% prior to transformation] which has improved flow, and increase in the proportion of patients being diverted/discharged home with support vs being admitted to a  MH acute setting [71% up from 31%]. • Discharge to Assess (D2A) Pathway 1 (P1) Integration: The service continues to show high utilisation (92% in Dec → 94% in Jan). Length of stay is improving (9.3 → 7.8 days) but remains above the ≤5-day KPI,  driven primarily by reablement waits and family-related delays. To address this, the service is restructuring the daily D2A coordination call, launching daily joint Therapy care case reviews, piloting the new  Patient Discharge P1 leaflet, and establishing regular touchpoints between care providers, to unblock delays and improve flow. • Discharge Pathways & NC2R Reduction: Continued daily multi-agency ward reviews, weekly Gold Command oversight, revised standard operating procedures and strengthened discharge pathways. This  has contributed to a significant reduction in NC2R, currently at a daily average of 38 down from an average of 48, improving flow and freeing bed capacity. Programme Update: Reactive Care (Urgent & Crisis Response, Hospital Discharge) 12 10.2 Next 6 Months Priorities (to September 2026) • Full Mobilisation of the Coordination Hub: Planning for Phase 2 (now live) will include frailty pathways, end-of-life rapid response and mental health integration, moving towards a future 24/7 model. • Lighthouse Mental Health Crisis Expansion: Complete permanent recruitment; embed the new team;  operational leads to consider walk-ins and risk mitigations before agreeing to roll it out. Walk-ins  has the risk of using up required capacity to take on MH patients in crisis from and to support A&E/UTC. • Launch of an Integrated Rehabilitation & Reablement Service: Work continues on refining the operating model, governance and weekend capacity, with the aim of enabling consistent 7-day discharges.  Further expansion (including community rehab beds) will be explored to address Pathway 2 delays. • Sustain NC2R ≤34: Work aggressively to sustain NC2R (medically fit) inpatients at or below 34 per day through winter and beyond. This involves Interim IDT Leadership, operationalising the daily multi-agency  discharge huddles, weekly system reviews, Place Gold Command, reviewing functioning of IDT , and escalating any issue early. By end of Q4, the aim is that Hillingdon will 10.3 Issues & Risks (Reactive Care) • ED Demand High A&E attendances continue to place pressure on flow and reactive services. Demand surges may reverse recent gains unless community capacity and same-day alternatives remain consistently available. • Workforce Fragility UCR, therapy, discharge teams and Lighthouse all rely on skilled staff. Any gaps—particularly in SCDMs, therapists or assessors—risk slower response times and reduced community capacity. • Variation in Discharge Processes The system remains over-reliant on senior escalation rather than routine operational practice, leaving performance vulnerable as we move into winter . Interim senior leadership for the Integrated Discharge  Team and a rapid multi-agency redesign of the discharge operating model to be implemented to ensure the improvements made to date can be stabilised, embedded and sustained through winter and  beyond. • Scaling New Models Mobile diagnostics, community IV and the Coordination Hub are early in implementation. Their full impact will depend on adoption by referrers, reliable staffing and integration across INTs and acute services. Reactive Care (Urgent & Crisis Response, Hospital Discharge) Dashboard 13 Narrative / Likely Cause Actions to Remedy Timeline Accountability The 10-week rolling average is currently 174 attendances per day, with  a April average of 174 also. Type 1 attendances have decreased  significantly in recent months, with a greater proportion of patients  being appropriately redirected to UTC and SDEC services.  Accelerate community alternatives to A&E by  embedding the Coordination Hub, scaling UCR response,  and increasing use of mobile diagnostics, SDEC supported  by continued optimisation of the Lighthouse service to  expand crisis capacity to sustaining the downward trend  Phased Rollout  on-going SRO Reactive Care Narrative / Likely Cause Actions to Remedy Timeline Accountability The 10-week rolling average currently stands at 39 NEL admissions per day,  against a target of 29. This figure has remained relatively stable over recent  months. While there has been an overall reduction in NEL activity over time, and  NEL admissions with a length of stay (LoS) of 0 days continue to decline, further  improvement is required in reducing admissions with a LoS greater than >2 days. Strengthen community alternatives by scaling  UCR, embedding the Coordination Hub, and  expanding neighbourhood MDT management  and diagnostics. SRO Reactive Care Narrative / Likely Cause Actions to Remedy Timeline Accountability Significant progress has been made in reducing the number of patients  recorded as having No Criteria to Reside over recent months. The 10-week  rolling average currently stands at 37, with an April monthly average of 38.  This represents an increase of one compared to March and places  performance four above the target of 34. SRO Reactive Care Narrative / Likely Cause Actions to Remedy Timeline Accountability Overall, we are meeting the discharge delay targets for all pathways.   Please note Pathway 2 is not split out and contains Rehab. Key contributors to delay include discharge process bottlenecks— particularly time to placement within the P2 pathway—referral process  delays across all pathways (including D2A and District Nursing), family  choice-related delays, and broader capacity constraints. Embed MDT-led referral quality checks into daily D2A  coordination calls to strengthen front-door decision- making and alignment with the Bridging + D2A  Therapy integration model Choice Policy  Live.  Integrated  services to be in  place by April  26 SRO Reactive Care Narrative / Likely Cause Actions to Remedy Timeline Accountability Variable Care Home capability in managing pts who have behaviours that  challenge and also recognising signs of deterioration. Not all CHs have  routine Pharmacy input to ensure pts at highest risk have a medication  review.  Structured medicine and UCP reviews on-going.   SCDM to support Care Home at weekends.  Roll out  of recognising signs of deterioration training to take  place in Q4. Phased Rollout  on-going SRO Reactive Care Programme Update: Best Start to Life (Children & Young People) 14 11.1 Purpose and Model The Best Start in Life programme aims to ensure every child in Hillingdon has the foundations for a healthy, safe and positive start. The programme focuses on: • Early identification and intervention: Detecting developmental, health and wellbeing needs as early as possible (during pregnancy, infancy and early childhood) and providing timely support through the  Healthy Child Programme and early years checks. • Integrated children’s services: Bringing together health, social care, education and voluntary services around the child and family, supported by Family Hubs and the emerging Child Health Hub model,  enabling families to access multiple services in a coordinated way. • Preventing ill-health: Tackling risk factors early by promoting healthy weight, good oral health, high vaccination coverage and positive mental wellbeing to reduce future problems. • Reducing inequalities: Targeting support to the most vulnerable children and communities, particularly those facing deprivation or at higher risk of poor outcomes. This aligns with Core20PLUS5 priorities,  which highlight immunisation, obesity, mental health, oral health and asthma as key focus areas. • Through these priorities, Hillingdon aims to improve early years outcomes such as school readiness, healthy weight in Reception and Year 6, and longer-term health and wellbeing across the life course. 11.2 Delivery Update Recent progress in the Best Start in Life program include: Child Health Hub Development A multi-agency group met in November 2025 to begin designing Child Health Hubs aligned with the neighbourhood model. These hubs will provide a single, integrated point of access for paediatric clinics,  developmental assessments and family support linked to Family Hubs. Work continues to have these Hubs up and running in 2026/27. CYP Neighbourhood Dashboard Work is underway on a Children & Young People dashboard to provide a consolidated view of key metrics by neighbourhood, including immunisations, A&E attendances for under-fives, developmental checks,  school readiness, oral health and obesity. The dashboard will support improved outcome monitoring, transparency and targeted action where inequalities persist. Full development and launch are expected by  the end of Q2 2026/27. Mental Health • Mental Health Support Teams (MHSTs) - Hillingdon was selected for the Wave 14 expansion of MHSTs, which will extend provision to an estimated ~80% of schools from January 2026 (up from ~60%).  MHSTs provide early support for children with mild-to-moderate mental health needs and play a vital role in reducing escalation into specialist CAMHS service. • Mental Health pathways for young adults - We are continuing to focus on improving our mental health pathways for young adults aged 16-25.  Our Discovery College is co-produced with young adults and  mental health professionals, offering in-person or online workshops, tailored to meet their unique needs.  It continues to expand with our ‘Making Sense of Senses’ course launching in June and a focus on  preparedness for University in August.  Neurodevelopmental Pathways Demand for neurodevelopmental assessment has increased significantly, and Hillingdon currently had just under 2,000 children awaiting assessment (as of October 2025). Additional NWL ICB (pre merger)  investment for 2025/26 will enable around 75% of these children to be assessed. CNWL is redesigning pathways—using digital tools and streamlined clinical processes—to increase productivity and reduce  waiting times. See next page for actual deliver Baby Friendly Initiative (BFI) Hillingdon has achieved Baby Friendly Initiative (BFI) Stage 3 accreditation, which is a very proud and significant moment, as it is the final step towards full accreditation, assessing the actual experiences of  parents.  It ensures Maternity and Health Visiting services provide high-quality, practical support for infant feeding and parent-infant relationships.  Programme Update: Best Start to Life (Children & Young People) 15 11.3 Metrics & Performance (CYP Outcomes) Key outcome measures for Best Start in Life are being consolidated into the new Children & Young People (CYP) dashboard. Current headline metrics include: Neurodevelopmental Waiting Times • As of October 2025, ~1,980 children were waiting for a neurodevelopmental assessment. • Non-recurrent funding provided by the ICB in late 2025 has increased capacity to see 1,500 of these children and significantly reduce the number of children waiting • CNWL are mobilising a new model for assessing children – SHINE (Specialist Hub for Integrated Neurodevelopmental Evaluation).  • This is an optimised pathway across the whole Trust to assess children with neurodevelopmental concerns which is digitally optimised (including fully utilising ambient voice technology) and providing one  neurodevelopmental assessment rather than separate ASD and ADHD diagnoses.  • Modelling is showing that the new pathway will double our capacity and allow us to have capacity to see close to 60% of the referrals we receive, up from 30% currently.  Although there will still be a gap in  capacity and children will still be adding to the waiting list, this is will increase slower than currently.  • Phase One is due to go live in August and includes a new Single Point of Access.  Further communication is forthcoming to relevant stakeholders such as primary care and schools.  Mental Health Support Teams (MHSTs) in Schools • Wave 14 expansion of our MHST offer in schools went live in January.  • MHSTs in Hilllingdon now covers 74% of schools • The newly formed West and North ICB are proposing a staged approach for all boroughs to reach 100% coverage by 2029/30.  For Hillingdon, additional waves of funding are scheduled in 2027/28 and  2029/30.  • Performance tracks number of schools supported, pupils reached, and uptake of interventions (individual support, groups, workshops) • The MHST team are also finalising webinars to support parents which will be run over the summer holidays.  Early Years Outcomes • Two priority indicators—school readiness and children’s oral health—show room for improvement and are central to Best Start priorities. • Data for school readiness, immunisations, dental access and oral health prevalence will be incorporated into the CYP dashboard. • The Children’s Oral Health pilot is expected to improve the % of under-5s attending a dentist annually, particularly in high-need areas. • Childhood obesity (Reception and Year 6) will be monitored as a key long-term prevention measure. Service Utilisation and Preventative Reach • The dashboard will monitor uptake of Health Visitor reviews (new birth visit, 2–2½ year checks), immunisation coverage (including MMR), and A&E attendances for under-5s. • These metrics provide insight into access, prevention, and parental support. • The intention is to introduce an overall Best Start RAG rating in future reports to show progress and highlight areas requiring targeted action Cross-Cutting System Risks & Mitigations 16 12.1 Cross-Cutting System Risks and Mitigations This section summarizes system-wide risks that span multiple programmes (Neighbourhoods, Reactive Care, Best Start) and their mitigation strategies: High ED Attendances: Emergency Department visits remain above target, risking overcrowding and missed performance standards.  • Impact: Strains hospital resources, increases wait times, and could lead to poorer outcomes if patients aren’t seen timely.  • Likelihood: Medium/High, given underlying demand.  • Mitigation: Strengthen alternatives to ED – e.g. Front Door Diversion strategies such as GP direct-to-SDEC pathways and Pharmacy First referrals to handle minor cases. The UCR 2-hour crisis response and  Lighthouse mental health diversion reduce unnecessary A&E arrivals. Continued public messaging to use 111 and community services for non-critical needs (including 24/7 urgent dental care via 111) also  supports this. The new Coordination Hub will play a role by directing referrers to appropriate community options, further easing ED burden.  NC2R (No Criteria to Reside) Relapses: After intensive effort, NC2R (delayed discharges) numbers have dropped to ~35, but could rise again without sustained focus.  • Impact: High – rising NC2R leads to bed shortages, and ED backups (when wards are full).  • Likelihood: Moderate; risk increases if winter capacity is strained or if processes slip.  • Mitigation: Embed the discharge improvement measures as business-as-usual: daily multi-agency discharge huddles, a and strict escalation according to the NC2R SOP. The Place “Gold” command structure  will continue to quickly resolve blockages. In addition, new community capacity (through integrated Reablement and bridging care) coming online in Dec 2025 will help absorb more discharges promptly.  Maintaining NC2R ≤34 is a key success criterion, and any upward trend will trigger a rapid response by the system resilience group Workforce Constraints: Across the system, recruiting and retaining skilled staff is a concern.  • Impact: If key roles are unfilled (e.g. community nurses, care coordinators, GPs, therapists, psychologists), it hampers service delivery and innovation uptake. Burnout is also a risk with the current pressures.  • Likelihood: High in certain areas (national shortages in nursing, therapy, social care).  • Mitigation: A multifaceted approach – targeted recruitment drives (for example, WNL has funded 4 additional specialist nurses for palliative care to fill critical gaps), cross-skilling existing staff (training  pharmacists and paramedics to take on expanded roles in UCR and care homes). The integration of teams also offers opportunity to better utilise the collective workforce – e.g., having PCN pharmacists assist  with care home medication reviews, or mental health practitioners working within INTs, to spread expertise.   Long-Term Condition Growth: The population is experiencing growing prevalence of chronic conditions (diabetes, heart disease, COPD, etc.), which could drive future unplanned care demand.  • Impact: Medium to long-term – without action, more people will present in crisis with preventable complications (strokes, heart attacks, decompensated COPD).  • Likelihood: High, given demographic and national trends.  • Mitigation: Prevention and early intervention are our main tools. The Neighbourhoods programme directly addresses this through hypertension and frailty initiatives (already showing success in reducing  admissions), and the WNL Enhanced Services focus on Cardiovascular-Renal-Metabolic diseases will further help manage risk factors in primary care. Continued investment in wellness services (smoking  cessation, weight management) and community engagement in healthy lifestyles (leveraging Healthy Places and Equity work) is crucial. Essentially, mitigating this risk means continuing the “left shift” of care  – moving care into community and preventative settings – which is exactly the strategy of Live Well and Age Well interventions. Better Care Fund (BCF) 17 13.0 Better Care Fund (BCF) 2025/26 End of Year Reporting There is a national requirement for Health and Wellbeing Boards to complete and return a template that reports on compliance with national conditions, performance against three national metrics as well as  performance against the agreed income and expenditure plan. Details from end of year reporting template can be found this link Better care fund 2025/26 documents | Hillingdon Council. Headlines Metrics • Emergency admissions (target not met): The outturn for 2025/26 is 9,644 admissions against a planned target of 9,490, which means that performance was marginally above the plan.  • Discharge delays (target not met): The 2025/26 outturn shows that nearly 91% of adult patients were discharged on their discharge ready date (DRD) against a target of 93.9%. The average number of  delayed days between the DRD and the actual discharge date was 5.1 days against a ceiling of 5.9 days, which is positive. • Permanent admissions to care homes (target met): There were 170 permanent admissions to care homes during 2025/26, which was the ceiling.  Income and Expenditure • The total value of the 2025/26 plan was £74,606,938 and expenditure was 98% (£73,333,652). • There was a £1,944,243 underspend against the DFG budget and a £671,000 overspend in the NHS additional contribution attributed to increased costs arising from the new community equipment contract.  Successes • Population approaches: Holistic cross sector approaches at Neighbourhood level are supporting proactive care and controlling demand from at risk groups. • Integrated workforce: Development of workforce passport across Place enables staff to move around providers to develop their skills whilst retaining their expertise at Place. It is expected that the true  benefits of this initiative should start to be realised in 2026/27. Challenges • Digital records, data and shared information: The timeliness and accuracy of data but improvement as new systems embed, e.g., Optica. • Sustainable care provider market: This is a continuing issue that is critical to the sustainability of the health and care system. Key issues continue to be recruitment and retention of a suitably qualified  workforce and addressing inflationary pressures. The Board may wish to note that 2025/26 saw the liquidation of the community equipment service provider, which presented a major challenge to the  system but was managed effectively by collaboration between the Council,  local partner organisations, and the ICB. Key Project Highlights 18 Integrated Response Coordination Hub 19 Purpose The Integrated Response Coordination Hub will provide a single coordination point for out-of- hospital patients in crisis, ensuring right care, right time, right place decisions, rapid response, and safer transitions between proactive, planned and urgent care to reduce unnecessary acute activity Achievements Phase 1 • Senior Clinical Decision Maker (SCDM) Operational – 8-8pm 7days – supporting UCR/YLL/CCTs/CHST/FAU, inc making referrals for diagnostics • Improved referral and communication to Adult Social Care • Agreed Wellbeing support to be able to accept referral earlier • Direct stepdown to CCTs and other specialist services for appropriate patients. • Direct links into SDUC and Phlebotomy service • Comms posters created for SCDM and Mobile Diagnostics Phase 1 Still to be embedded by March 26 • Developing YLL and DNs reporting on SystemOne to include 2hr response • Implement SCDM supporting FAU and Podiatry – pathway being developed • Implementing earlier identification of Wellbeing Support • New process for NWL ICC Coordination hub to refer to SCDM for onward care if appropriate – signed off 12/02- went live 09/02 -on going improvements • Improved shared information UCP care planning and better coordination of care-SCDM trained and updated UCPs if appropriate • Increased utilisation for SCDM and Mobile Diagnostics – posters created, and webinars organised • IT scope requirements documents created –presented at HHCP IT & Digital Data Steering group 10th Feb. Prioritisation and mapping exercise to be done. • Conduct workforce mapping on services with identified functions/skills and current capacity Phase 2 From March to June 26 • Extend wider than UCR to include EOL, Frailty and mental health and align with the Neighbourhood model being developed • Agree and Implement core team for Coordination hub • Set up infrastructure, systems, process, workforce and training • Working with ED/Virtual Wards to prevent admission • Align with Bridging/D2A improvement being developed • Performance framework and metrics agreed with automated reports set up Impact and data • ASC, UCR, DNs, SCDM and HIU Wellbeing support attend regular MDTs, cases are brought  to discuss urgent complex patients. • CNWL has enhanced the accuracy of UCR LoS reporting by removing rejected referrals from the dataset. • In March , 251 referrals were received from UCR and 52 from YLL • CNWL is working on SystmOne templates for YLL to include 2h response, this is due to be tested and completed in April. From May the data will be captured in the same way as UCR. • Below is the expected plan in place to train UCR to take on DNs SOS and the expansion of UCR. As the changes are implemented the increased activity will be recorded the same as UCR. Integrated Response Coordination Hub MDTs 20 Key Themes Emerging Across Cases • Safeguarding and self-neglect • Including domestic abuse concerns, hoarding, poor living conditions, refusal of care, and risks linked to capacity. • Deteriorating physical health and frailty • Recurrent falls, mobility decline, pressure damage, leg ulcers, and complex wound care. • Complex social circumstances • Social isolation, family conflict, financial abuse concerns, lack of informal support, or carers unable to cope. • Mental health and capacity concerns • Anxiety, agitation, poor engagement, cognitive impairment (incl. dementia/brain tumors), and fluctuating capacity. • Hospital interface and discharge risk • Frequent admissions/readmissions, delayed discharges, and need for coordinated care planning. • Refusal or inconsistency with care • Patients declining packages of care, medication, or assessments, increasing clinical and safeguarding risk. Next Steps • Continue 3 x weekly Response Hub / MDT oversight for active cases. • Maintain early escalation of safeguarding themes, particularly self-neglect and refusal of care. • Hub membership has grown to include Wellbeing Support Officers (Harlington Hospice) and Care Connection Team in the last two weeks. • Strengthen discharge planning links between hospital, DN, UCR, and Adult Social Care to reduce readmissions. • Monitor high-risk patients with repeat presentations for proactive, preventative interventions. • Improve data collection with system wide shared tracker and clear reporting on impact to admission avoidance, linked with learning from closed cases to support earlier identification of recuring risk themes. Activity Summary (Reporting Period) 27/2/26- 22/4/26 ASC DN UCR Total Active 2 3 3 8 Closed 12 9 5 26 Total 14 12 8 34 25 20 15 10 5 0 30 40 35 Active Closed Total UCR • Admission avoidance and bridging care. • Rapid clinical assessment and escalation. • Safeguarding initiation where self-neglect identified. • Coordination with Social Care for onward support. DNs • Clinical monitoring and escalation • Social or safeguarding concerns identified/ raised early. • Wound care, pressure damage management, palliative input. • Identification of safeguarding concerns and risks in the home. • Ongoing liaison with families and escalation to MDT . ASC • Safeguarding enquiries and triage (including MASH). • Capacity assessments and social care reviews. • Allocation of social workers and commissioning/review of packages of care. • Liaison with families around financial assessments and longer term planning. Wellbeing • Emotional wellbeing and practical support to reduce stressors such as housing,  finances, benefits, and daily living concerns. • Signposting and referral to community, voluntary, and statutory wellbein5g services. Frailty 21 Aim of the Project:  Deliver a borough-wide Frailty Model aligned to the NWL Framework that strengthens prevention, early identification, proactive management and coordinated multidisciplinary care.  Key components: Proactive case finding (WSIC) and risk stratification; Clear mild and moderate–severe frailty pathways; Standardised Comprehensive Geriatric Assessment (CGA); Consistent personalised care planning (UCP); Regular GP huddles and INT MDTs with consultant geriatrician support; Integration with UCR/Reactive Care, care homes and palliative care. Project Summary: • Phase 1 [April 2026: Model]: Hillingdon Frailty Model design/agreement to pilot delivery, based on the NWL Framework/spec. • Phase 2 [April – Sept 2026: Pilot, evaluation]: Mobilise six-month model pilot + evaluation in the North Neighbourhood, to inform improved SOP , gap analysis and funding requirements • Phase 3 [Oct 2026: Borough-wide roll-out]: Borough-wide rollout (SE and SW), depending on resource gaps/funding agreements to mitigate. Delivery Progress: 5 May 2026  ​ • Monthly Frailty Model Mobilisation Group established to oversee workstreams to deliver the frailty model pilot, evaluation, gap analysis and borough-wide rollout • Workstream subgroups held through April to plan and establish a complex case MDT INT; finalise proactive case-finding methodology; agree paperwork (CGA, care plans etc). • First weekly MDT INT held on 5 May with four complex case discussions with positive feedback. Initial focus on Cedars and Mountwood Surgeries. Debrief and learning to be taken forward into following MDTs as the process gets refined/improved before wider rollout. SOP drafted. • Proactive case-finding has commenced via CCTs with the use of WSIC. Approach to be documented (SOP) and standardised across GP practices and consistently captured on EMIS for reporting. Focus on severe/rising risk frailty cohort. • CLCH CGA template transfer to EMIS underway via PrimaryCareIT. • Resource gap analysis to conclude end of May to outline requirements for wider / full model mobilisation. • Programme KPIs drafted and will be finalised in May, with baseline collected where available. • HHCP Digital workstream and SROs agreed, first meeting held, Project Initiation Doc and TOR drafted; with a focus on digital solutions for Frailty, including MDT digital workflows, shared CGA template, UCP , proactive case-finding enablement etc. • Meeting held with Haringey for shared learning re their Frailty model. Challenges:  ​ • Digital solution for shared MDT INT documentation, CGA (likely Blinx) and care plan (likely UCP) • Resource required to operate a weekly INT MDT with core membership e.g. sufficient geriatrician time, admin support • Sufficient CCT/GP resource available to support the severe/rising risk cohort identified via WSIC; cases to be prioritised by Frailty Risk Score. • Given GP workload pressures, the patient’s GP may not always be able to fully attend MDTs, so a GP representative may need to be agreed to ensure continuity and input. Next steps: Core delivery through Q1 • Pilot underway in two North INT practices; continue May–June refinement of proactive case finding and INT MDT model, with learning used to update SOPs ahead of wider rollout across North INT. • Complete resource mapping for frailty services. • Access, set-up, rollout the standardised CGA and care planning documentation. • Support the HHCP Digital workstream to collate integrated neighbourhood requirements (Frailty, Reactive Care etc. requirements); explore and oversee digital solutions. Mobile Diagnostic 22 Aim of the Project ​ To deliver and evaluate a 6‑month Community Diagnostics pilot providing mobile and community‑based diagnostic provision for frail, housebound, and care‑home patients, with the objective of reducing hospital conveyances, improving patient experience, and informing future commissioning Delivery Progress to Date  ​- April 2026 • Strong early uptake and patient benefit demonstrated: Between the 15 November and the end of April, the Community Diagnostics Service has received 285 referrals . Patient case studies continue to evidence the benefits for frail, housebound and care‑home residents, highlighting avoided hospital conveyances and improved experience. • Increasing activity and good utilisation for an early-stage service: since the service started in November referrals have been steadily increasing with March remaining our highest level of monthly referrals at 67 with a slight drop in April with referral rates being 59. This is attributed to the Easter bank holidays. Average referral to discharge remains at 3 days which is extremely good and utilisation is currently sitting at 60% which which is a slight drop compared to March due to the bank holidays. • Impact of the Community Diagnostic Service: Audits undertaken have identified that since the service started, 196 patients would have either been transfer to the hospital or taken to A&E. This is a significant saving based on transport and acute costs. • Engagement across multiple community pathways: Referrals have been received from Direct GPs (60%), CHST (28%), SCDM (7%), Michael Sobell (3%) and Other (2%). We have also seen our first acute referral in April. This reflects the service gaining traction across the wider community provider network. • Integrated Primary Care Service Proposal: A proposal for a Integrated Primary Care Service is currently going through the governance process for approval. It is has already been approved at the HHCP Finance and Performance Committee and will be going through the Operational Oversight Committee on the 13th May. This will include funding to commission the Community Mobile Diagnostic service (currently just X-Ray at this point in time) and also the Senior Clinical Decision Maker for 2026/27. Challenges: • We hope that the existing Mobile Diagnostic Service will be commissioned for 2026/27, however there are Place discussions that need to take place regarding the potential to expand the diagnostic provision based on the “left shift” priorities. • Limited referrals from THH continues to be a challenge Core Delivery Model to Accelerate Improvement by May 2026 • Confirm Commissioning of Service, the contract is ready to be issued to the provider to continue the mobile diagnostic service (X-Ray) provision for 2026/27 following confirmation of approval of the Integrated Primary Care Service Proposal. • Improve awareness and increase referral volumes: We are aiming to continue to promote the service and wider to other services to enabled an increase in utilisation rates Mobile Diagnostic 23 Impact and data​ Significant potential to reduce avoidable acute demand: 15th November to the end of April data shows clear impact on avoidable hospital use: • 167 patients would otherwise have required hospital attendance with transport • 14 patients would have had an outpatient hospital appointment • 29 patients would have been taken to A&E • 54 patients would have had no X‑ray performed, potentially delaying diagnosis • 8 were recorded as other (i.e FAU) The following outlines indicative system savings associated with the Community Diagnostic service.  It is likely that this is an underestimation as further tests,  treatment and follow-ups are likely to occur for this patient group once they attend an acute setting. Activity Total Cost Saving HomeMed Cost (based on 6 months) Place Savings (system savings minus service cost) Transport Costs (based on average £350 to THH and back) £137,200 A&E Attendance (based on £200 attendance & £172 investigation and treatment HRG) £72,912 NEL (based on 50% of care home patients being admitted at an average cost of £4,200) £176,400 Outpatient (based on £232) £3,248 Total Cost £389,760 £135,000 £254,760 Discharge-to-Assess (D2A) Pathway 1 (P1) Integration 24 Purpose – Phase 1 Objectives To stabilise, integrate and optimise D2A Pathway 1 across Acute, Therapy, CCS and ASC by: • Reducing duplication and hand‑offs • Improving referral quality and MDT decision‑making • Embedding System C as the single record for Pathway 1 decisions • Improving discharge flow and Length of Stay (LOS) Phase 2 Objectives • Move from stabilisation to integration

Health and Wellbeing Board report 17 June 2026 DRAFT JOINT HEALTH AND WELLBEING STRATEGY UPDATE Relevant Board Member(s) Cllr Susan O’Brien – Co-chair Keith Spencer – Co-chair Sandra Taylor – Corporate Director, Adult Social Care and Health Organisation London Borough of Hillingdon Report author Gary Collier - Adult Social Care and Health Directorate, LBH Sharon Stoltz – Adult Social Care and Health Directorate, LBH Keith Spencer – Hillingdon Health and Care Partners Papers with report Appendix 1 – Resident Survey Respondent Demographics. Appendix 2 – Resident Survey Questions. HEADLINE INFORMATION Summary This report updates the Board on the outcomes from the consultation undertaken on the draft Joint Health and Wellbeing Strategy. It also seeks approval for delegated arrangements to approve the final strategy and delivery plan. Contribution to plans and strategies The Health and Wellbeing Strategy is the statutory overarching strategy that sets out partner ambitions to support the health and wellbeing needs of the Hillingdon Place. Financial Cost There are no direct cost implications from this report. Ward(s) affected All RECOMMENDATIONS That the Health and Wellbeing Board: 1. notes the outcomes of the public consultation on Hillingdon’s Joint Health and Wellbeing Strategy, 2026 – 2031 as summarised in the report. 2. approves the proposed amendments set out in the report. 3. delegates authority to the Corporate Director of Adult Social Care and Health to approve a final version of the strategy (including a n equality and human rights impact assessment and delivery plan), in consultation with the Co -chairs, the NHS West and North London representative and Healthwatch Hillingdon. INFORMATION 1. The Board has a statutory duty under the Health and Social Care Act, 2012 to produce a Joint Health & Wellbeing Strategy. The Board meeting on 2 December 2025 approved the draft strategy subject to wider stakeholder engagement. This report provides the Board with an update on the approach taken and the intended sign-off process. Health and Wellbeing Board report 17 June 2026 Summary of the Strategy 2. The Board is reminded that the strategy was developed by Hillingdon Health and Care Partners (The GP Confederation, Central and North West London NHS Trust, The Hillingdon Hospitals and the third sector consortium 3ST) with input from the Council. The draft strategy can be accessed using this link Joint Health and Wellbeing Strategy 2026 to 2031 | Hillingdon Council. It sets a shared vision for a fairer, healthier, more integrated Hillingdon and is structured around the four life-course outcomes:  Best Start in Life  Live Well  Age Well  Healthy Places 3. There are seven high-impact programmes identified in the draft strategy, including neighbourhood proactive care, hypertension (also known as high blood pressure) detection, mental health early intervention, frailty and falls, and reducing No Criteria to Reside. Delivery is underpinned by Hillingdon’s Place Operating Model, centred on:  Three Integrated Neighbourhood Teams, supported by Local Access Hubs.  Family Hubs.  A Borough-wide Reactive Care Service.  The new Hillingdon Hospital, linked seamlessly into community provision. Consultation Methodology Residents 4. The consultation approach included an online survey that lasted from 10 February to 30 April 2026 and face to face discussions using existing residents’ groups and fora such as the Carers Forum, Older People’s Assembly and the Assembly for People with Disabilities. For the online survey residents were provided with a summary of the proposals within the strategy as well as a link to the draft document. 55 residents completed the online survey, and the demographic breakdown of the respondents can be found in Appendix 1. The online survey form is shown in Appendix 2. Social Care and Public Health Professionals 5. A targeted email was sent to social care staff working in adults’ and children's services and Public Health Professionals and an online survey was available from 17 February to 31 March 2026. 10 staff members completed the survey. 6. Health and care professionals were asked if the right priorities and populations were being targeted in the strategy and whether the ambitions and delivery plan was realistic. Views were also sought as to whether the proposals in the strategy would have a positive impact on their work. Consultation Results Residents 7. Residents were asked to identify from a drop-down list what was most important to them. The following were in the top three priorities with percentage support shown in brackets: 1. Faster help when something goes wrong (76%) Health and Wellbeing Board report 17 June 2026 2. Better joined-up care (not having to constantly repeat their story) (64%) 3. Prevention and early help (60%) 4. Care closer to home (52%) 8. The second question asked residents to identify the issues that they found most difficult to get help with. The top ‘difficulty areas’ are illustrated in the table below. Issue % of respondents Urgent & emergency access 38% Cost of living 36% Long-term conditions 31% Mental health 20% Housing 18% 9. The third question sought to identify what health, care or support services residents found it most difficult to access and the response was free text. The four main themes arising from resident responses are illustrated below. Theme 1: GP access and primary care responsiveness Residents cite: Difficulty booking appointments, long phone waits, limited choice (incl. face-to-face), and frustration with online triage systems. Theme 2: Hospital outpatient access, long waits, and specialist pathways Frequent mentions include: Outpatient appointments, delays to operations/procedures (e.g., orthopaedics), long waits for specialist review (e.g., cardiology), and concerns about services moving further away. Theme 3: Urgent care access and lack of alternatives to A & E Residents describe: Wanting weekend/urgent access options and clearer alternatives to A&E when GP access is limited. Theme 4: Mental health services (including children/young adults) Residents raise: Mental health support availability and waiting times, including child mental health support needs. 10. The final question was also free text and asked residents to identify what changes to health and care services would help them the most frequent responses were:  Shorter waiting times and better updates while waiting (hospital and community services).  More GP appointments + easier booking routes (including face-to-face choice and better systems)  More consistent joined-up working and information sharing (“hospitals able to talk to each other”, less repetition) Health and Wellbeing Board report 17 June 2026  Prevention offers, such as free/subsidised exercise classes, proactive check- ups/early detection, weight management support.  Care closer to home, that is the desire for local provision to reduce travelling and parking costs. Resident Consultation Headline Themes Summary 11. The strongest themes arising from discussions at the variety of forum and resident group meetings include:  Joined-up care & communication were the dominant concerns: people are repeatedly retelling their story and experiencing poor cross-service coordination. The ideal situation proposed was a ‘Tell us once’ approach, which refers to the government service that enables a person to report a death to most government organisations in one go.  Access to timely help is inconsistent, especially urgent response and mental health crisis thresholds.  Digital exclusion was repeatedly cited on the basis that online-only approaches block access for some population groups.  Quality, accountability, and person-centred care: concerns about care standards delivered by providers, e.g. care homes and home care companies, and management oversight were raised.  Strong support for local hubs, but residents want clarity on what practical support would be available, whether there would be walk-in access or appointment only. Queries were also raised about opening hours and whether the hubs would be accessible by public transport.  Carer support and navigation: people want advocacy/case support, and clearer pathways, especially around discharge and rehab. Advocacy and case support is already available through the Carer Support Service contract with the Hillingdon Carers Partnership, which emphasises the importance of promoting this service. Health and Social Care Professionals 12. The following summarises the headlines from staff consultation feedback:  Most respondents (80%) believe that the strategy is targeting the right priorities and populations, while 20% are uncertain, indicating broad support with some reservations.  There is some uncertainty about the realism of the ambitions and delivery plan, with 60% answering 'Yes' and 40% selecting 'Maybe'.  Half of respondents (50%) also indicated that the proposed changes may or may not make their job easier, suggesting mixed confidence in the practical impact of the plan.  Open-text feedback highlights recurring concerns about access to GP appointments, the need for more face-to-face consultations, and questions about the integration of community health checks with follow-up care. Consultation Conclusions and Actions 13. Feedback received is consistent with the direction of travel for the strategy. Whilst there are some areas of clarity to be reflected in the strategy as highlighted in paragraph 11 above, the key amendments arising from the consultation process are set out in the table below. Health and Wellbeing Board report 17 June 2026 Proposed Strategy Changes Summary Proposed Change Rationale Change 1: Change Best Start in Life heading for children and young people’s aspect of the life-course outcome approach to meeting health and wellbeing needs to Start Well. Best Start in Life is a specific government led programme that is focused on the 0-5 age groups. Changing to Start Well aligns more closely to the World Health Organisation (WHO)’s life-course model. This was feedback from the Hillingdon Health Children and Young People’s Partnership Board, Infant Steering Group and staff consultation. Change 2: Add to actions section to current BSiL1: Attain ‘UNICEF UK Baby Friendly’ accreditation status across relevant settings. Recommendation of the Infant Steering Group Change 3: Change KPI from ‘increase the % of infants totally or partially breastfed’ to ‘increase the % of infants totally/exclusively breastfed at 6 to 8 weeks to 70% (2024/25 baseline 34%)’. Recommendation of the Infant Steering Group to create a SMART target. 14. The Board is advised that Baby Friendly accreditation is based on a set of interlinking evidence-based standards for maternity, health visiting, community and hospital-based children’s services. The maternity unit at Hillingdon Hospital already has silver accreditation and is seeking to increase it to gold (the top level). It is proposed that other settings acquire accreditation during the lifetime of the strategy. Next Steps 15. Subject to Board approval, it is intended that the draft strategy will be designed to address points of clarification identified by the consultation process and reflect proposed amendments. A delivery plan will be developed and the final strategy subject to final approval under proposed delegation arrangements. The Board will then receive updates on the implementation of the strategy delivery plan as part of the integrated performance report. The Board decide at future meetings that it wishes to consider implementation of aspects of the strategy in more detail. Financial Implications 16. There are no direct financial implications arising from this report. BACKGROUND PAPERS 17. None Health and Wellbeing Board report 17 June 2026 Appendix 1 Resident Consultee Profile 35% 20% 20% 15% 6% 4% 0% 5% 10% 15% 20% 25% 30% 35% 40% 65+ 55-64 45 - 54 35 - 44 25 - 34 Not given Resident Survey Respondents by Age 75% 22% 3% Resident Survey Respondents by Gender Female Male Preferred not to say Health and Wellbeing Board report 17 June 2026  HA4 – Ruislip, Ruislip Manor, Eastcote  UB3 – Hayes, Harlington, Heathrow  UB8 – Uxbridge, Cowley, Colham Green  UB10 – Ickenham, North Uxbridge  UB4 – North Hayes, Yeading 22% 18% 16% 15% 11% 13% 5% Resident Survey Respondents by Location HA4 UB3 UB8 UB10 UB4 Various Not given 14.5% 3.6% 1.8% 3.6% 14.7% 61.8% 0.0% 10.0% 20.0% 30.0% 40.0% 50.0% 60.0% 70.0% Asian/Asian British Black/Black British Mixed Other ethnic group Preferred not to say White group/background Resident Survey Respondents by Ethnicity Health and Wellbeing Board report 17 June 2026 Appendix 2 Resident Survey Questions

Health and Wellbeing Board report 17 June 2026 2026/27 BETTER CARE FUND PLAN Relevant Board Member(s) Councillor Susan O’Brien – Co-chair Keith Spencer – Co-chair Sandra Taylor – Corporate Director, Adult Social Care and Health Organisation London Borough of Hillingdon Report author Gary Collier - Adult Social Care and Health Directorate, LBH Sean Bidewell – Integration and Delivery , NHS West and North London Papers with report Appendix 1 – Discharge Fund Spending Plan 2026/27 HEADLINE INFORMATION Summary The Better Care Fund (BCF) is a national initiative that has been in place since 2015. Its vision is to support the national policy objectives of supporting the shift from sickness to prevention and supporting people to live independently and the shift from hospital to home. This report explains how the plan meets national requirements. Sign-off by the Health and Wellbeing Board is a one of the national requirements. Contribution to plans and strategies The Better Care Fund plan contributes to the delivery of Hillingdon’s Joint Health and Wellbeing Strategy and ensures compliance with requirements under the 2006 National Health Service Act. Financial Cost The total value of the 2026/27 BCF plan is £76,342k. This comprises of an NHS contribution of £29,668k and a Council contribution of £46,674k. Ward(s) affected All RECOMMENDATIONS That the Health and Wellbeing Board: 1. approves the 2026/27 Better Care Fund Plan as described in the report, including the proposed financial arrangements and targets for the national metrics. 2. agrees to delegate authority to approve amendments to the plan arising from the national plan assurance process to the Corporate Director for Adult Social Care and Health in consultation with the Co-chairs, the NHS West and North London representative and Healthwatch Hillingdon. 3. notes the actions arising from the Equality and Human Rights Assessment (para 23). Health and Wellbeing Board report 17 June 2026 INFORMATION Strategic Context 1. The Board considered an update report on Better Care Fund (BCF) requirements for 2026/27 at its March 2026 meeting. This report is seeking the Board’s approval for the plan that Hillingdon’s plan that was submitted on 19 May 2026 in accordance with national requirements. The submission was made subject to formal approval by the Board. 2. The 2026/27 BCF plan submission comprises of the following documents:  Narrative plan  Planning template 3. The narrative plan and key aspects of the planning template, i.e., income and expenditure, and targets for metrics and supporting rationale, can be accessed using the following link Better Care Fund | Hillingdon Council. 4. There are three key drivers that have influenced the development of the 2026/27 plan, and these are:  2024/26 BCF review full-year effect - The Board is reminded that in 2025/26 there was a 50% reduction in the ICB’s additional contribution to the BCF resulting from the 2024/25 review. This resulted in part-year savings of £796k in 2025/26, with the full- year effect of £1,515k being delivered in 2026/27.  Impact of inflation – The increase in costs faced by the Council from Adult Social Care (ASC) providers exceeds the 4.4% uplift in the minimum contribution to ASC.  Hospital to Community Transformation (also known as ‘Left shift’ from acute to community)– This is the need to redirect resources from acute to community to focus on prevention rather than crisis management. Plan Structure 5. The content of the planning requirements was intended to reflect the national intention that 2026/27 would be a transition year that would be followed by major reform from 2027/28. The structure of the plan has not changed from 2025/26 and remains aligned to the outcomes of the BCF review that was undertaken in 2024/25 and the life-course approach principle reflected in the draft Joint Health and Wellbeing Strategy, 2026 - 2031. The schemes and intended aims are summarised below:  Scheme 1: Living Well. Aim: Maximising independence and preventing unnecessary admission to hospital and residential care - Adults of working age.  Scheme 2: Age Well. Aim: Maximising independence and preventing unnecessary admission to hospital and residential care - People aged 65 +.  Scheme 3: Active Recovery. Aim: Promoting recovery and independence after acute illness.  Scheme 4: Infrastructure Enablers. Aim: Providing effective foundations for operational service delivery. 2026/27 Priorities 6. The main priorities reflected in the 2026/27 BCF plan include:  Further developing three Integrated Neighbourhood Teams (INTs) and the neighbourhood working approach to deliver care and support closer to home.  Continuing the development of fewer, larger integrated teams aligned to the Integrated Neighbourhood Teams that cover seven days and have a single leader. Health and Wellbeing Board report 17 June 2026  Developing and delivery of the Hospital to Community Transformation ‘left shift’ from acute to community and to focus more on prevention rather than crisis management.  Implementing a single borough-wide Reactive Care Service that maximises the ‘Homefirst’ approach and delivers community-based urgent responses. This includes exploration and implementation of options for greater integration or alignment between reablement and rehabilitation services. Summary of Key Changes from 2025/26 Plan 7. Headline changes in 2026/27 from the 2025/26 plan include:  Service funding stream contributions: Funding for the Extra Care Team Manager post has been moved from the NHS minimum contribution to Adult Social Care to the Local Authority Better Care Grant. The commissioning post within this funding stream has been deleted and the remaining funding repurposed to contribute to inflationary pressures.  Senior clinical decision maker role: This is new for 2026/27 and is funded from the discharge aspect of the NHS minimum contribution. It is GP-level cover from 8am to 8pm 7-days a week intended to support community teams, e.g., Urgent Community Response, Your Lifeline (advice line for people on the end-of-life pathway), Care Home Support Team, and Community Diagnostics, with the intention of preventing avoidable admissions and providing care closer to home and enhances a pilot established in 2025/26. Support is also provided to the Frailty Assessment Unit at Hillingdon Hospital.  Community mobile diagnostics: The plan contains an additional contribution to meeting the costs of this preventative service that includes mobile x-ray provision.  Out of borough coordinator role: This post will be responsible for improving coordination for people whose discharge requires placement or agreement with other local authorities. It was a role previously undertaken by the ICB, which becomes a responsibility of Place following the creation of NHS West and North London. This post will help to improve flow through Hillingdon Hospital.  Self-funder advice and guidance service pilot extension: Intended to increase understanding amongst self-funders and their families about available options and reduce delayed days attributable by expediting take-up of options, funding has been identified to extend the pilot for 2026/27 to enable a full evaluation of impact to be undertaken.  Strengthening the housing and homelessness support: This includes clinical support in A & E delivered through the NHS West and North London Homeless Health Enhanced Model role. This service is supported by a dedicated housing officer post whose role it is to address housing-related barriers to discharge. This was a pilot established in 2025/26 and funding is extended for 2026/27. The post is based within the Integrated Discharge Hub at Hillingdon Hospital to enhance opportunities for earlier involvement in discharge planning.  Technology enabled care (TEC) digitalisation: DFG funding has been included to support the digital upgrade of existing TEC supplied to residents in the community in time for the digital switchover in January 2027.  Risk share for community equipment: The risk ratio has moved from 71:29 (NHS:LA) in 2025/26 to 70:30 in 2026/27. This is in accordance with an intended alignment across the NHS West and North London footprint. Health and Wellbeing Board report 17 June 2026 2026/27 BCF Plan National Requirements National Conditions Compliance 8. There are three national conditions that are similar to those in 2025/26, and these are summarised below. 9. National Condition 1: Effectively support the delivery of integrated and preventative care – ICBs and local authorities must develop joint plans, agreed by health and wellbeing boards, outlining how they intend to use BCF funding to deliver more integrated and preventative care, linked to the relevant areas of neighbourhood health and social care services. 10. National Condition 2: Comply with expenditure and grant conditions - ICBs and local authorities must comply with all national grant and funding conditions and deliver in accordance with their approved plan submission. ICBs must maintain the NHS minimum contribution to adult social care and pool NHS BCF contributions into a section 75 (of the NHS Act 2006) pooled fund. 11. National Condition 3: Effective governance, reporting and engagement – ICBs and local authorities must comply and engage with BCF planning, governance and reporting requirements, including adherence to any assurance and oversight processes. National Metrics 12. There are three national metrics in 2026/27 and these concern emergency admissions to hospital, discharge delays and permanent admissions to care homes. Following previous Board direction, in drafting the plan targets have been set that are achievable. The detailed rationale supporting the targets, including the services funded via the BCF supporting them can be found by using the link shown in paragraph 5. This section summarises some key points. 13. Emergency admissions to hospital for people aged 65 + per 100,000: The 2026/27 target has been arrived at by identifying the number of non-elective admissions associated with older people in the specialist segmentation within our Whole Systems Integrated Care Commentary: Hillingdon will be compliant with this condition if the Board agrees to recommendation 1 of this report. Commentary: Hillingdon Place compliance with this condition is stated in the ‘National Conditions’ tab of the planning template and would be confirmed if the Board approves recommendation 1. Commentary: Hillingdon’s commitment to engage with BCF oversight is stated in the ‘National Conditions’ tab of the planning template and the joint system governance is described in the narrative document. Hillingdon is therefore compliant with the requirements of this condition, which would be confirmed if the Board approves recommendation 1. Health and Wellbeing Board report 17 June 2026 (WSIC) database (1,274) and applying a 30% reduction, i.e., 382. This has then been deducted from the projected 2025/26 outturn. The latter has been obtained from the Department of Health and Social Care (DHSC)’s Better Care Database. 14. Discharge delays, i.e., average length of discharge delay for all acute adult patients: The 2026/27 goals for this metric have been established using the data within the DHSC’s Better Care Database to establish baselines based on 2025/26 activity. An average 0.5% reduction has been applied to the average number of days between the Discharge Ready Date (DRD) and the actual date of discharge and a 0.5% increase in the proportion of adult patients discharged on their DRD. 15. Long-term support needs of older people (aged 65 +) met by admission to residential and nursing care homes, per 100,000 population: In compliance with national requirements, the numbers in planning template show the admissions in the twelve-month period to the end of each quarter and the corresponding rate per 100,000 65 + population. This shows 183 admissions to the end of Q1 2026/27 decreasing to 170 admissions at the end of Q4. The target number of actual permanent admissions for 2026/27 is 170 (or fewer), which reflects the outturn for 2025/26. Maintaining the actual number of admissions at this level takes into consideration the increase in the older people population, especially the increase in those aged 80 and above. Improving Reablement Outcomes 16. The planning requirements ask areas to set out how they intended to improve outcomes from Reablement without setting an actual target for 2026/27. It is, however, clearly indicated that a target is likely to be set for 2027/28. 17. There is work in progress as part of the development of the Reactive Care Service to integrate, or more closely align, Reablement and Rehabilitation Services to increase efficiency through the deployment of staff with the most appropriate skill set to address need. There are two existing Reablement metrics reflected in the Adult Social Care Outcomes Framework, i.e., the proportion of people who received reablement during the year, who previously were not receiving services, where no further request was made for ongoing support, and the proportion of people aged 65 and over discharged from hospital into reablement and who remained in the community within 12 weeks of discharge. The most recent comparative data is for 2024/25 and showed that Hillingdon performed well against the first measure. 2025/26 comparative data is unlikely to be available until November 2026. Hospital Discharge Fund 18. The Board is reminded that the Discharge Fund comprises of a local authority aspect, which is funding paid directly to the Council via a grant under section 31 of the Local Government Act, 2003, as part of the Local Authority Better Care Grant and an ICB aspect. It is important that the Board is aware that these funding streams are unring- fenced, which means that the money can be deployed for admission prevention as well as discharge support purposes. 19. The ICB aspect forms part of the NHS minimum contribution. It is distributed on a Health and Wellbeing Board basis with the value determined by the DHSC. A detailed breakdown of this funding for 2026/27 can be found, for ease of reference, in Appendix 1. The Board may wish to note the following:  Local Authority Discharge Fund: Nearly 92% (£1,525k) of the Council’s allocation is Health and Wellbeing Board report 17 June 2026 committed to discharge-related homecare and placement costs that support the financial implications of the Home First model and ensuring that assessment of long- term care needs primarily take place in the community and not in hospital. The remaining 8% is funding additional social work and brokerage capacity to ensure weekend and bank holiday coverage as well as a contract to address requirements for deep cleans.  ICB Discharge Fund: 72% (£1,898k) of the funding is supporting discharge support, 21% (£565k) admission prevention and 7% (£180k) is cross cutting, i.e., Senior Clinical Decision Maker (see para 7). 20. The inclusion of the following has been directed by the ICB:  Gap commissioning: spot purchased HIV placement, homeless and specialist 1:1 support.  E-wallet cards.  Homeless Health NHS West and North London enhanced model. Equality and Human Rights Impact Assessment 21. The full assessment can be found by using the link shown in paragraph 3. This concludes that the 2026/27 BCF plan is strongly aligned with advancing equality of opportunity for Hillingdon residents, particularly through:  Targeting deprived communities and high-risk populations at INT level.  Investing in community-based preventative services.  Supporting independence, carers, and least restrictive care options. 22. Key risks identified included:  Access inequalities, particularly for deprived, minority and digitally excluded groups.  Care market sustainability affecting vulnerable residents.  Carer burden arising from system pressures. 23. Key actions and commitments arising from the assessment include:  Develop ethnicity-disaggregated data on BCF service access and outcomes during 2026-27, where possible.  Review service user monitoring to capture sexual orientation and gender identity data across BCF-funded services, where appropriate.  In partnership with Healthwatch Hillingdon, explore options for obtaining the views of LGBTQ+ residents about service access challenges.  Monitor carer breakdown triggers and the short-term to long-term placement conversion rate.  Ensure that engagement with people with lived experience, including older people, people with disabilities, carers and diverse communities, is embedded in BCF monitoring and review.  Undertake a full evaluation of the self-funder advice and guidance pilot in Q3 2026-27.  Progress the TEC digitalisation programme to protect residents reliant on analogue telecare ahead of January 2027 switchover. Next Steps 24. The result of the assurance process is expected in July 2026. Once assured status is confirmed it will be possible for the Council and ICB to enter into an agreement under section 75 (s75) of the NHS Act, 2006, to give legal effect to the financial and partnership arrangements under the BCF. Plans are in place to secure agreement between the ICB Health and Wellbeing Board report 17 June 2026 and the Council on the content of the s75 subject to confirmation of assured status. The national target for s75 agreements to be in place is 30 September 2026. Risk Share Arrangements 25. The arrangement for previous iterations of the plan has been that each organisation manage its own risks, and it is proposed that this will continue for 2026/27, except for community equipment as mentioned in paragraph 7. The detail of risk share arrangements will also be reflected in the s75 agreement referred to previously. 2027/28 and Beyond 26. It is understood that consultation on the next stage reform of the BCF will not take place until the autumn of 2026. This would be with a view to any proposed changes taking effect from 2028/29 and not 2027/28. This means that 2027/28 is likely to be a further transitional year. Financial Implications 27. The Board is reminded that there are three mandated BCF income streams in the BCF and these are:  NHS minimum contribution: This funding is passported to ICBs via NHS England and allocations to Place determined nationally.  Local Authority Better Care Grant: This funding is paid directly to local authorities by the Ministry of Housing, Communities and Local Government (MHCLG).  Disabled Facilities Grant (DFG): This funding is also paid directly to local authorities by MHCLG. 28. There are three components to the NHS minimum contribution, and these are:  NHS minimum contribution to Adult Social Care: It is a legal requirement that these funds are passed to the local authority.  NHS minimum contribution (discharge): Although the value of this component is determined nationally it is not ring-fenced so it can legitimately be used to support admission prevention.  NHS minimum contribution to health: This funding mainly supports community health services. The only aspect of this funding being received by the Council is the ICB contribution to children’s safeguarding. Financial Uplift 29. Table 1 below provide a comparison of NHS and Council contributions in 2025/26 compared with 2026/27. Table 1: Financial Contributions by Organisation 2025/27 Organisation 2025/26 2026/27 NHS 29,431,059 29,668,105 LBH 44,729,879 46,674,122 TOTAL 74,160,938 76,342,227 30. Table 2 below provides a comparison of NHS and Council contributions by funding stream in 2026/27 compared with 2025/26. The increase in the Council’s additional contribution is attributable to the underspend in the 2025/26 DFG allocation. It is a national BCF Health and Wellbeing Board report 17 June 2026 requirement that underspends in 2025/26 be carried forward into 2026/27 as additional voluntary contribution for the initial recipient of the funds, i.e., the ICB for the NHS minimum contribution and the Council for the LA Better Care Grant and DFGs. Table 2: Financial Contributions by Funding Stream 2025/27 FUNDING SOURCE FUNDING 2025/26 2026/27 Minimum NHS Contribution 27,145,109 27,927,934 Additional NHS Contribution 2,285,950 1,740,171 NHS TOTAL 29,431,059 29,668,105 Minimum LBH Contribution 15,554,754 15,554,754 Additional LBH Contribution 29,175,125 31,119,368 LBH TOTAL 44,729,879 46,674,122 TOTAL BCF VALUE 74,160,938 76,342,227 31. Table 3 below provides a comparison in value of the mandated BCF income streams in 2025/26 and 2025/26. Table 3: BCF Minimum Contributions Summary 2025/27 Funding Breakdown 2025/26 2026/27 NHS MINIMUM CONTRIBUTION BREAKDOWN  Minimum to Adult Social Care 9,157,453 9,564,653  Minimum to Health 15,396,775 15,718,297  ICB Discharge Fund 2,590,881 2,644,984 TOTAL 27,145,109 27,927,934 LBH MINIMUM CONTRIBUTION BREAKDOWN  Disabled Facilities Grant (DFG) 6,341,993 6,341,993  Local Authority Better Care Grant 9,212,761 9,212,761 TOTAL 15,554,754 15,554,754 MINIMUM BCF VALUE 42,699,863 43,482,688 32. Table 4 below summarises the Council and NHS funding contributions for the 2026/27 plan by scheme. The ICB’s contribution to children’s safeguarding has been included with the Live Well scheme for the purposes of this report. Table 4: Funding Breakdown by Scheme 2026/27 Scheme NHS LBH TOTAL 1: Live Well 2,138,960 11,973,563 14,112,523 2: Age Well 11,576,184 32,926,357 44,502,541 3: Active Recovery 15,494,965 1,658,502 17,153,467 4: Infrastructure Enablers 457,996 115,700 573,696 TOTAL 29,668,105 46,674,122 76,342,227 Local Authority Better Care Grant 33. The grant conditions for the Local Authority Better Care Grant are that it must be used to: Health and Wellbeing Board report 17 June 2026 ● Meet adult social care needs. ● Reduce pressures on the NHS, including supporting more people to be discharged from hospital when they are ready (including supporting the principles of ‘Discharge to Assess’); and/or ● Ensure that the local social care provider market is supported. 34. It is intended that in 2026/27 £1,658,502 of this grant will be used to support discharge as illustrated in Appendix 1 and that the remaining £7,554,259 to support the care market. This includes funding commissioning capacity to ensure greater effectiveness in delivering the Council’s responsibilities under section 5 of the Care Act, 2014, which was identified as an area for development during the assurance process undertaken by the Care Quality Commission in 2024. BACKGROUND PAPERS Better Care Fund framework 2026 to 2027 - GOV.UK Health and Wellbeing Board report 17 June 2026 Discharge Funding Breakdown 2026/27 LOCAL AUTHORITY BETTER CARE GRANT (DISCHARGE) SPEND 2026/27 Spend Item 2026/27 Allocation £1,658,502 Discharge-related placements 908,608 Discharge-related homecare 432,685 Reablement 96,000 Block nursing dementia step-down 88,316 Deep clean & house clearance contract 16,000 Social Work 7-day Discharge 59,561 Additional Brokerage Capacity 57,332 TOTAL 1,658,502 NHS MINIMUM CONTRIBUTION (DISCHARGE) Spend Item 2026/27 Allocation 2,644,984 Bridging Care Service 256,381 Block step-down beds 383,197 Home-based Active Recovery Service (D2A Therapy) 801,571 Discharge support: Homefirst D2A capacity 135,500 Same Day Urgent Care capacity 200,000 Urgent Community Response 135,500 Senior Clinical Decision Maker 180,996 Gap commissioning: Community IV Antibiotics 139,835 Community IV Antibiotics 90,166 Housing Officer (Discharge) 61,778 Gap commissioning: spot purchased HIV placement, homeless and specialist 1:1 support. 59,000 E-wallet cards 10,000 Homeless Health NWL enhanced model 191,060 TOTAL 2,644,984 Appendix 1

Health and Wellbeing Board report 17 June 2026 OCCUPATIONAL THERAPY SERVICE UPDATE Relevant Board Member(s) Julie Kelly – Corporate Director, Children’s Services Organisation London Borough of Hillingdon Report author Gary Binstead - Head of Commissioning, LBH Claire Eves - Service Director for Outer London Services, CNWL Papers with report Occupational therapy update – March 2026 HEADLINE INFORMATION Summary This report is to update the Board on the delivery of Occupational Therapy (OT) statutory contacts for children with SEND, as outlined in their Education, Health, and Care Plans (EHCPs). Contribution to plans and strategies The delivery of therapies outlined in a child’s EHCP is part of a statutory duty related to the SEND code of practice, and CNWL are jointly commissioned to deliver these therapeutic interventions on behalf of Hillingdon Council and the ICB. Financial Cost £2,739,345 overall contract value for therapies (LBH & ICB) Ward(s) affected All RECOMMENDATION That the Health and Wellbeing Board notes the content of the report. Information 1. This report provides an update on the continued collaborative work between CNWL and the Council in relation to the delivery of Occupational Therapy (OT) to the children and young people of Hillingdon in mainstream schools. 2. This is in relation to the recovery plan for children who did not receive their full statutory entitlement of contacts during the academic year 20 24 / 25 as ou tlined in the previous papers submitted to the Board. Background 3. There continues to be a national shortage of OT’s due to a range of factors which are impacting service delivery across many regions , and CNWL has not been immune to the recruitment and retention challenges in the country. This has had a significant impact on the workforce, with a reported vacancy rate of approximately 50% last year, which in turn affected the service’s capacity to deliver all statutory contacts. However, CNWL has undertaken a comprehensive recovery plan, and as of the end of June 2026, all posts are fully covered. Health and Wellbeing Board report 17 June 2026 4. CNWL have also continued to commission additional OT support from external organisations to ensure all children and young people receive their statutory contacts 5. Plans remain in place to ensure that all children and young people continue to receive their statutory contacts from a therapist, and the Council are continuing to work with CNWL to manage the situation. Current position 6. The continued recruitment efforts, and the engagement of agency staff has enabled every school to have a named link therapist and has created the required capacity to deliver EHCP annual reviews and reduce caseload pressure maintaining the provision of all statutory contacts as planned for children and young people. 7. CNWL have also commissioned an external consultant who has been undertaking a detailed review of the Children’s Integrated Therapy Service (CITS) , to refine pa thways, quantify workload, and identify where efficiencies or service changes may be required. Workforce planning also continues, to support retention and enhance skill mix. 8. Further meetings are taking place over the summer between CNWL and the Council to review the demand and capacity required to meet the needs of children and young people, and development work will continue to ensure the service adapts as necessary, including the potential introduction of a screening tool for OT like the one in place for speech and language needs. 9. The Council and CNWL are also ensuring that the service will be able to meet and changing needs as a result of the Department for Education (DfE) recent white papers Every child achieving and thriving - GOV.UK, and the SEND reform: putting children and young people first - GOV.UK.

APPENDIX Health and Wellbeing Board report 18 March 2026 OCCUPATIONAL THERAPY SERVICE UPDATE Relevant Board Member(s) Julie Kelly – Corporate Director, Children’s Services Organisation London Borough of Hillingdon Report author Gary Binstead – Head of Commissioning Papers with report None HEADLINE INFORMATION Summary This report is to brief the Board on the challenges of the delivery of Occupational Therapy (OT) statutory contacts for children with SEND, as outlined in their Education, Health, and Care Plans (EHCPs). Contribution to plans and strategies The delivery of therapies outlined in a child’s EHCP is part of a statutory duty related to the SEND code of practice, and CNWL are jointly commissioned to deliver these therapeutic interventions on behalf of Hillingdon Council and the ICB. Financial Cost £2,739,345 overall contract value for therapies (LBH & ICB) Ward(s) affected All RECOMMENDATION That the Health and Wellbeing Board note the content of the report. INFORMATION 1. This report relates to the number of children who did not receive their full number of statutory contact hours for OT during the last academic year (2024 / 25), setting out a recovery plan with approximate timescales. The information below sets out the number of children affected. 2. In the academic year 2024 / 25, approximately 400 children and young people did not receive their full allocation of OT contacts as set out in their EHCP, although more than half of all contacts were delivered as expected, and only a handful of children and young people did not receive any contacts. 3. This matter is being brought to the Board’s attention because of the potential risk if the service is unab le to meet the current demand and sets out how the CNWL service will recover from the current backlog. Context APPENDIX Health and Wellbeing Board report 18 March 2026 4. The number of EHCPs in Hillingdon have been growing significantly over the years like many Local Authorities are experiencing . More recently, the growth has slowed compared to previous trends due to robust annual reviews, more opportunities for young people to be supported into employment and a range of other factors. 5. Not all children will have therapy input in their EHCPs but many children do. A number of children have personal budgets in place for therapy or have a private provider due to specific needs. The rest of the children with OT in their EHCPs will have their therapy delivered by CNWL as part of the commissioning arrangements. Background 6. This issue was highlighted to CNWL during the last academic year, and CNWL have been working closely with the Head of Commissioning in the Council to agree a plan to recove r from the backlog. 7. There is a national shortage of OTs due to a range of factors which are impacting service delivery across many regions , and CNWL has not been immune to the recruitment and retention challenges in the country. This has impacted the current workforce, and in turn, the capacity to deliver all statutory contacts. 8. These pressures have been evident through a reduced workforce due to maternity leave, recruitment challenges and other factors, and has reduced the OT capacity for a prolonged period of time, despite CNWL efforts to recruit to the appropriate staffing levels. 9. As a result, there are a number of children and young people who have not received their statutory number of contacts during the last academic year as outlined above, and work is underway to correct this as set out below. Recovery Plan 10. Where a child or young person has been identified for not receiving any contacts, plans have been put in pl ace to recover these through separate commissioning arrangements in conjunction with families, and some of these have been delivered already. 11. The therapy needs of all the other affected children are being assessed, and plans are being developed to ensure their individual needs are met appropriately. This will include input from children, families , therapists, and schools. Once these assessments are complete, appropriate therapy will be provided as agreed. 0% 2% 4% 6% 8% 10% 12% 14% 2022/23 2023/24 2024/25 2025/26 (current) Net Growth of EHCPs - Hillingdon v. National Hillingdon National APPENDIX Health and Wellbeing Board report 18 March 2026 12. CNWL are planning to commission additional capacity from the independent therapy market, in order to ensure that the appropriate level of therapy is provided to all children as outlined in their EHCP and also keep pace with the increased demand for assessments . T hese discussions are well developed , and CNWL are aiming to have additional capacity commissioned before the end of December. 13. It is expected that the appropriate OT provision will have been delivered by the end of the Spring term at the end of March for the children impacted during the 2024 / 25 academic year. 14. Reassuringly, all the scheduled OT statutory contacts are forecast to be delivered by the end of the Autumn term at the end of December as planned, showing a marked improvement due to additional capacity. 15. Discussions will continue between all organisations involved, and t he recovery plan will remain under review. Plans will be updated as necessary to ensure the appropriate levels of therapeutic input are delivered to all children and young people as outlined in their EHCPs.

Health and Wellbeing Board report 17 June 2026 BOARD PLANNER & FUTURE AGENDA ITEMS Relevant Board Member(s) Councillor Sue O’Brien 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 2026/2027 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 2026/2027 Board Planner, attached at Appendix 1. 3. INFORMATION Supporting Information Reporting to the Board The draft Board Planner for 2026/2027, 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 17 June 2026 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 2026/2027 were considered and ratified by Council at its meeting on 22 January 2026 as part of the authority’s Programme of Meeti ngs for the new municipal year. The proposed dates and report deadlines for the 20 26/2027 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 17 June 2026 APPENDIX 1 BOARD PLANNER 2026/2027 9 Sep 2026 2.30pm Committee Room 5 Business / Reports Lead Timings Reports referred from Cabinet / Policy Overview & Scrutiny (SI) LBH Report deadline: 3pm Friday 28 August 2026 Agenda Published: 1 September 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 2 Dec 2026 2.30pm Committee Room TBA Business / Reports Lead Timings Reports referred from Cabinet / Policy Overview & Scrutiny (SI) LBH Report deadline: 3pm Monday 23 November 2026 Agenda Published: 24 November 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 10 Mar 2027 2.30pm Committee Room 5 Business / Reports Lead Timings Reports referred from Cabinet / Policy Overview & Scrutiny (SI) LBH Report deadline: 3pm Monday 1 March 2027 Agenda Published: 2 March 2027 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