Health & Wellbeing Board

Minutes HEALTH AND WELLBEING BOARD 17 June 2026 Meeting held at Committee Room 6 - Civic Centre, High Street, Uxbridge UB8 1UW Board Members Present: Councillor Susan O'Brien (Co Chair), Keith Spencer (Co-Chair), Sean Bidewell, Amanda Carey-McDermott, Julie Kelly, Dr Alan McGlennan (In place of Lesley Watts), Samreen Nawshin, Sharon Stoltz and Sandra Taylor Officers Present: Gary Binstead (Head of Education and SEND Commissioning), Gary Collier (Health and Social Care Integration Manager) and Nikki O'Halloran (Democratic, Civic and Ceremonial Manager) 1. APOLOGIES FOR ABSENCE (Agenda Item 1) Apologies for absence had been received from Lesley Watts (Alan McGelennan was present as her substitute) and Tony Zaman. 2. DECLARATIONS OF INTEREST IN MATTERS COMING BEFORE THIS MEETING (Agenda Item 2) There were no declarations of interest in matters coming before this meeting. 3. TO APPROVE THE MINUTES OF THE MEETING ON 18 MARCH 2026 (Agenda Item 3) RESOLVED: That the minutes of the meeting held on 18 March 2026 be agreed as a correct record. 4. TO CONFIRM THAT THE ITEMS OF BUSINESS MARKED PART I WILL BE CONSIDERED IN PUBLIC AND THAT THE ITEMS MARKED PART II WILL BE CONSIDERED IN PRIVATE (Agenda Item 4) It was confirmed that Agenda Items 5 to 9 would be considered in public and Agenda Items 10 to 12 would be considered in private. 5. INTEGRATED HEALTH AND WELLBEING PERFORMANCE REPORT AND PROGRAMME UPDATE (Agenda Item 5) Mr Sean Bidewell, West and North London Integrated Care Board (WNL ICB), advised that the report detailed how partners had been working together to provide joined up preventative community-based support. Work had been undertaken in relation to hospital flow and discharge and mental health crisis care, with twice as many individuals being supported back home through Lighthouse than being admitted (with the majority going home within 24 hours). Care continued to be delivered closer to home with mobile diagnostics becoming more established. However, Hillingdon still faced some challenges with further work needed to reduce hypertension, A&E attendances (although still below target, Hillingdon Hospital had been coping with an 8% increase in A&E presentations – around 11 people per day) and the number of patients staying 2+ days. Year on year, there had been an increase in the number of GP appointments available which had reduced the pressure in hospital, and Urgent and Emergency Care attendances had reduced from an average of 200 per day to 180. In addition, work had been undertaken in care homes in the Borough to reduce the number of residents going to the Emergency Department, being admitted and reducing their length of stay if they were admitted. Mr Bidewell advised that some analysis had been undertaken in relation to the increase in presentations at A&E. It appeared that the majority lived in the two Primary Care Network (PCN) areas closest to the hospital. The ICB had met with these PCN Clinical Directors to work out why these patients were bypassing their GP and going straight to A&E. Dr Alan McGlennan, Chief Medical Officer and Managing Director at The Hillingdon Hospitals NHS Foundation Trust (THH), noted that this work had had a positive impact on the hospital. Despite an ever-increasing number of people attending A&E, and no real rationale for this, THH had been performing well in comparison to North West London, London and England. The only way that these numbers would come down would be by targeting specific areas and providing alternative options. A&E had previously been reluctant to turn people away from the front door, but staff were now diverting individuals (where appropriate) to alternative services such as GPs and pharmacies but more could be done. Ms Sandra Taylor, the Council’s Corporate Director of Adult Services and Health, advised that all agencies and Public Health were commissioning early intervention and prevention services. Information about these services could be useful to some of these individuals that were being diverted away from A&E. Ms Amanda Carey-McDermott, Chief Executive Officer at The Confederation Hillingdon CIC, noted that individuals had the ability to be able to book a same day GP appointment through NHS 111 so this was not an issue. It seemed that for some people, it was a cultural norm for them to go straight to hospital rather than through primary care and it would be important to get the right messaging to these individuals. Dr McGlennan advised that acute trusts were now being rated every quarter against a national oversight framework. THH was currently in the top tier. Mr Keith Spencer, Co Chair and Managing Director at Hillingdon Health and Care Partners, questioned what would happen if THH went into OPEL 4 (the highest clinical risk level within a framework for managing operational pressures). Consideration needed to be given to putting more support at the hospital front door to manage times of surge. Integrated Neighbourhood Teams (INTs) had been set up and were operational across Hillingdon. Regarding reactive care, a coordination hub had been set up to provide a stronger community response and there had been a reduction in the discharge delays. With regard to Hillingdon’s five strategic priorities, insofar as ‘Best start in life’ was concerned, work had been progressing to strengthen integrated provision for children and young people, including Child Health Hubs, school mental health support and neurodevelopmental pathways (wait lists had reduced from around 2,000 to 500). The Thrive website had gone live in March 2026 and the Mental Health Support Team had been expanded across all schools (additional funds had been secured to support this work for the next two years). However, there was still more work to do to embed these changes and build on the work already undertaken. Ms Sharon Stoltz, the Council’s Director of Public Health, noted that the children’s oral health pilot had been going well on the back of whole system working (outperforming NWL outcomes). This was just one example of what Hillingdon could achieve when partners worked together. However, the risk was that the funding for this project had been non-recurrent so consideration needed to be given to the children’s early health pilot to determine how it could be retained. Mr Gary Collier, the Council’s Health and Social Care Integration Manager, advised that the NHS England Better Care Fund template with three national metrics had been rolled forward into 2026/27. Hillingdon had not achieved its target for the first metric (emergency admissions to hospital), had partly met the second metric (discharge delays) and had met the third (permanent admissions to care homes). There had been a 98% expenditure against the plan with a £1.9m underspend against Disabled Facilities Grant (DFG) (there had been £446k additional allocation received in Q4) and £761k overspend in the NHS related to community equipment. Multi agency working at a neighbourhood level had been controlling demand from risk groups and the liquidation of the community equipment provider had ended up being a positive because of the collaborative working between partners. Ms Stoltz advised that she had started work on a review of early intervention and prevention services from midlife with a view to pushing the onset of frailty back. Preventative programmes had been in place in Hillingdon for many years but the evaluation data for these initiatives had not been great. There had been a lot of talk about ‘left shift’ (moving services from hospital into the community) so work needed to start earlier in the lifecycle. Ms Stoltz would bring a report back to the Board on progress in due course. Councillor Susan O’Brien, Co Chair and Cabinet Member for Adults, Children, Health and Care, queried whether the priority targets stated in the report were achievable. Mr Bidewell advised that Hillingdon was currently still achieving 32 against the No Criteria To Reside target of 34, despite an increase in demand. Work had also been undertaken to reduce frailty bed days and the number of elective admissions (there had been a reduction in the number of care home patients admitted). He was confident about the reactive care hub progress and was aware that the community transformation work would not be a small task. Mr Spencer noted that there would be a Place Board meeting the following day. Hillingdon needed to deliver a significant transformation programme and it would be important to establish if the right resources were in place to be able to do this. RESOLVED: That: 1. Ms Sharon Stoltz provide the Board with an update on the review of the evaluation of early intervention and prevention services in Hillingdon at a future meeting; and 2. the report and discussion be noted. 6. DRAFT JOINT HEALTH & WELLBEING STRATEGY UPDATE (Agenda Item 6) Mr Gary Collier, the Council’s Health and Social Care Integration Manager, noted that the Joint Health and Wellbeing Strategy was a statutory document which set out the direction of travel to support the health and wellbeing of Hillingdon residents. In developing the document, residents and partners were able to respond to online surveys and consultation had been undertaken using existing fora and residents’ groups. The feedback provided support for the general direction of travel, but issues raised included concerns about joined up care, communication, inconsistent access to timely help, digital exclusion and the quality and accountability of care home providers. Residents had been supportive of the hubs but there had been some questions about access and public transport access. In relation to carer support and advocacy, consideration needed to be given to ensuring that carers were aware of the support that was available to them. There was also a suggestion in paragraph 13 to change the KPIs in relation to the ‘Best start in life’ priority. Mr Collier advised that consideration now needed to be given to addressing the points raised in the feedback and finalising the document. Mr Keith Spencer, Co Chair and Managing Director at Hillingdon Health and Care Partners, had not been surprised by the feedback. As changes to meet the needs of patients might not make the lives of staff easier, a balance would need to be struck. Ms Samreen Nawshin, Operations Manager at Healthwatch Hillingdon (HH), confirmed that the feedback resonated with the patient experience being reported to HH. Gaps had been identified in the joined up services during Q3 and Q4 and consideration needed to be undertaken to improve communication between agencies and with residents. Thought would also need to be given to how this would be measured from a patient perspective with an audit being undertaken in two years to determine if residents found it easy to access services. Mr Spencer noted that patients continued to be unhappy about being bounced between services and having to repeat their story. The plan was to have an operating model whereby a patient had just one referral so that it was the professional’s responsibility to find the right support / service for the patient if it was not them. However, there had been some resistance to this idea so there would need to be a cultural change. The ICB was not requiring multiple referrals so this could not be used as an excuse. Ms Amanda Carey-McDermott, Chief Executive Officer at The Confederation Hillingdon CIC, advised that frailty was already discussed at multi-disciplinary team meetings and Dr Ritu Prasad had been driving home the ‘no wrong front door’ approach through a trial in the north of the Borough. However, it was acknowledged that there would be challenges given that some current contracts required providers to count certain things which might be at odds with this approach. Ms Sandra Taylor, the Council’s Corporate Director of Adult Services and Health, advised that improvements were needed with regard to communication. It was suggested that communication needed to be more explicit about which services residents should contact and how they could contact them (maybe an online directory). Mr Spencer noted that the Place Communications and Engagement Group had just been established and would have a lot of work to do. RESOLVED: That: 1. the outcomes of the public consultation on Hillingdon’s Joint Health and Wellbeing Strategy, 2026 – 2031 as summarised in the report be noted. 2. the proposed amendments set out in the report be approved. 3. an audit be undertaken in two years to establish whether or not residents found it easy to access services. 4. authority be delegated to the Corporate Director of Adult Social Care and Health to approve a final version of the strategy (including an 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. 7. 2026/27 BETTER CARE FUND UPDATE (Agenda Item 7) Mr Gary Collier, the Council’s Health and Social Care Integration Manager, advised that the value of the Better Care Fund (BCF) in 2026/27 had risen from £74.1m to £76.3m. There had been a 4.4% increase to the NHS minimum contribution towards social care and a 2.1% increase in the rest of the NHS minimum contribution. There had been no other increases. It had been anticipated that 2026/27 would be a transitional year so the contents of the BCF had largely rolled forward with a priority for ‘left shift’ (transferring the provision of services from hospital to the community). The report identified key changes to the plan (e.g., admission prevention, etc) and the national metrics remained the same. The report included a summary of the Equality Impact Assessment and the actions arising for 2026/27. It was noted that there had been a requirement to roll forward the DFG underspend against the additional local government contribution to the BCF. The meeting was informed that consultation was now expected to be undertaken in the autumn on the integration of the BCF into Neighbourhood Health Plans and that the timing of this meant that substantive changes were unlikely before 2028/29. With the likely incorporation of BCF into neighbourhood care, Mr Keith Spencer, Co Chair and Managing Director of Hillingdon Health and Care Partners, suggested that partners look at the BCF to determine whether Hillingdon achieved best value for money (looking at legacy schemes). RESOLVED: That: 1. the 2026/27 Better Care Fund Plan as described in the report be approved, including the proposed financial arrangements and targets for the national metrics. 2. authority to approve amendments to the plan arising from the national plan assurance process be delegated 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. the actions arising from the Equality and Human Rights Assessment (para 23) be noted. 4. A review be undertaken to determine value for money of BCF legacy schemes. 8. OCCUPATIONAL THERAPY SERVICE UPDATE (Agenda Item 8) Mr Gary Binstead, the Council’s Head of Education and SEND Commissioning, advised that there had been a national struggle to recruit occupational therapists (OTs) but that, by the end of June 2026, Central and North West London NHS Foundation Trust (CNWL) would have a full complement of OTs. Furthermore, plans were all up to date and all young people that should have had a contact had received a contact. Mr Keith Spencer, Co Chair and Managing Director at Hillingdon Health and Care Partners, noted that there were some concerns about the sustainability of this performance into the new financial year. Mr Binstead advised that discussions about demand and capacity continued with CNWL. It was OK at the moment but new legislation had been introduced which could have an impact. Ms Julie Kelly, the Council’s Corporate Director of Children’s Services, advised that the Act covered dual diagnosis which would likely result in a demand bulge but that this would be short term. She advised that the Board would need to consider the Borough’s readiness for an inspection in the SEND space which would take place by April 2027. Ms Sharon Stoltz, the Council’s Director of Public Health, advised that the Joint Strategic Needs Assessment (JSNA) was a statutory responsibility of the Health and Wellbeing Board. A SEND JSNA needed to be undertaken which would be the first of a new style that included customer experience. Ms Stoltz would be setting up a SEND JSNA Steering Group to support and underpin the plans. RESOLVED: That the content of the report be noted. 9. BOARD PLANNER & FUTURE AGENDA ITEMS (Agenda Item 9) It was agreed that the draft SEND Joint Strategic Needs Assessment be considered by the Board at its meeting on 9 September 2026 along with the complete place operating model (which would need to be considered in PART II). The SEND reforms, plans and funding would be considered at the meeting on 2 December 2026. It was noted that Ms Sharon Stoltz, the Council’s Director of Public Health, would provide the Board with an update on the review of the evaluation of early intervention and prevention services in Hillingdon at a future meeting. RESOLVED: That the Board Planner be agreed subject to the addition of the following reports: 1. 9 September 2026 - a. SEND JSNA; and b. Place Operating Model (PART II) 2. 2 December 2026 – SEND reforms, plans and funding. 10. TO APPROVE PART II MINUTES OF THE MEETING ON 18 MARCH 2026 (Agenda Item 10) RESOLVED: That the confidential minutes of the Health and Wellbeing Board meeting held on 18 March 2026 be agreed as a correct record. 11. WEST & NORTH LONDON ICB LEFT SHIFT AND NEIGHBOURHOOD CARE – APPROACH & USE OF INITIAL INVESTMENT (Agenda Item 11) Consideration was given to the report. RESOLVED: That: 1. the W&NL Neighbourhood Health Programme and associated Neighbourhood Health / Left Shift investment programme be noted. 2. Hillingdon's role as one of the Places with which W&NL intends to work in greater depth and at pace be noted. 3. the proposed direction of travel described within the report be supported. 4. it be noted that the Hillingdon Place Partnership Board will shortly consider the updated Place Operating Model and associated governance arrangements. 5. the Board receive a further update following Place Partnership Board consideration and completion of the governance review. 12. UPDATE ON CURRENT AND EMERGING ISSUES AND ANY OTHER BUSINESS THE CHAIRMAN CONSIDERS TO BE URGENT (Agenda Item 12) Board members discussed the restructure of the ICB and the impact on place. RESOLVED: That the discussion be noted. The meeting, which commenced at 2.30 pm, closed at 4.26 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 9th September 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 — Start Well, 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 four principal areas: I. Integrated Neighbourhood Teams (INTs), continue to strengthen preventative, personalised & joined-up care, with specific progress in frailty, hypertension & community diagnostics.  II. Reactive Care, which is improving urgent community response, patient flow and discharge. III. Best Start in Life, work is progressing to strengthen integrated provision for children and young people, including Child Health Hubs, school mental health support and neurodevelopmental pathways.  IV. Beter Care Fund (BCF) Quarter 1 reporting – Emergency admission (on track), Discharge delays (not on track), Permanent admissions to care homes 65+ (on track). Please see specific section for further details 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 population impact. Progress made through the latter part of last year and continuing through this year  demonstrates that the direction of travel is positive, with 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 ~41/day over the last 10 weeks.  Although we have seen an increase compared to April & May,  daily multi‑agency and Gold oversight meetings are now embedded providing greater grip, translating into improving bed availability and flow. • Frailty and preventative care: Weekly MDTs now taking place in 9 practices (50%) and opened to all North Neighbourhood population, supporting the reduction in A&E attendances and Non-Elective admissions.  Post MDT cross partner  debrief sessions for learning and improvement continues. • Mental health crisis response: The redesigned Lighthouse model has improved system flow, with 78% 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. This is now moving to business as usual. • Community alternatives to hospital: The Reactive Care Coordination Hub has improved pathways with earlier handover to  CCTs and step up to H2H to improve urgent response flow within UCR.  X-ray Diagnostics have now been set-up for HICU  and OAMH unites to reduce unnecessary LAS call outs and improved patient experience. UCR, SCDM, Adult Social Care, DNs, HIU Wellbeing is now embedded into MDTs and strengthen links between the ICC  Hub joining up care. 4. Where Performance Remains Off‑Track • Emergency demand: ED attendances remain above the operational hospital target (July average ~182/day vs target 164/day), with a circa 10% increase in Q1 of 26/27 compared to Q4 of 25/26. This has started to reduce back  down and overall average activity levels are back in line with the previous year . However, we are undertaking deep dive to understand the key drivers within particular PCNs and patient cohorts.  • 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 14.4%. A delivery plan is in place with the Public Health Team to reach the 16% target by December 2026. 5. Key Risks ​ • Organisational changes: Following the national changes to ICB structures. The previous structure that provided the local Hillingdon Borough team has now ceased and they are no longer in place.  • Workforce fragility: Delivery of key transformation programmes remains dependent upon successful mobilisation of community, discharge and coordination hub workforce capacity. Delays in recruitment or  implementation may limit the pace of improvement. • Scaling new models: The Coordination Hub and Integrated community IV antibiotics need further development and resource allocated to further embed; their full impact depends on staffing stability and  integration with wider system working. Executive Summary 4 6. Priorities to Q2 (to December 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. Scale frailty across Borough and review bed‑day reduction Embed and evaluate the frailty MDT model in the North Neighbourhood, using learning to refine the operating model and inform phased rollout across the South East and South West.  Assess impact through agreed KPIs, with a focus on reducing avoidable admissions, length of stay and associated bed days. III. Fully mobilise Reactive Care for Physical Health: Embed the seven-day Coordination Hub (08:00–20:00), integrating Physical Health, Adult Social Care and Mobile Diagnostics, with Senior Clinical Decision Maker oversight. Maximise digital functionality  to strengthen coordination and support hospital in-reach during periods of surge.  Develop the Integrated Rehabilitation & Reablement Service: Progress from service stabilisation to an integrated and  optimised operating model, strengthening needs-based decision-making at the acute front door . Streamline referral, triage and assessment to ensure patients access the right pathway at the earliest  opportunity, improving flow, efficiency and pathway visibility. 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: The Board is asked to note the content of the report.  5 Delivery against new Hospital assumptions The above dashboard shows the Place operational metrics daily performance against the new hospital targets.   The 2025/26-year end position showed significant improvement against the 2024/25 baseline, particularly on ED  attendances, NC2R and hypertension optimisation.  This suggests the Place operating model is beginning to  deliver measurable impact.  The Jun/Jul 2026/27 year-to-date position shows however , that there is more work to do to fully deliver the New  Hospital assumptions. ED and UTC attendances remain above trajectory, and length of stay for adults staying >2  days remains above target. These are the main areas requiring sharper operational focus in the next phase.   Key achievements and updates: • Non-elective admissions remain below the new hospital target and suggests early impact from admission avoidance, same-day care, neighbourhood support and Reactive care. • ED & UTC Attendances (Hillingdon Borough) remain above target, with  demand continuing to be high. Following the elevated levels of activity seen  throughout May, attendances began to stabilise in June and reduced further in  July. Average daily ED attendances fell from 131 in May to 127 in July, while UTC  attendances reduced from 161 to 156 per day over the same period. Although the  dashboard indicates that the overall 2026/27 position is in line with 2025/26, it is  important to note that activity reduced during the final quarter of 2025/26, with ED  attendances averaging approximately 121 per day and UTC 150 per day. Further  analysis indicates that the South West and South East Neighbourhoods are the  main drivers of the current increase in ED and UTC demand, highlighting these  areas as a priority for further investigation and targeted demand-management  interventions. • NC2R has remained broadly stable, with a current YTD daily average of 40 patients, compared with 41 in 2025/26 and 50 in 2024/25. While still above the  target of ≤34, performance reflects sustained improvement, supported by robust  discharge grip, Place Gold oversight and strengthened multi-agency escalation. • Adult LoS remains above the target at 9.6 days (target ≤8.5 days). While this  represents a slight increase from 9.3 days reported last month, continued focus on  reducing time to medical optimisation and sustaining robust discharge grip will be  essential to improve patient flow and reduce length of stay. • Outpatients position is TBC; the next quarter should mobilise the Hospital-to- community Place transformation programme as part of the Place Operation model, the new hospital assumptions and the wider W&NL Neighbourhood health /Left Shift programme. There are six proposed specialist pathways: (Geriatrics, Cardiology, Respiratory, Diabetes and Endocrinology, Renal/CKD, MSK/Rheumatology). • Hypertension prevalence and optimisation remain below the target of 16% & 80%. Delivery plan in place to reach 16% by December 26 with support from Public Health around outreach and education. Hypertension prevalence and Optimisation positions are as at a point in time. As more patients are diagnosed  with hypertension, the optimisation percentage is likely to decrease initially, as a  greater number of newly diagnosed patients will need to be optimised before they  achieve blood pressure control. Programme Update: Neighbourhoods (Live Well & Age Well) 6 8.0. 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, North INT MDT has expanded from 3 to 9 practices, proactive WSIC case-finding commenced across CCTs with the top 200 frailty risk cases shared clinically for review, and standardised CGA/care planning development progressing. • Hypertension programme: Strategic and operational governance groups mobilised, delivery continues towards increasing recorded prevalence to 20% by April 2027 while sustaining optimisation and targeting support to low prevalence practices. Prevalence has increased to 14.4% for the whole population and 18.3% for the 18+ population with optimisation currently at 76% overall. • 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: Future state pathway mapping has progressed beyond the original frailty pathway to include post-MDT services and coordination hub  interactions. Integration testing confirmed Blinx data can be surfaced successfully within SystmOne, mitigating a key technical risk. • Integrated Neighbourhood Hubs: SOA workshop has been held with Healthcare Planner for all 3 hubs alongside this, a Benefits and Case for change OBC workshop has been held. 8.1. Forward Plan (Qtr. 3 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 Formalise the frailty model through a Standard Operating Procedure. Accelerate MDT working across all neighbourhoods, progressing towards 100% frailty coverage across the Borough. o Broaden anticipatory care beyond hypertension to include COPD, diabetes, falls prevention and multi-morbidity, prioritising residents at moderate risk. o Completion and agreement of UCP SOP which includes communication and engagement strategy to enable patients to self initiate. • Implement the Hillingdon Hypertension Strategy o Finalise and adopt the borough-wide Hypertension Strategy through the Public Health Team who are now leading this programme of work. o Support Public Health Business Cases for outreach and education, agree searches, and explore how to provide specific support working towards the interim milestone of 20% by April 2027. Continue monitoring of the standardised proactive case-finding methodology, high opportunity practices, and outreach. Include engagement events data capture to measure impact. Programme Update: Neighbourhoods (Live Well & Age Well) 7 By Q3 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. • 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 • Financial modelling substantially progressed for all three hubs subject to SOA/design development and the validation of the Nestle Hub SOA.  Advance the Outline Business Case, ensuring alignment with  hospital redevelopment, left-shift priorities and wider system enablers including workforce and digital. 8.2. 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 8 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 Ongoing 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 Narrative / Likely Cause Actions to Remedy Timeline Accountability The 10-week rolling average is currently at 234 attendances  per day with a June monthly average of 232, this is against a  target of 180 per day.  Although attendances have increased  over the 10-week rolling average the monthly attendances in  July have decreased by 2 per day. Revised delivery plan incorporating stronger  front door diversion & capacity improvement.  Discussions underway with THH, GP Confed  and HHCP about an audit into patients within  particular PCNs.   SRO  Neighbourhoods Narrative / Likely Cause Actions to Remedy Timeline Accountability Hypertension prevalence has continued to increase  gradually over the last few months, but the July position has  remained static at 14.4% against a target of 16%.  Currently,  14 practices within the Borough are achieving the 16%  prevalence target. Hypertension delivery plan and tracking in  place to reach 16% by Dec 26, education and  outreach to be progressed by the Public Health  Team. To meet 16%  Prevalence  target by Dec- 26 SRO  Neighbourhoods Narrative / Likely Cause Actions to Remedy Timeline Accountability Hypertension optimisation is currently 76% across the  Borough, 4% under the 80% target. Optimisation  Performance dipped in June & July 26 since diagnosing more  cases of hypertension, and work needs to happen to ensure  the newly diagnosed patients are optimised. 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 Programme Update: Reactive Care (Urgent & Crisis Response,  Hospital Discharge) 9 9.0. 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. 9.1. Components of Reactive Care (Progress Update) • Reactive Care Coordination Hub (Phase 1): Diagnostic pathways have been strengthened through improved access via the HICU pathway and Older Adult Mental Health (OAMH) Unit, enabling timelier  assessment and reducing unnecessary LAS callouts. A system-wide Surge Plan has been developed (awaiting final sign-off), with key hub enablers now in place, including agreed workforce roles, submitted  staffing plans, and a confirmed location. • 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 41 down from an average of 50, improving flow and freeing bed capacity. 9.2 Next 6 Months Priorities (to December 2026) • Full Mobilisation of the Coordination Hub: Focus will be on fully embedding the Integrated Coordination Hub, strengthening urgent and community care pathways, optimising workforce  deployment, and enhancing system-wide triage, referral management and clinical decision-making to support more coordinated and responsive care. • Integrated Rehabilitation & Reablement Service: Work continues to develop a more streamlined and integrated model across acute, therapy, community and Adult Social Care, reducing  duplication and unnecessary hand-offs. Focus is on improving referral quality, multidisciplinary decision-making and shared access to digital systems, supporting improved discharge flow  and reduced Length of Stay (LoS).  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.  Programme Update: Reactive Care (Urgent & Crisis Response,  Hospital Discharge) 10 9.3 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 Establishing a dedicated Coordination Hub workforce to manage referral acceptance, triage and allocation is critical to delivering timely decision-making, effective care coordination and the intended benefits  of the integrated Hub model. • 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 or still within a pilot phase. 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 11 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 41, with an August monthly average of 42. This represents an  increase of one compared to previous months and places performance eight  above the target of 34. SRO Reactive Care Narrative / Likely Cause Actions to Remedy Timeline Accountability The 10-week rolling average is currently 185 attendances per day, with a July  average of 182.  This has decreased over the last few weeks by 4 a day on  average compared to June.  Type 1 attendances have started to decrease  following the recent surge in May although they still remain high and above the  target.  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 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 SRO Reactive Care Programme Update: Start Well (Children & Young People) 12 10.1 Purpose and Model The Start Well 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. 10.2 Delivery Update Recent progress in the Start Well program include: 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 (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 and a focus on preparedness for  University. Neurodevelopmental Pathways Demand for neurodevelopmental assessment has increased significantly.  Additional investment 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.  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) 13 10.3 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 • 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.  Mental Health Support Teams (MHSTs) in Schools • Wave 14 expansion of our MHST offer live in schools • MHSTs in Hillingdon 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 14 Better Care Fund 2026/27 Quarter 1 Reporting 11.1 Better Care Fund 2026/27 There is a national requirement for Health and Wellbeing Boards to monitor performance against the BCF plan. There will be regional reporting of performance from Quarter 2 and a  national end of year template that is likely to be based on that completed for 2025/26 Headlines Metrics • Emergency admissions (on track): Based on nationally available data for April and May, this suggests a Q1 outturn of 2,317 admissions against a ceiling of 2,394 and an average rate  per 100,000 admissions 65 + of 1,788 against a ceiling of 1,847. To give context, this would be a higher rate than for the Greater London (1,676) region, England (1,599) and the Local  Authority peer group average (1,676). • Discharge delays (not on track): There are two components to this metric: Ø People 18 + discharged on their discharge ready date: The average number discharged from hospital on their discharge ready date was 90.3% against a target of 92.2%. In  context, this is better than the average Greater London performance (86%), that for England (85%) and our Local Authority peer group (86%). Ø Average number of days between discharge ready date and actual discharge:  The Q1 average was 5.45 days compared to a target of 5.27 days. The Hillingdon average was  lower than that for Greater London (6.78 days), that for England (6.38) and our Local Authority peer group (6.78). • Permanent admissions to care homes 65 + (on track): The twelve-month rolling average for Q1 was 167 against a ceiling of 183, which a rate of 387 admissions per 100,000 65 +  population against a ceiling of 423.6 for the quarter . There were 44 actual permanent admissions, which compares to 55 in Q1 2025/26. Comparative data for 2026/27 is not currently  available. Cross-Cutting System Risks & Mitigations 15 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 ~40, 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 during winter if 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, community capacity (through integrated Reablement and bridging care) 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 –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 Neighbourhood 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. Key Project Highlights 16 17 Integrated Response Coordination Hub – 2Hr Response Data   • The increase in activity reflects UCR’s expanded remit to accept catheter SOS calls, alongside an exceptionally busy  period for other UCR referrals. Despite the heightened demand, the team has worked extremely hard to sustain service  provision, remain operational, and flex capacity effectively to meet patient needs. • The reduction in length of stay (LOS) may be partly explained by the increase in catheter SOS patients, who often  require only a single catheter change visit. Additionally, the ongoing development and maturation of the Hospital at  Home service is likely contributing to shorter overall lengths of stay by supporting timely care and discharge in the  community. 18 Reactive Care - Integrated Response Coordination Hub Frailty 19 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: July 2026 INT MDT pilot progressing and expanding: • Weekly INT MDT commenced 5/5/26 with three GP practices, increased to nine (50%) by early July. At 4 August opened to all North population (ahead of Sept) • Total of 36 cases heard to date. • Post MDT cross partner debrief session for learning/improvement continues • Next steps: Continue comms to remaining North practices to onboard by Sept; open referral-in pathway from other disciplines/partners Proactive case-finding underway: • Rolled out across CCTs using WSIC, with monthly activity monitoring commenced; focuses on 18+ severe/rising risk frailty, excl. care homes & EoL cohort: • Top 200 WSIC cases (by Frailty Risk Score) shared with matrons and GPs to review and proactively find unknown cases to engage with. • CCT matron and GP communications to onboard GPs with the approach Frailty KPIs: • 5% population: 18+, mod/severe EFI, 2+ A&E attendances or 2+ NEL admissions, or 2+ LTCs (from specific list of 15, includes dementia) • KPI framework agreed covering system-level and frailty-specific measures (e.g. A&E/NEL admissions; case finding, MDT activity and outcomes) • Visual ‘prototype’ dashboard being developed via Gill. Timescales: Sept: Raw data view; Oct: Dashboard format view • Targets to be reviewed based on previous years’ performance Documentation standardisation in progress: • One London have confirmed capital funding to proceed with developing an integrated CGA/UCP solution. Rollout expected end 2026 • Hillingdon reps were involved in 3x July pan-London scoping workshops – positive feedback, keen for the solution • Borough-wide SOP to UCP completion – establishment of an oversight group given the system partners involved Resource mapping underway: • Exercise taken forward facilitated by external consultants (HIP) via the GP Confederation re workforce requirements to support required 5% frail population • Includes modelling for scaling MDT across all three (N, SE, SW) neighbourhoods; additional resource is a dependency • Business case due at the end of July 20 Challenges:  ​ • ICB definition of the 5% population cohort and how to source this population • Resource restriction in wider INT MDT roll-out to SE and SW [Geriatrician time] • Operational consistency: Need to standardise case-finding, referral and documentation processes; onboard GPs with the approach • Digital interoperability: Digital workstream for a shared, integrated solution for MDT documentation (S1>Blinx one-way integration), shared records and CGA Next steps: Core delivery through Q1 • Gain access to UCP dashboard • Continue raising awareness of the MDT with North GPs and partners • CCT and GP communications to socialise CCT roles/criteria and proactive case-finding requirement • Advance digital solutions – one-way interoperability (SystmOne to Blinx) Frailty Hillingdon Lighthouse  21 Background  • Hillingdon Mental Health Lounge, the Lighthouse, has been operational since August 2023 but since mid-Nov 25 via additional ICB funding, the Lighthouse operating model has been implemented (Completed via a cross-partner T&F Group including CNWL, THH and patient representatives). • The Lighthouse is set-up as an alternative mental assessment space away from the often-busy A&E/UTC, offering a more therapeutic environment for swift MH assessment and treatment commencement. • The primary aim is to support patients in MH crisis, to provide them with the support, treatment, signposting required and divert an acute MH admission. • Patient capacity increased from four to six, however flexes up to ten as required and based on clinical risk in the space, given the small staff capacity; and is open 24 hours per day seven days a week • Referral in route: medically cleared via A&E, UTC or PLS. ​ Latest data shows The Lighthouse has received 781 referrals from A&E, UTC & PLT since January 1st, 2026, to  now. Of these, 558 (80.8%) patients were transferred/accepted to the Lighthouse for assessment. 482 patients were discharged back into the community with a majority receiving support or  follow up from a respective team in the community. 77.5% of patients admitted were safely  discharged/transferred from the Lighthouse  within 24 hours Hillingdon Children & Young People (CYP) Transformation Board 22 Purpose of the meeting The Board met to reset and clarify the strategic governance for Children and Young People (CYP) across Hillingdon, ensuring clear leadership, system‑wide coordination, and stronger alignment with neighbourhoods, commissioning, and the Health & Wellbeing Strategy. Key themes and discussion 1. Need for a single strategic CYP forum • Strong consensus that CYP work is currently fragmented across multiple meetings and partnerships, leading to duplication and lack of strategic direction. • Agreement that a focused CYP strategic group is needed to provide leadership, coordination, and parity of esteem with adult priorities. 2. Strategic vs operational separation • Clear agreement that the CYP strategic group should not replace operational or contractual forums, particularly those managing the CNWL–Local Authority collaborative agreement. • Proposal to keep contractual and delivery detail in separate operational groups, with escalation into the strategic forum where required. 3. Governance and system alignment • Extensive discussion on how the group should sit within existing structures (Executive Oversight Board, Health & Wellbeing Board, HHCP). • Emerging preference to embed CYP within existing governance routes, ensuring visibility through integrated performance reporting rather than creating parallel structures. 4. Neighbourhoods and integration • Strong emphasis on ensuring CYP is embedded within neighbourhood and integrated team models, which are currently perceived as adult‑focused. • Recognition that CYP services (family hubs, child health hubs, therapies, mental health) need clearer system‑level visibility and coordination. 5. Voice of children, young people and families • Consensus that CYP and family voices must be systematically included, rather than ad‑hoc. • Existing mechanisms (Healthwatch, Family Hub Parent Groups, engagement forums) should be better coordinated and linked into strategic decision‑making. • Action taken to clarify how Healthwatch and other engagement routes feed into CYP governance. 6. Outcomes, data and performance • Agreement that a shared outcomes framework and dashboard is essential to track impact across prevention, early intervention, and specialist services. • Recognition that data sharing and consistency remain challenging but are critical for accountability and reporting to the Health & Wellbeing Board. 7. Health & Wellbeing Strategy influence • The draft Health & Wellbeing Strategy was discussed, with recognition that CYP priorities (particularly prevention and early intervention) must be clearly reflected and measurable. • Opportunity identified to influence final sign‑off through integrated reporting and verbal updates. Child Health Hubs – Overview and Next Steps  23 Child Health Hub Expansion – Mobilisation Summary • Approve & design: Secure governance approvals and finalise the  CHH service specification (Q1 2026) • Mobilise workforce: Recruit programme and clinical resources and  agree GP and paediatrician capacity • Enable delivery: Finalise contracts, funding, data capture, and  reporting infrastructure • Phased rollout: Launch hubs in cohorts from Q1 to Q3 Apr 2026 to  Sep 2027, supported by comms and engagement • Evaluate & sustain: Evaluate impact and use findings to inform  outcomes, scaling, and long-term funding Integration of neighbourhood services for children and families

Health and Wellbeing Board report 9 September 2026 JOINT HEALTH AND WELLBEING STRATEGY, 2026 – 2031: UPDATE Relevant Board Member(s) Cllr Susan O’Brien – Co-chair Keith Spencer – Co-chair Sandra Taylor – Corporate Director, Adult Social Care and Health Julie Kelly – Corporate Director, Children’s Services Organisation London Borough of Hillingdon Hillingdon Health and Care Partners 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 – Equality and Human Rights Impact Assessment 1. HEADLINE INFORMATION Summary This report updates the Board on the development of the draft Joint Health and Wellbeing Strategy and summarises the further work being undertaken. 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 None Relevant Select Committee Children, Families, Health and Care Ward(s) affected N/A 2. RECOMMENDATIONS That the Health and Wellbeing Board: 1. Notes the content of the report, including the outline of work in progress to finalise the strategy and the delivery plan. 2. Notes the content of the Equality and Human Rights Impact Assessment and the actions arising from it. 3. Delegates authority to the Corporate Director of Adult Social Care and Health to approve the final version of the strategy and delivery plan , in consultation with the Co-chairs, the NHS West and North London representative and Healthwatch Hillingdon. 3. INFORMATION Supporting Information 3.1 The June 2026 meeting of the Board considered the outcome of the public consultation on the draft strategy and agreed to delegate to the Corporate Director of Adult Social Health and Wellbeing Board report 9 September 2026 Care and Health to approve a final version of the strategy in consultation with the Co- chairs, the NHS West and North London representative and Healthwatch Hillingdon. There is further work to be done to complete the strategy and delivery plan and the Board is therefore asked to reaffirm its earlier decision to delegate final approval authority as described above. 3.2 Since the June meeting the strategy document has been designed by the Council’s Communications Team, a delivery plan drafted and an equality and human rights impact assessment (EHIA) completed. The draft strategy and delivery plan can be accessed through the following link Joint Health and Wellbeing Strategy 2026 to 2031 | Hillingdon Council. The EHIA is attached as Appendix 1. 3.3 The Board is reminded that the strategy 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 3.4 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. 3.5 Many of the life-course outcomes are dependent on the successful mobilisation of the Place Operating Model. Strategy Delivery Plan 3.6 The delivery plan creates a single framework for measuring the impact of the strategy and this is illustrated below. Impact Area What should be evidenced Operating model mobilisation: Are we building and scaling the model across the borough? • Delivery of mobilisation milestones. Place outcomes: Are we reducing demand, improving flow through the health and care system and shifting care from hospital to community? Core System Metrics: • Non-Elective Admissions – 20,180 per year • Non-Elective Admissions ≥2 days – 9,827 per year • Emergency Department Attendances – 40,600 per year • Urgent Treatment Centre Attendances – 120 per day • No Criteria to Reside (NC2R) – ≤34 patients per day • Average length of stay for adults staying ≥2 days Health and Wellbeing Board report 9 September 2026 Impact Area What should be evidenced – 8.5 days • Outpatient activity – 300,911 per year • Hypertension prevalence – 24% • Hypertension target-to-treatment – 80% • Permanent admissions to care homes – 170 per year Wider strategy outcomes: Are we supporting better resident health and reducing inequalities? • Improvement in Core20PLUS5 • Improvements in Best Start and Healthy Places’ measures. • Delivery of EHIA actions. • Improved resident and carer experience. Equality and Human Rights Impact Assessment (EHIA) 3.7 The conclusion of the EHIA attached as Appendix 1 was that the strategy has strong positive equality impacts across all relevant protected characteristics and community issues, and demonstrates clear intent to advance equality of opportunity, eliminate disadvantage and foster good relations between communities. For ease of reference the conclusions from the assessment are set out below. The Board is asked to note that actions from the assessment are reflected within the delivery plan described above. 3.8 The significant positive equality impacts of the strategy include: • The Core20PLUS5-aligned targeting of the most deprived communities in south Hillingdon (Hayes, Yiewsley, West Drayton and Harefield) across Start Well, Live Well, Age Well and Healthy Places priorities, directly advancing equality of opportunity for communities facing the greatest health disadvantage. • Explicit actions to address maternity inequalities for Black, Asian and deprived women, including personalised maternity pathway access and culturally tailored support — a priority area where national evidence demonstrates significant health harm. • The hypertension and cardiovascular risk programme targeting South Asian and Black communities disproportionately affected by these conditions, which are the largest drivers of emergency admissions in Hillingdon. • Proactive frailty care, Urgent Community Response, Hospital at Home and reablement programmes for older adults, supporting the right to independent living in line with the UN Convention on the Rights of Persons with Disabilities (UNCRPD). • The Disabled Facilities Grant and housing adaptations programme enabling disabled and older residents to remain at home. • Investment in children's mental health, SEND pathways and Family Hubs, targeted at disadvantaged children in the south of the borough. • Improved carer identification and support, addressing the significant but largely invisible burden on the estimated 22,465 unpaid carers (59% of whom are women). • Fostering good community relations through Healthy Places priorities — reducing isolation, improving neighbourhood safety, and embedding health in all policies. 3.9 The potential negative impacts and the actions to address them include:  Children in deprived south Hillingdon face entrenched compound disadvantage. The strategy commits to targeted Family Hub investment, immunisation outreach and Health and Wellbeing Board report 9 September 2026 monitoring of the Good Level of Development (GLD) gap by ward and ethnicity.  Children with Special Educational Needs and Disabilities (SEND) face long waits and fragmented pathways. The strategy commits to a coordinated neurodevelopment (ND) pathway and improved Education, Health and Care Plan (EHCP) timeliness targets, with monitoring by deprivation.  Older adults in the more deprived south of the borough are experiencing rapidly worsening income deprivation. The Core20PLUS5 approach and neighbourhood- level monitoring will ensure these residents benefit from Age Well priorities.  People with severe mental illness face physical health inequalities. Serious mental illness (SMI)-inclusive physical health checks will be embedded within Integrated Neighbourhood Teams (INTs) hypertension (also known as high blood pressure) and cardiovascular disease (CVD) programmes.  Many unpaid carers — particularly men and young carers — remain under identified. Proactive carer identification through INTs, GPs and MECC is committed, with a target of 40% registration by 2030.  Lesbian, gay, bisexual and transgender + (LGBT+) residents are at risk of invisibility in service planning. Partners commit to developing LGBT+-specific data, reviewing service design for LGBT+ inclusivity, and engaging LGBT+ community groups.  Digital exclusion risks for older and disabled residents, especially around the Technology Enabled Care (TEC) switchover, will be addressed through the TEC digitalisation programme and continued non-digital access routes. Next Steps 3.10 Work is currently in progress to complete the alignment of actions between the strategy and delivery plan and confirm metric baselines. 3.11 If recommendation 3 is agreed, the Board will receive updates on the implementation of the delivery plan through the single integrated performance report. The Board may decide during the lifetime of the strategy that it wishes to consider some aspects in more depth. Financial Implications 3.12 There are no direct financial implications arising from the recommendations in this report. 4. EFFECT ON RESIDENTS, SERVICE USERS & COMMUNITIES Consultation Carried Out or Required 4.1 As outlined in paragraph 3.3, the Board considered the outcome of the consultation on the draft strategy at its June 2026 meeting. 5. CORPORATE IMPLICATIONS Hillingdon Council Corporate Finance comments 5.1 There are no financial implications arising from the recommendations in this report. Hillingdon Council Legal comments 5.2 The Board has a statutory duty under the Health and Social Care Act, 2012 to produce a Health and Wellbeing Board report 9 September 2026 Health & Wellbeing Strategy. 6. BACKGROUND PAPERS Draft Joint Health and Wellbeing Strategy, 2026 – 2031 Draft Joint Health and Wellbeing Strategy, 2026 – 2031 Delivery Plan Health and Wellbeing Board report 9 September 2026 Appendix 1 Equality and Human Rights Impact Assessment Joint Health and Wellbeing Strategy, 2026 - 2031 STEP A) Description of what is to be assessed and its relevance to equality What is being assessed? Please tick  Review of a service  Staff restructure  Decommissioning a service  Changing a policy  Tendering for a new service  A strategy or plan  The Joint Health and Wellbeing Strategy (JHWS) creates a borough-wide framework for improving health and wellbeing, reducing inequalities and supporting residents to live well across the life course. It covers Start Well, Live Well, Age Well and Healthy Places, and will be delivered through Integrated Neighbourhood Teams, Family Hubs, Local Access Hubs, a Borough-wide Reactive Care Service and wider partnership arrangements. Who is accountable? E.g. Head of Service or Corporate Director Sandra Taylor – Corporate Director, Adult Social Care and Health, Hillingdon Council. Keith Spencer – Managing Director, Hillingdon Health and Care Partners. Date assessment completed and approved by accountable person July 2026 Names and job titles of people carrying out the assessment Sharon Stoltz – Director of Public Health Gary Collier – Health and Social Care Integration Manager Health and Wellbeing Board report 9 September 2026 A.1) What are the main aims and intended benefits of what you are assessing? The strategy's shared vision is: "To create a fairer, healthier borough where people of all ages can live well, stay well and age well." It is underpinned by three core ambitions:  A Fairer Hillingdon – narrowing the gap in health outcomes between the most and least advantaged communities and ensuring those facing the greatest barriers receive the greatest support.  A Preventative Hillingdon – focusing on early help, prevention and proactive care, delaying or avoiding the need for hospital and long-term care wherever possible.  An Integrated Hillingdon – organising services around people and communities rather than organisational boundaries, delivered through Integrated Neighbourhood Teams (INTs) and Family Hubs. The strategy's life-course framework and the intended benefits for Hillingdon residents are:  Start Well: improved maternal health; higher immunisation coverage; improved school readiness and good level of development; better emotional wellbeing and mental health for children and young people; earlier SEND support; reduced childhood obesity.  Live Well: earlier detection and management of long-term conditions (especially hypertension, diabetes, obesity, anxiety, depression); improved mental wellbeing; reduced health-harming behaviours; stronger support for working-age carers.  Age Well: proactive frailty care and rapid community support; improved falls prevention, reablement and discharge; better dementia and end-of-life care; more older adults independent at home for longer.  Healthy Places: improved housing stability; safer and healthier neighbourhoods; reduced social isolation and improved community connection. By 2031, the strategy aims to deliver: fewer avoidable hospital admissions; faster, safer discharge; more older adults independent at home; reduced health inequalities between the most and least deprived neighbourhoods; and a sustainable community health and care system capable of supporting the new Hillingdon Hospital. A.2) Who are the service users or staff affected by what you are assessing? What is their equality profile? The strategy affects all Hillingdon residents and communities and is particularly relevant to people and families who experience poorer health outcomes, barriers to access, or higher reliance on health, care, housing and community support. Population Overview • Total population: 329,185 (ONS mid-year 2024) — approximately 8% higher than the 2021 Census figure of 305,900. • Projected to increase to 333,958 by 2032 and 337,697 by 2035. Health and Care Need • 48% (127,264) of adults registered with a Hillingdon GP are living with one or more long- term conditions — among the highest weighted average in Northwest London. • The top five long-term conditions are hypertension (also known as high blood pressure), Health and Wellbeing Board report 9 September 2026 anxiety, depression, obesity and diabetes. Hypertension accounts for approximately 50% of unplanned hospital admissions in older adults and 20% in working-age adults. • 4,400 residents (approx. 1.4%) account for 50% of all emergency hospital admissions. Age • Under 5 (early years): 21,132 people (6.4%). • School age (5–17): 54,392 people (16.5%). • Working age (18–64): 210,463 people (63.9%). • Older adults (65+): 43,198 people (13.1%); of whom 11,881 are aged 80+ (3.6%). The 65+ population is projected to rise to 53,082 by 2035, with the 80+ cohort reaching 15,092. • People aged 65+ account for over 30% of GP and A&E activity and 40% of emergency hospital admissions. • 2,200 residents die each year; only 26% die in their usual place of residence (below national aspirations). • The Income Deprivation Affecting Children Index (IDACI) 2025 shows 6 LSOAs in the most deprived decile (up from 2 in 2019) and 30 in decile 2 (up from 8); all in the south of the borough. • The Income Deprivation Affecting Older People Index (IDAOPI) 2025 shows 12 LSOAs in the most deprived decile (up from 6 in 2019) and 25 in decile 2 (up from 14); again, all in the south. Sex • Female: 50.6% (approximately 155,000 residents); Male: 49.4% (approximately 151,000). • Life expectancy: women 83.9 years; men 79.4 years — a gap of approximately 4 years. • Healthy life expectancy is broadly similar: women 66.6 years; men 66.0 years. • Nearly 59% of unpaid carers are female, indicating that women bear a disproportionate caring burden. Disability • For the total population aged 15+: 87% (266,466 people) do not identify as disabled. 7.3% (22,379) have a disability that limits daily activities a little; 5.5% (17,075) have a disability that limits daily activities a lot. • For the 65+ population: 66.4% (27,344) do not identify as disabled; 16.8% (6,946) have a disability limiting activities a little; 16.7% (6,879) a lot — meaning approximately one- third of older adults in Hillingdon live with disability. • By neighbourhood (disability: not disabled): North 86.7%; Southeast 88.1%; Southwest 86.3%; Borough-wide 87.1%. Note: the neighbourhood monitoring dashboard was not operating correctly at the time of this assessment, so these figures are estimates only. Race and Ethnicity • Hillingdon is highly diverse: 51.8% of residents identify as Black, Asian or from other minority ethnic groups (up from 2011). • Borough-wide ethnicity profile (2021 Census): White 48.2% (147,408); Asian 33.3% (101,954); Black 7.8% (23,963); Mixed 4.4% (13,356); Other 6.3% (19,262). • Diversity varies significantly by neighbourhood: Harefield ward (North) is the least diverse; Belmont ward (Southeast) is the most diverse. • South Asian and Black communities are disproportionately affected by diabetes and hypertension. Religion or Belief • Christian: 39%; Muslim: 14.4%; Hindu: 10.8%; Sikh: 8.6%; No religion: 19.4%. • Younger residents are more likely to identify as Muslim; older residents more likely to identify as Christian or Jewish. Sexual Orientation • 88.9% identify as heterosexual /straight; 2.2% identify as lesbian, gay, bisexual or other orientation; 8.8% declined to answer. Health and Wellbeing Board report 9 September 2026 • For the 65+ population: 90.4% heterosexual; 0.5% LGB; 8.9% declined to answer. • Among non-White English ethnic groups: 87.9% heterosexual; 2% LGB; 10% declined to answer. Gender Reassignment • Just under 1% (2,116 people aged 16+) stated they had a different gender identity to that registered at birth (2021 Census). • 7.4% (17,963 census respondents) did not answer the question. Marriage or Civil Partnership • 38.7% married or in a registered civil partnership; 29.2% never married; 20.9% under 16; 5.6% divorced/dissolved civil partnership; 1.6% separated; 4% widowed. Pregnancy or Maternity • Approximately 4,100 babies born each year. • Low birth weight and access to maternity care are identified as key issues. • Baseline smoking at time of delivery (SATOD): 3.3–3.4%. • Breastfeeding at 6 –8 weeks (totally/exclusively): 34% (2024/25 baseline) — well below the 70% target. Carers • 22,465 unpaid carers identified in the 2021 Census; 29% provide 50+ hours of care per week. • Nearly 59% of carers are female; male carers are likely significantly under-identified. • As of 30 June 2026, approximately 35% of carers (against the 2021 Census baseline) are registered on Hillingdon's Carers Register. • The 2025/26 national carers survey found that 21% of carers felt socially isolated. Socio-economic Status • Deprivation has increased over the past seven years. In 2025, 18 Lower Super Output Areas (LSOAs) fall within the second -highest deprivation level — compared to just 2 in 2019. All LSOAs in the top two deprivation levels are in the south of the borough. • Overcrowding, homelessness and food insecurity are concentrated in Hayes, Yiewsley and West Drayton. • Respiratory conditions, income, employment and education deprivation are key drivers of inequality in Harefield. • Socio-economic deprivation and poor air quality around Heathrow contribute to respiratory and cardiovascular risk in adjacent communities. • 56.6% of Hillingdon’s households own their own home and 30% own outright without a mortgage. Outright ownership is concentrated in the north of the borough. Nearly 26% of household rent from a private and just over 16% rent from a social landlord, including 9.3% that rent from the Council or a housing association. A.3) Who are the stakeholders in this assessment and what is their interest in it? Stakeholders Interest Residents, service users and carers. Fair access to prevention, early help, health, care, housing and community support; assurance that priorities reflect lived experience and reduce inequalities. Seldom heard and disadvantaged communities. Meaningful involvement in shaping neighbourhood delivery, culturally appropriate support, and removal of barriers to access. Children, young people, families and parent- carers. Early years, SEND, mental health, school readiness, attendance and healthy weight Health and Wellbeing Board report 9 September 2026 outcomes; improved navigation and coordinated support. Older residents, people living with frailty, dementia or long-term conditions. Earlier identification, proactive care, safe discharge, rehabilitation, reablement, independence and dignity. Hillingdon Health and Wellbeing Board Statutory oversight of strategy delivery and assurance that the public sector equality duty is met. Council services: Public Health, Adult Social Care, Children’s Services, Housing, Community Safety. Delivery of cross-council action on wider determinants, safeguarding, prevention, housing stability and community safety. NHS partners, i.e., primary care, Integrated Care Board and Hillingdon Hospital. Integrated neighbourhood delivery, urgent and planned care redesign, discharge performance and reduced avoidable demand. VCSE sector, Healthwatch Hillingdon and community organisations. Co-production, engagement, prevention, carers’ support, loneliness reduction, community connection and support to Core20 neighbourhoods. Cabinet Member, Council Cabinet and senior leaders Strategic assurance, resource alignment, risk management and delivery of improved outcomes for residents. Health and Wellbeing Board report 9 September 2026 A.4) Which protected characteristics or community issues are relevant to the assessment?  in the box. Age  Sex  Disability  Sexual Orientation  Gender reassignment  Socio-economic status  Marriage or civil partnership X Carers  Pregnancy or maternity  Community Cohesion  Race/Ethnicity  Community Safety X Religion or belief  Human Rights  STEP B) Consideration of information; data, research, consultation, engagement B.1) Consideration of information and data - what have you got and what is it telling you? Age — children and young people Children and young people face a range of inequalities that are concentrated in the south of the borough. The IDACI 2025 shows a significant worsening of child income deprivation, with 6 LSOAs now in the most deprived decile (versus 2 in 2019). Approximately one in five children live in low-income households. Only 70% of children achieve a Good Level of Development (GLD) at age 5; the gap for disadvantaged children (51.9% GLD) is 19 percentage points below their peers. Asthma is a leading cause of unplanned paediatric hospital admissions. Childhood obesity at age 11 (Year 6) affects 38.3% of pupils — highest in deprived neighbourhoods. There is growing and unmet demand for SEND and neurodevelopmental assessment, with families reporting long waits. Demand for children's and young people's (CYP) mental health support is rising, with MHST coverage only at 44%. Persistent absence from school (above 21.2% nationally) is a particular concern, with health factors including long-term conditions, anxiety and neurodiversity all contributing. Proportionality and intersectionality: Children in the south of the borough (Hayes, Yiewsley, West Drayton) experience a compound disadvantage of income deprivation, poorer housing, higher rates of childhood obesity, lower school readiness and higher rates of asthma. Children from South Asian backgrounds (dominant in the Southeast neighbourhood) are disproportionately affected by some of these inequalities. Age — older adults (65+) People aged 65+ account for 13.1% of the population but 30%+ of GP and A&E activity and 40% of emergency admissions. The 65+ population is growing and is projected to rise 23% by 2035. The older population faces increasing deprivation: the IDAOPI 2025 shows 12 LSOAs in the most deprived decile (from 6 in 2019) — a doubling in six years. Approximately one-third of people aged 65+ live with disability (either limiting activities a little or a lot). Frailty, falls and dementia are major drivers of avoidable admissions and long-term care Health and Wellbeing Board report 9 September 2026 need. Only 26% of the 2,200 annual deaths in Hillingdon occur in the person's usual place of residence, indicating that most residents are not currently dying in their preferred place. The dementia diagnosis rate is below the target of 66.7%. Proportionality and Intersectionality: Older residents in the south of the borough face the greatest inequalities. The IDAOPI shows rapid deterioration in older people's income deprivation concentrated in the south. Older women outlive older men by approximately 4 years, making older women the primary users of long-term care services. Older residents from Black and South Asian communities face elevated risk of hypertension and diabetes- related complications. Sex Women make up 50.6% of Hillingdon's population but account for nearly 59% of identified unpaid carers — a significant gendered burden. Women live approximately 4 years longer than men (83.9 vs 79.4 years), but healthy life expectancy is similar (66.6 vs 66 years). This means older women spend more years living with ill health or disability. Women are disproportionately represented in part-time and low-paid care sector roles, making them more vulnerable to the financial impacts of health-harming conditions and socio-economic pressures. Men are less likely to identify themselves as carers, leading to significant under- registration. Men also have higher rates of smoking, higher cardiovascular mortality and lower engagement with preventative health services. Proportionality and Intersectionality: Black and South Asian women face compounded disadvantage in maternal health outcomes, including maternity inequalities in smoking in pregnancy, breastfeeding rates and access to personalised maternity pathways. Women in deprived areas carry multiple burdens — caring, low income, poor housing — that compound health risk. Disability The 2021 Census indicates that 12.8% of Hillingdon's population aged 15+ identify as having a disability (7.3% limiting a little; 5.5% limiting a lot). For the 65+ population, this rises to approximately 33.5%. Neighbourhood-level data shows broadly similar rates across the three INTs (not disabled: North 86.7%; Southeast 88.1%; Southwest 86.3%) with the note that dashboard reliability was limited. Disabled people face well-documented barriers to accessing services, employment and social participation, and are at heightened risk of poverty. The strategy explicitly addresses the needs of people with physical disability, learning disability, autism, ADHD and dementia. The Disabled Facilities Grant (DFG) provides adaptations for disabled people to remain in their homes. People with severe mental illness face significant physical health inequalities, including much lower rates of hypertension and diabetes detection and management. Proportionality and Intersectionality: Older disabled women in deprived parts of the borough face acute compound disadvantage — socio-economic deprivation combined with disability, age and gender. Children with SEND in low-income households face multiple interlocking barriers. People with learning disabilities or autism are at elevated risk of diagnostic overshadowing, i.e., misattribution of a person’s symptoms to an existing mental health condition or disability and may have unmet physical health needs. Race and Ethnicity Hillingdon is highly ethnically diverse: 51.8% of residents identify as Black, Asian or from other minority ethnic backgrounds. The borough's ethnicity profile is: Asian 33.3% (101,954); Black 7.8% (23,963); Mixed 4.4% (13,356); Other 6.3% (19,262); White 48.2% (147,408). People from South Asian (including Punjabi, Indian and Pakistani communities) and Black communities are disproportionately affected by diabetes and hypertension — the two largest drivers of emergency admissions and long-term conditions in Hillingdon. Maternity inequalities are well-documented for Black and Asian women (higher rates of preterm birth, low birth weight and maternal mortality nationally). The Southeast neighbourhood (Hayes and Harlington) is the most diverse and among the most deprived — combining ethnicity, deprivation and health inequalities. Some migrant communities and people with insecure Health and Wellbeing Board report 9 September 2026 immigration status may face additional barriers to accessing services. Proportionality and Intersectionality: South Asian and Black residents face the dual disadvantage of higher clinical risk (diabetes, hypertension) and residence in the most deprived parts of the borough. Younger residents from Muslim, Sikh and Hindu backgrounds require culturally tailored approaches in maternity care, mental health services and lifestyle programmes. Religion or Belief 14.4% of residents identify as Muslim, 10.8% as Hindu and 8.6% as Sikh. Religious communities are significant trusted intermediaries for health promotion, especially in the southeast and southwest of the borough. Faith settings are already being used for health outreach (e.g. blood pressure checks at the Hayes Mosque). Cultural and religious beliefs may influence engagement with specific health services, dietary interventions, end-of-life care preferences and mental health support. There is a risk that services designed without awareness of religious observance (e.g. Ramadan, Diwali, religious dietary requirements) may inadvertently create barriers. Sexual Orientation 2.2% of residents identify as lesbian, gay or bisexual, with 8.8% declining to answer (a high non-response rate). LGBT+ residents nationally face higher rates of mental ill health, social isolation and barriers to healthcare access, including fear of discrimination and historical mistrust of health services. Older LGBT+ adults (only 0.5% of 65+ residents identified as LGB — likely a significant undercount due to non-response and historical reluctance to disclose) may face acute isolation and inadequate social care. Gender Reassignment Just under 1% (2,116 people) of adults stated they had a different gender identity to that registered at birth. 7.4% did not answer, suggesting potential undercounting. Trans and non- binary residents face elevated rates of mental health difficulties, discrimination in service access and specific healthcare needs (including access to gender-affirming care). The strategy does not currently contain specific data or actions for trans residents. Pregnancy or Maternity Approximately 4,100 babies are born in Hillingdon each year. The smoking at time of delivery (SATOD) rate of 3.3–3.4% exceeds the strategy target of ≤3%. The breastfeeding rate at 6–8 weeks (34%) is well below the 70% target and national averages. Low birth weight and limited access to maternity care are identified as key issues. Maternity inequalities are concentrated in the south of the borough, with Black, Asian and deprived women experiencing worse outcomes. The neonatal and stillbirth rate (baseline 3.9 per 1,000) and neighbourhood variation represent a significant inequality. Carers 22,465 unpaid carers (2021 Census) support Hillingdon's health and care system substantially. 29% provide 50+ hours of care per week, placing them at significant risk to their own health and wellbeing. The 21% of carers (2025/26 survey) who feel socially isolated reflects a significant unmet wellbeing need. Only 35% of carers are on the Carers Register (as of June 2026), leaving the majority unknown to statutory services. Women make up nearly 59% of carers, but male carers are significantly under-identified. Young carers face specific risks to their education and development. Socio-economic Status Deprivation has worsened significantly over six years: 18 LSOAs are now in the second- highest deprivation band (versus 2 in 2019), and all are in the south of the borough. This represents a widening of intra-borough inequality. The south of the borough experiences the compounding effects of low income, poor housing (including overcrowding and homelessness), food insecurity, poorer air quality, and higher rates of long-term conditions. Housing tenure data shows that private renters (26%) and social renters (16%) face higher housing insecurity than owner-occupiers. Approximately one in five children live in low- Health and Wellbeing Board report 9 September 2026 income households. Community Cohesion and Community Safety The strategy seeks to improve neighbourhood cohesion through INTs, Family Hubs and community connection programmes. Social isolation is identified as a significant issue (24% of adults report loneliness). The Safer Hillingdon Partnership link to the Health and Wellbeing Board is designed to ensure health considerations are embedded in community safety approaches. Air pollution, particularly around Heathrow, is a specific environmental and community safety issue in the south of the borough. Human Rights The strategy engages directly with a range of human rights under the European Convention on Human Rights (ECHR) and the UN Convention on the Rights of Persons with Disabilities (UNCRPD). Relevant rights include: Article 2 (right to life) — addressed through maternal health improvements and emergency admission reduction; Article 3 (prohibition of inhuman or degrading treatment) — addressed through discharge improvement and dignified care; Article 8 (right to respect for private and family life) — addressed through support for independent living, home adaptations and carer support; Article 14 (prohibition of discrimination) — the whole strategy is oriented towards reducing health inequalities. The UNCRPD right to independent living is addressed through the DFG, community equipment, reablement and TEC. Consultation B.2) Did you carry out any consultation or engagement as part of this assessment? Please tick  NO  YES  Consultation was undertaken as part of the process of developing the JHWS. 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 JHWS as well as a link to the draft document. 55 residents completed the online survey. The profile of respondents is attached as Annex 1. The strongest themes arising from this exercise were:  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 Health and Wellbeing Board report 9 September 2026 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. 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. Feedback headlines include:  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. The June 2026 Health and Wellbeing Board meeting agreed to repeat the consultation in 2028/29 to test and change in the experience of residents and views of staff. B.3) Provide any other information to consider as part of the assessment Legal Context The Council and its partners have a public duty under Section 149 of the Equality Act 2010 to pay due regard to the need to: eliminate discrimination; advance equality of opportunity; and foster good relations between those who share protected characteristics and those who do not. This assessment fulfils that duty in respect of the JHWS. The Health and Wellbeing Board's statutory duty to produce a Joint Health and Wellbeing strategy is established by the Health and Social Care Act 2012. Additional legal duties relevant to this assessment include: the Care Act 2014 (adult social care, carers' assessments, safeguarding); the Children Act 1989 and 2004 (children's safeguarding and wellbeing); the Mental Health Act 1983 (as amended); the Human Rights Act 1998; the United Nations Convention on the Rights of the Child (UNCRC); and the UN Convention on the Rights of Persons with Disabilities (UNCRPD). Financial Context Alongside increasing demand, the cost of meeting the health and care needs of Hillingdon's population is projected to rise due to demographic change, increasing complexity of need, inflationary pressures and workforce and provider market costs. This strategy is therefore intended to deliver improved health and wellbeing outcomes within a constrained financial environment. A strong focus on prevention, early intervention and integration is essential to support better outcomes for residents, reduce avoidable long-term demand for services and ensure the sustainability of health and care provision. The financial implications of not improving health and wellbeing outcomes are summarised below. Health and Wellbeing Board report 9 September 2026 Financial Impact of Not Improving Health and Wellbeing Outcomes Service Area Financial Implications Unplanned hospital demand Continued growth in admissions, emergency department attendances and bed occupancy. New hospital development Failure to realise full benefits of hospital redevelopment programme. Social Care Increased packages of care and residential placement costs. Primary Care Continued workload growth and unmet need. Community services More complex health and care needs, and caseloads and services being reactive to demand. ICB Reduced ability to achieve recurrent financial balance. The strategy is funded through a blend of existing National Health Service and local authority budgets, pooled arrangements under Section 75 of the National Health Service Act 2006, and transformation investment. National Policy Context The strategy aligns with:  NHS 10-Year Plan and the national Neighbourhood Health programme (Hillingdon is a first-wave implementation site).  Core20PLUS5 framework for reducing health inequalities.  West and North London ICB Integrated Care Strategy.  NICE guidance on a range of conditions including frailty, hypertension, diabetes and perinatal mental health; national SEND policy.  Government's ambitions on reducing health inequalities as set out in the NHS Long Term Plan; and  Making Every Contact Count (MECC) framework for health promotion. C) Assessment What did you find in B1? Who is affected? Is there, or likely to be, an impact on certain groups? C.1) Describe any NEGATIVE impacts (actual or potential): Equality Group Impact on this group and actions required Age: Children in deprived south Hillingdon at risk of persistent disadvantage. Without sustained, targeted investment in early years, family support and school-based services in Hayes, Yiewsley and West Drayton, children in these areas will continue to face compounding disadvantages — child poverty, poor school readiness, higher childhood obesity, higher rates of asthma and poorer emotional wellbeing — that persist into adulthood and drive long-term health and care demand. The 19-percentage- point GLD gap for disadvantaged children risks becoming entrenched. Actions: • Family Hubs to be established and embedded in high-need Health and Wellbeing Board report 9 September 2026 neighbourhoods with priority targeting of deprived communities. • Expand speech, language and communication support in all neighbourhoods. • Targeted immunisation outreach in communities with below- 95% coverage. • Deliver measurable reductions in the GLD disadvantage gap by 2031. • Monitor outcomes data disaggregated by ward and ethnicity to detect if inequalities are widening. Age: Children and young people with SEND at risk of delayed support. Growing demand for neurodevelopmental (ND) assessments and SEND support, combined with long waiting times and fragmented pathways, risks significant harm to children's educational attainment, mental health and family functioning. Children from low-income households with SEND face additional financial barriers to accessing appropriate support. Actions: • Develop a coordinated ND pathway across paediatrics, CAMHS, schools and Family Hubs by agreed timescales. • Provide early pre-diagnostic support to reduce harm during waiting periods. • Improve EHCP timeliness to ≥60% within 20 weeks by 2030. • Monitor waiting times by ethnicity and deprivation index. Age: Older adults in deprived south Hillingdon intersecting age and socio-economic disadvantage. The IDAOPI 2025 shows a rapid doubling in the number of LSOAs in the most deprived decile for older people's income deprivation (from 6 to 12) since 2019, all in the south of the borough. If neighbourhood-level investment does not specifically target these communities, the strategy risks benefiting older adults in less deprived areas first, widening the inequality gap. Actions: • Apply the Core20PLUS5 framework to direct INT proactive care resources to the most deprived neighbourhoods. • Monitor frailty care plan coverage, hospital admission rates and care home admission rates by neighbourhood and deprivation decile. Disability: People with severe mental illness (SMI) — physical health inequalities People with SMI have significantly lower rates of hypertension and diabetes detection and management than the general population, and much shorter life expectancy. Without specific action within the INTs and Long-Term Condition programmes, people with SMI risk being overlooked in the hypertension and CVD risk management programmes. Actions: • Embed SMI-inclusive physical health checks within the INT hypertension and CVD prevention programmes. • Track hypertension prevalence capture and blood pressure control rates disaggregated by SMI status. • Strengthen links between community mental health and INT MDTs. Race/Ethnicity and Maternity: Black and Black and Asian women nationally face disproportionately higher rates of maternal mortality, poor birth outcomes and Health and Wellbeing Board report 9 September 2026 South Asian women maternity inequalities. inadequate access to personalised maternity care. Hillingdon's SATOD rate (3.3–3.4%) and breastfeeding rate (34%) both indicate areas where inequality may be concentrated in communities in the south of the borough. Without targeted action, the strategy risks failing to address well-documented maternity inequalities. Actions: • Deliver targeted and culturally tailored maternity support in the most deprived neighbourhoods. • Increase personalised maternity pathway access specifically for Black, Asian and deprived women (Core20PLUS5 action). • Monitor SATOD, breastfeeding rates and stillbirth/neonatal mortality by ethnicity and neighbourhood. • Target reduction in neighbourhood variation in stillbirth and neonatal mortality by 20% by 2031. Unpaid carers: isolation, health risk and under- identification (particularly men and young carers) Only 35% of Hillingdon's estimated 22,465 carers are on the Carers Register. 21% of carers feel socially isolated. Men are significantly under-identified as carers. Young carers face specific risks to their education and wellbeing. Without proactive identification and support, most carers remain unknown to services and without the help they need, which risks carer breakdown and increased demand on formal health and care services. Actions: • Strengthen carer identification through INTs, GP practices, MECC and Family Hubs. • Achieve 40% carer registration on the Carers Register by 2030 (from 35% baseline in June 2026). • Implement targeted outreach to male carers and young carers. • Use the 2025/26 survey baseline (21% reporting isolation) to track improvement. Sexual orientation: LGBT+ residents facing isolation, barriers to access and potential invisibility. LGBT+ older adults (aged 65+) face heightened risk of social isolation, loneliness and inadequate care due to historical discrimination and fear of disclosure. The high non-response rate to the sexual orientation census question (8.8%) suggests significant undercounting. The strategy does not currently include explicit actions or data for LGBT+ residents, creating a risk that this group will not benefit equitably from the strategy's intentions. Actions: • Develop LGBT+-specific data and needs assessment within INT monitoring. • Review service design and staff training to ensure LGBT+ inclusive practice across all funded services. • Ensure community connection programmes are accessible to and designed for LGBT+ older adults. • Engage with LGBT+ community groups in co-production of relevant service elements. Health and Wellbeing Board report 9 September 2026 Gender reassignment: Trans and non-binary residents — potential invisibility in service planning. Just under 1% of adults (2,116 people) reported a gender identity different to that registered at birth, with 7.4% not answering — again suggesting undercounting. Trans and non- binary residents face elevated rates of mental health difficulties and barriers to accessing services. The strategy has no specific data or actions for this group. Actions: • Include trans and non-binary residents in equalities monitoring and service planning. • Ensure staff training on cultural competence includes trans- inclusive practice. • Review the Strategy's mental health and social isolation priorities to ensure they reach trans residents. Age and Disability: Older and disabled residents at risk of digital exclusion from digital-first approaches. The strategy includes a significant digital enabler, including improved data sharing, digital population health tools and technology enabled care (TEC). Older adults, people with disabilities, people with low digital literacy and those in lower socio-economic groups risk being excluded from or disadvantaged by digital-first approaches if appropriate safeguards are not in place. The TEC digital switchover (January 2027) creates specific risk for residents currently relying on analogue telecare. Actions: • Deliver the TEC digitalisation programme ahead of the January 2027 switchover, prioritising vulnerable residents. • Include digital inclusion support for older adults and vulnerable groups as part of Healthy Places priority HP3. • Ensure INTs and Local Access Hubs maintain non-digital access routes for all services. C.2) Describe any POSITIVE impacts Equality Group Impact on this group and actions Age - Children and young people and particularly those in deprived neighbourhoods. The strategy's Start Well priorities and the Family Hubs model represent a significant positive investment in children and young people. The explicit targeting of the south of the borough through Priority SW1 (maternal health), SW2 (immunisation), SW3 (school readiness) and SW6 (childhood obesity) — combined with the Core20PLUS5 framework — directly advances equality of opportunity for disadvantaged children. The SEND and neurodevelopmental pathway improvements will benefit children with disabilities. School-based mental health support expansion from 44% to 60% coverage by 2027 will reach many more children with mental health needs. Age - Older adults and especially those at risk of frailty and loss of independence. Age Well priorities AW1, AW2 and AW3 collectively represent a major positive programme for older residents. Proactive frailty identification and personalised care plans (100% of severely frail residents by 2027), Urgent Community Response (90% within 2 hours by 2026), Hospital at Home, and improved falls Health and Wellbeing Board report 9 September 2026 prevention all support older residents to remain independent at home. The aim to maintain the rate of permanent care home admissions at the 2025/26 baseline is a positive protection against inappropriate residential care. Race and Ethnicity - South Asian and Black communities and diabetes and hypertension inequalities. Priority LW1 (earlier detection of long-term conditions) and Programme 2 (hypertension and cardiovascular risk management) directly address the disproportionate burden of diabetes and hypertension on South Asian and Black communities. Neighbourhood-based outreach (including at community venues and faith settings), NHS Health Checks and targeted screening programmes represent positive action to advance equality of opportunity for these groups. The target of increasing hypertension prevalence capture from 13.8% to 16% by 2027 (and towards 24% by 2028) will disproportionately benefit communities with high undetected rates. Race and Ethnicity and maternity - Maternity outcomes for Black and South Asian women. Priority SW1 explicitly includes increasing personalised maternity pathway access for Black, Asian and deprived women (a Core20PLUS5 action). Culturally tailored maternity support and opt-out smoking cessation referral are positive actions to reduce maternity inequalities. The target to reduce neighbourhood variation in stillbirth and neonatal mortality by 20% by 2030 is a direct positive equalities commitment. Unpaid carers - especially women and those providing intensive care. Priority LW1 explicitly includes improved carer identification, with a target of 40% of carers registered by 2030. Priority HP3 (reducing social isolation) addresses the 21% of carers who feel isolated. The VCSE sector — recognised as a key delivery partner — is particularly important for carer support services. The strategy's commitment to identifying and supporting young carers through schools and Family Hubs is a positive step for this often-invisible group. Disability — independent living and UNCRPD compliance. Priority HP1 (housing stability) explicitly includes maximising the use of the Disabled Facilities Grant (DFG) to enable disabled and older residents to remain in their own homes. This directly advances the UNCRPD right to independent living. The reablement, rehabilitation and assistive technology programmes further support this right. The SEND improvements under Start Well directly benefit children with disabilities. Disability - People living with mental health conditions. Programme 3 (Mental Health Early Intervention) and Priority LW2 (neighbourhood mental health support) represent a significant positive investment in mental health. Embedding mental health practitioners in all INTs, expanding talking therapies, social prescribing and community wellbeing programmes, and reducing MH crisis presentations by 10% by 2030 will benefit the significant proportion of Hillingdon's population living with anxiety, depression and more serious mental health conditions. Socio-economic status and community Healthy Places priorities HP1–HP3 represent a whole-system commitment to addressing the wider determinants of health: Health and Wellbeing Board report 9 September 2026 cohesion - Deprived communities and tackling the wider determinants of health housing, safety, community connection and the environment. The Health in All Policies framework (HP2) will embed health equity considerations across Council strategies. The joint working between the Health and Wellbeing Board and the Safer Hillingdon Partnership (HP2) addresses community safety as a determinant of health and wellbeing. These actions collectively foster good relations between communities and advance equality of opportunity. D) Conclusions The Hillingdon Joint Health and Wellbeing Strategy 2026–2031 is, at its core, an equalities strategy. Its overarching vision — "to create a fairer, healthier borough" — is directly aligned with the public sector equality duty under Section 149 of the Equality Act 2010. The strategy has strong positive equality impacts across all relevant protected characteristics and community issues, and demonstrates clear intent to advance equality of opportunity, eliminate disadvantage and foster good relations between communities. Significant positive equality impacts include: 1) The Core20PLUS5-aligned targeting of the most deprived communities in south Hillingdon (Hayes, Yiewsley, West Drayton and Harefield) across Start Well, Live Well, Age Well and Healthy Places priorities, directly advancing equality of opportunity for communities facing the greatest health disadvantage. 2) Explicit actions to address maternity inequalities for Black, Asian and deprived women, including personalised maternity pathway access and culturally tailored support — a priority area where national evidence demonstrates significant health harm. 3) The hypertension and cardiovascular risk programme targeting South Asian and Black communities disproportionately affected by these conditions, which are the largest drivers of emergency admissions in Hillingdon. 4) Proactive frailty care, Urgent Community Response, Hospital at Home and reablement programmes for older adults, supporting the right to independent living in line with the UNCRPD. 5) The Disabled Facilities Grant and housing adaptations programme enabling disabled and older residents to remain at home. 6) Investment in children's mental health, SEND pathways and Family Hubs, targeted at disadvantaged children in the south of the borough. 7) Improved carer identification and support, addressing the significant but largely invisible burden on the estimated 22,465 unpaid carers (59% of whom are women). 8) Fostering good community relations through Healthy Places priorities — reducing isolation, improving neighbourhood safety, and embedding health in all policies. Identified negative or potential impacts and the actions committed to address them: 1) Children in deprived south Hillingdon face entrenched compound disadvantage. The strategy commits to targeted Family Hub investment, immunisation outreach and monitoring of the GLD gap by ward and ethnicity. 2) Children with SEND face long waits and fragmented pathways. The strategy commits to a coordinated ND pathway and improved EHCP timeliness targets, with monitoring by deprivation. 3) Older adults in deprived south Hillingdon are experiencing rapidly worsening income deprivation. The Core20PLUS5 approach and neighbourhood-level monitoring will ensure these residents benefit from Age Well priorities. 4) People with severe mental illness face physical health inequalities. SMI-inclusive physical health checks will be embedded within INT hypertension and CVD programmes. 5) Some unpaid carers — particularly men and young carers — remain under identified. Proactive Health and Wellbeing Board report 9 September 2026 carer identification through INTs, GPs and MECC is committed, with a target of 40% registration by 2030. 6) LGBT+ and trans residents are at risk of invisibility in service planning. Partners commit to developing LGBT+-specific data, reviewing service design for LGBT+ inclusivity, and engaging LGBT+ community groups. 7) Digital exclusion risks for older and disabled residents, especially around the TEC switchover, will be addressed through the TEC digitalisation programme and continued non-digital access routes. Health and Wellbeing Board report 9 September 2026 Annex 1 Profile of Strategy Consultation Respondents Health and Wellbeing Board report 9 September 2026 Priorities and Challenges by Age Group Age Group Top Themes 65 + Urgent care, hospital waits (planned care), GP access 55 - 64 Hospital waits (planned care), affordability, GP access. 45 - 54 Joined-up care, hospital waits (planned care), GP access, mental health 35 - 44 Cost of living, housing, mental health, children’s services 25 - 34 Mental health support

Health and Wellbeing Board report 9 September 2026 GAMBLING HARM PREVENTION Relevant Board Member(s) Councillor Sue O’Brien Keith Spencer Organisation London Borough of Hillingdon GamblingHarmUK Report author Nick Sinclair, Public Health Lucy Hays, GamblingHarmUK Papers with report Appendix 1: Local Authority Gambling Harms Prevention Grant FAQ’s Appendix 2: Gambling Harm Baseline Assessment 1. HEADLINE INFORMATION Summary To raise the issue of gambling harm in Hillingdon, to highlight work currently being undertaken, an d to reques t support from HWBB members to progress gambling harm prevention activity for Hillingdon residents. Contribution to plans and strategies Joint Health & Wellbeing Strategy Financial Cost None Relevant Select Committee N/A Ward(s) affected All 2. RECOMMENDATION That the Health and Wellbeing Board considers the information presented and identifies ways to support the development of gambling harm prevention activity for Hillingdon residents 3. INFORMATION Supporting Information Gambling Levy The gambling levy is a mandatory charge on licensed gambling operators. It came into effect on 6 April 2025 , replacing voluntary contributions 1. The levy is collected by the Gambling Commission and overseen by the UK Government. For the 2026-2027 financial period, t he levy has raised just under £120 million. This money is 1 Statutory Gambling Levy - Introduction Health and Wellbeing Board report 9 September 2026 ringfenced exclusively for gambling harm research, prevention and treatment2. Funding is distributed to the NHS to commission treatment and support services (5 0%); Office for Health Improvement and Disparities (OHID) to support public health approaches, awareness campaigns, early intervention and community -based prevention programmes (30%); and to UK Research and Innovation (UKRI) to fund independent research programmes, evidence reviews, research coordination and innovation partnerships focused on understanding gambling harms and effective interventions2. Of the funding allocated to OHID, £12M of that has been given to Local Authorities to support Public Health approaches to reducing gambling harms for the 2026 -2027 financial year . This funding is expected to be provided on an annual basis but may vary in future years depending on the value the gambling levy raises and what OHID determine the allocation value to local authorities to be . Hillingdon’s allocation for 2026 -2027 is £65 ,585 and is provided as a ringfenced grant award to Public Health for the purpose of supporting gambling harm prevention activity. There are specific requirements for how these funds are used and must be used exclusively for gambling harm prevention activity, not treatment. This activity may include  Building local capacity, capability and leadership in relation to gambling harms prevention  A health needs assessment specifically on gambling har ms prevention. It will be a request that all LAs use some of their funds to develop a gambling harms prevention needs assessment in the first year. If LAs have not used their funds for this purpose a justification will need to be presented.  Partnership development (including VCSE engagement)  Policy, regulatory and environmental approaches  Awareness, early intervention and harm reduction activity Appendix 1 can be viewed for Local Authority Gambling Harms Prevention Grant FAQ’s In addition to gambling levy funds allocated to local authorities by OHID, the funds that OHID have received have been used to fund national or regional organisations to provide training, awareness raising and prevention activity, and to support local gambling harm pre vention system development. GamblingHarmUK are one of the organisations funded by OHID to work with eleven local authorities in England to provide system development support. Hillingdon has been selected as one of the eleven areas and Public Health have begun worki ng with GamblingHarmUK to develop local responses to gambling harm prevention activities. Appendix 2 provides a Gambling Harms System Maturity Baseline Assessment . Board members will receive a presentation about this work at the 9th September HWBB meeting. Plans for Gambling Levy Funds for 2026-2027 Hillingdon’s gambling levy grant award will be utilised to fund a comprehensive needs assessment; to part-fund frontline staff training; to fund harm prevention, awareness raising and signposting to support offers. This activity can best be supported through a collaborative approach between all appropriate statutory and voluntary sector organisations supporting Hillingdon residents. Specific actions that HWBB members can support to progress this agenda are to:  Commit to inclusion of gambling harm prevention in relevant local strategies  Commit to joining a local steering group to develop gambling harm prevention work 2 Statutory gambling levy - GOV.UK Health and Wellbeing Board report 9 September 2026  Review the current baseline assessment and add any relevant detail or information to the existing assessment  Identify and share any existing activity within your individual organisations that supports gambling harm prevention activity  Participate as a contributor to the pending needs assessment about gambling harms in Hillingdon  Support frontlin e staff development and training opportunities to increase awareness about how to identify gambling harms and help affected people access support . Provide details of training need assessments and numbers of staff who would benefit from receiving training  Recognise the risks that gambling harm has in relation to suicide, and the impacts of gambling on those affected by gambling behaviour of a family member  Recognise that the gambling industry is well funded to advertise gambling activity in appealing ways a nd consider what can be done at a local level to restrict access to gambling and associated gambling harms, especially through licensing, trading standards activity, effective assessment of gambling behaviour a nd impacts of gambling on Hillingdon residents 4. EFFECT ON RESIDENTS, SERVICE USERS & COMMUNITIES Consultation Carried Out or Required A gambling harms need assessment is required to better understand gambling harm impacts on Hillingdon residents. Engagement of relevant and appropriate members o f local Gambling Harm Prevention Steering Group (including lived experience representation) will help shape local responses and strategic priorities. 5. BACKGROUND PAPERS Appendix 1: Local Authority Gambling Harms Prevention Grant FAQ’s Appendix 2: Gambling Harms System Maturity Baseline Assessment

1 Local Authority Gambling Harms Prevention Grant – FAQs 1. How have funding allocations been calculated? The Local Authority Gambling Harms Prevention Grant is funded entirely through the statutory gambling levy and totals £24 million over two years. • In 2026/27, £12 million will be distributed to upper-tier local authorities. • An anticipated £12 million will be available in 2027/28. • The amount available in the second year may increase if a number of upper-tier local authorities do not meet the eligibility conditions to receive funding in 2026/27, resulting in unclaimed funding being rolled forward within the local authority workstream. Funding allocations to upper-tier local authorities are calculated using a 50:50 formula: • 50% based on total population • 50% based on deprivation-weighted population, using each authority’s average Index of Multiple Deprivation (IMD) score How population weighted deprivation works (explanatory section) • In this approach, each UTLA’s population is adjusted using its average Index of Multiple Deprivation (IMD) score. Areas with higher deprivation receive a greater weighting to account for their higher average levels of gambling‑related harm. • Weighting population by IMD score means, for example, that a person living in an LA with an average IMD score of 43.5 (Blackpool) is weighted 7.1 times higher than a person living in an LA with an average IMD score of 6.1 (Wokingham). This produces a deprivation weighted population figure for each UTLA, used for a defined proportion of the allocation formula. • While deprivation is not the sole indicator of need for gambling‑related harm, there is currently insufficient evidence to support inclusion of additional factors in the allocation formula. As the programme develops, we will work to improve the allocation formula. 2. Will next year’s funding allocation be the same? The allocation formula is not expected to change during this two-year programme. However, the overall funding envelope depends on levy income, which is linked to gambling operator yield. Future allocations beyond 2027/28 will be informed by: • Levy receipts • Improved local data on gambling-related harm • Learning from this transition period Appendix 1 2 3. What are we expected to deliver with this funding? Funding must be used exclusively for gambling harms prevention, not treatment. This activity may include • Building local capacity, capability and leadership in relation to gambling harms prevention • A health needs assessment specifically on gambling harms prevention. It will be a request that all LAs use some of their funds to develop a gambling harms prevention needs assessment in the first year. If LAs have not used their funds for this purpose a justification will need to be presented. • Partnership development (including VCSE engagement) • Policy, regulatory and environmental approaches • Awareness, early intervention and harm reduction activity Local flexibility is encouraged, provided activity is clearly preventative and aligned with programme objectives. 4. When will we receive the Memorandum of Understanding. We anticipate that the MoU will be sent to all upper tier LAs that have met the conditions in the week commencing 06 April. 5. Will we receive funding in one go or spread out throughout the year? Funding will be paid via a Section 31 grant, issued quarterly. 6. When will the money arrive? The first payment is expected in May 2026 (mid-quarter), subject to completion of all required assurance steps. Including: • Completion of the maturity assessment survey. • Completion of the Declaration of Interest which includes a confirmation from the Director of Public Health (DPH) that the public health team will not be in receipt of any direct industry funding from April 2026. Memorandum of Understanding: • Once these conditions have been met, a Memorandum of Understanding (MoU) will be sent to upper-tier local authorities. The Director of Public Health will be required to sign the MoU, confirming that the funds will be used appropriately, in line with the grant conditions, and that the authority will participate in proportionate reporting and monitoring arrangements. Authorities that complete requirements later in the year will still receive their full allocation, but funds must be spent within the financial year. 3 7. Who needs to sign the Memorandum of Understanding (MoU)? The MoU must be signed by the Director of Public Health within each upper-tier local authority, with assurance that: • The funding will be managed by the Public Health team • The authority agrees to the grant conditions, reporting and monitoring requirements 8. What happens if we don’t spend the funding within the financial year? As with all Section 31 grants, funding cannot be carried forward. If there is a risk of underspend, authorities should engage early with their OHID regional lead. Where funding is not spent or is spent out of scope, DHSC may request repayment in line with Cabinet Office grant rules. 9. Can we use this funding for staff time? Are there restrictions on spend? Yes. Funding can be used for staff time, including new or existing roles, provided this supports gambling harms prevention. 10. Do we need to report on delivery and spend? Yes. Reporting is quarterly and proportionate. Authorities will be required to submit: • Quarterly financial returns • Quarterly progress updates on delivery, risks and milestones These are aligned with payment cycles and support national learning and assurance. 11. When will we know which VCSE organisations have been funded? VCSE funding is managed through a separate national commissioning process. Details of funded VCSE organisations will be shared once awards are confirmed. We anticipate that we will be in a position to share details by mid-April. DHSC and OHID will support local coordination to minimise duplication and encourage alignment between local authority and VCSE-led activity. 12. Will we need to submit plans of how we intend to use the funding? For the first year of funding you will not be expected to submit plans for how you intend to use the funding – however, this may change in the second year. 13. Will we be expected to maintain levels of activity if our allocation decreases in future years? No, your level of activity can be proportionate to the level of funding you receive. 14. Will the funding formula stay the same after e.g. HNAs and other means of indicating need and harm are in place? The formula will not change in the second year. As better local estimates of gambling harm are developed these will be used to inform future allocations after the two years. 4 15. When will the indicative allocation/provisional annual allocation be confirmed? Your funding allocation will be confirmed when we send out the MoU, indicative allocations will not change from what has been stated for financial year 2026/27 provided you meet the appropriate conditions. Please note there is a separate FAQ document which relates to the declaration of interest. Please contact your regional lead if you have not received a copy.

Appendix 2 Gambling Harms Systems Maturity Assessment Setup & sign-off Complete the yellow cells, then work through the Assessment tab. Yellow cells are the only inputs. Local authority london borough of hillingdon Lead contact(s) nick sinclair, public health principal, nsinclair@hillingdon.gov.uk name, role, email Baseline date 03.08.2026 Review cycle 6 monthly recommended 6-monthly Expert by Experience advisor involveno - one will be identified and asked to particiapte name / yes-no GHUK facilitator (baseline) lucy hays Participants (name, role, organisation) Conflict of interest declaration All relevant individuals have been / will be asked the question above yes / no Names of anyone declaring a conflict, and action taken All individuals involved in decisions related to the programme (Health & Wellbeing Board members, steering group members, commissioners, senior officers) must be asked: 'Do you have any personal, financial or professional connections to the gambling industry, gambling-related trade bodies, or organisations that receive gambling industry funding?' Where a conflict is declared, the individual must be recused from related decision-making, the conflict recorded in minutes, and details shared with GHUK in a GDPR-compliant manner. Consider 0 - Early Action 1 - Progressing 2 - Embedding 3 - Leadership Your score (0-3) 0 Evidence / notes Consider 0 - Early Action 1 - Progressing 2 - Embedding 3 - Leadership Your score (0-3) 1 Evidence / notes Consider 0 - Early Action 1 - Progressing 2 - Embedding 3 - Leadership Your score (0-3) 1 Evidence / notes Consider 0 - Early Action 1 - Progressing 2 - Embedding 3 - Leadership Some public statements made and some engagement with elected members, but commitment is not yet formalised or sustained. Active, public and sustained commitment from elected members, with gambling harm embedded in political priorities and members actively engaged or briefed. <- choose the level above that matches what currently exists Gambling harm as an area of national and local public health concern has been flagged with the Lead Member for Health & Social Care. Director of Adult Social Care and Children's Services has received a presentation about gambing harms and the k h bl lh b dd h d f h b 1.4 (T2) Cross-department working group established Representatives from Public Health, Safeguarding, Licensing, Planning, Housing, Education, Community Safety, Debt Advice, HR and other relevant departments? Agreed objectives and a shared action plan? Regular, documented meetings with named leads? Joined-up rather than siloed delivery? No cross-department working in place. Informal or ad hoc collaboration only; no agreed objectives or shared action plan. Working group established with most relevant departments represented, but engagement is inconsistent or actions are not yet coordinated. Structured, fully integrated cross-department working group meeting regularly, with shared objectives, documented actions and clear accountability. Limited awareness among some elected members; no formal or public commitment made. 1.2 (T1) Named lead and internal governance structure Gambling harms lead appointed within public health? Documented remit covering coordination, reporting and strategic oversight? Adequate resource (WTE) allocated? Clear escalation/reporting line to DPH or H&WB Board? No named lead and no internal governance in place. Responsibility exists informally or is split across roles, with no formal governance or documented remit. Named lead in post with a defined remit, but resource is limited or reporting lines are not yet fully established. Named lead in post with documented remit, adequate resource, and clear internal reporting to senior leadership. <- choose the level above that matches what currently exists A re-structure within the Public Health Department has recently concluded which will enable a review of roles and responsibilities, allocation of portfolios of work, and has also created a number of posts that are vacant at this point but when f ll d ll bl h bl h d b b dd d f l f k 1.3 (T2) Political and executive-level commitment Elected member or senior executive publicly endorsed action? Gambling harm referenced in political priorities or public-facing statements? Elected members engaged or briefed on gambling harm as a public health issue? Gambling harm has not yet been raised with elected members. Currently gambling harm is not referenced in any local strategies Domain 1 - Strategic Leadership & Partnerships Read the four levels, pick the ONE that matches what currently exists, enter 0-3 in the yellow cell and add evidence. If you are between two, take the lower. Maturity bands and gap counts update DOMAIN 1 - Strategic Leadership & Partnerships Is gambling harm treated as a strategic public health priority with accountable leadership? 1.1 (T1) Gambling harm included in local strategy and frameworks Presented to Health & Wellbeing Board? Referenced in the JSNA, H&WB Strategy or mental health/addiction strategies? Framed as a public health issue? Clear objectives, action plan, timelines and named officers? Aligned with NICE NG248, the statutory levy and national policy? Not referenced in any local strategy or framework. Mentioned briefly in at least one strategy but not embedded, actioned or aligned to national guidance. Included in strategy with some objectives, but not yet consistently prioritised, actioned or reviewed. Clear strategic priority across multiple strategies, with measurable outcomes, named officers, timelines and regular review. <- choose the level above that matches what currently exists Your score (0-3) 0 Evidence / notes Consider 0 - Early Action 1 - Progressing 2 - Embedding 3 - Leadership Your score (0-3) 0 Evidence / notes Consider 0 - Early Action 1 - Progressing 2 - Embedding 3 - Leadership Your score (0-3) 0 Evidence / notes Consider 0 - Early Action 1 - Progressing 2 - Embedding 3 - Leadership Your score (0-3) 0 Evidence / notes There is currently no established communications plan for the promotion of gambling harm reduction. Hillingdon did fund into a Pan-London World Cup Gambling Harm campaign which worked with The Council Communications Department but has not d l d l d l f Active engagement with ICS/NHS underway, but gambling harm is not yet formally embedded in system-level strategies or plans. Gambling harm formally embedded in ICS/NHS strategies with shared leadership and joint commissioning or funding. <- choose the level above that matches what currently exists No engagement with ICS or NHS at this stage. A report to the Health & Wellbeing Board will be considered to raise this issue and to seek cross-organisational support 1.7 (T3) Public health narrative adopted across council communications Activity to move away from stigmatising, individual-blame framing toward a public-health understanding of gambling harm? Consistent, agreed public- health language across council documentation? Does local language avoid stigmatising terms such as 'problem gambler' and 'responsible gambling'? No public health narrative adopted and no language guidance in place. Awareness of the issue exists, but language is inconsistent and no formal guidance has been produced or shared. Language guidance produced and some materials updated, but adoption across teams and partners is inconsistent. Consistent public-health language embedded across all communications and partnership materials, including agreed avoidance of stigmatising terms such as 'problem gambler'. <- choose the level above that matches what currently exists Informal or one-off conversations have taken place, but no formal agreements or shared workplans. 1.5 (T2) Cross-organisational steering group (ICS, NHS, police, VCFSE, EbE) Steering group including ICS, NHS, police, voluntary sector and EbE representatives? Roles, responsibilities and shared objectives defined in terms of reference? Regular, minuted meetings? EbE contributors remunerated and supported? No cross-organisational steering group in place. An informal network exists but has no formal structure, defined roles or shared objectives. Steering group established and meeting, but participation is inconsistent, EbE involvement is absent or governance is underdeveloped. Active, well-governed steering group with clear roles, shared objectives, regular minuted meetings and remunerated EbE involvement. <- choose the level above that matches what currently exists There is currently no cross-organisational working group established, outside of initial informal discussions with colleagues in the drug and alcohol treatment service, and a local charity 1.6 (T3) Engagement with ICS and NHS to embed gambling harm in system-wide strategies Formal commitments or partnerships with ICS/NHS specifically on gambling harms? Included in ICB/ICS strategies, joint forward plans or population health frameworks? Joint commissioning or shared funding? No engagement with ICS or NHS. There is currently no structured working group established, and outside of initial informal discussions with colleagues in the social care, and trading standards teams, no formal arrangements are currently in place <- choose the level above that matches what currently exists Consider 0 - Early Action 1 - Progressing 2 - Embedding 3 - Leadership Your score (0-3) 1 Evidence / notes Consider 0 - Early Action 1 - Progressing 2 - Embedding 3 - Leadership Your score (0-3) 0 Evidence / notes Consider 0 - Early Action 1 - Progressing 2 - Embedding 3 - Leadership Your score (0-3) 1 Evidence / notes Consider 0 - Early Action 1 - Progressing 2 - Embedding Outcome measures and evaluation in place for most interventions, but findings not yet systematically used to drive improvement or shared externally. Basic activity metrics recorded and reported, but outcome measures and evaluation are not yet in place. 2.3 (T2) Cross-agency service data collected and used Data on gambling harms captured from housing, debt advice, healthcare and safeguarding? Service provision data requested from VCFSE partners? Referral pathways and support services mapped and evaluated? No cross-agency data collection in place. Ad hoc data collection from at least one service, but no shared framework or regular aggregation. Systematic data collection in place across several agencies, but coverage is incomplete and data not yet regularly aggregated or used to evaluate pathways. Comprehensive cross-agency data collection with regular aggregation, shared reporting, and pathway evaluation demonstrating measurable impact. <- choose the level above that matches what currently exists Until need assessment is completed, awareness raising of gambling harm work being needed, and collaboration from partners and stakeholders, it is not possible to accurately assess the scope of any service level data collection currently in place. The l l d d l h l d d f b bl d h l 2.4 (T1) KPIs, outcome frameworks and continuous improvement in place Outcomes (not just activity metrics) defined and aligned to local strategy? Performance regularly monitored and reported to governance? Interventions evaluated using quantitative and qualitative evidence? Findings used to drive improvement and shared with wider networks? No KPIs, outcomes or improvement cycle defined. Until need assessment is completed, it is difficult to accurately assess this. Some national data sources exist but no mapping of local data collection has as yet been completed A needs assessment is published with moderate coverage, but not regularly updated, or its recommendations are not yet driving commissioning or strategy. A comprehensive, recently updated needs assessment is in place, with clear links to commissioning decisions and strategy, and a scheduled review cycle. <- choose the level above that matches what currently exists Plans to release a tender to utilise Gambling Levy funds to complete a gamboing harms need assessment are underway 2.2 (T2) Use of national and local data to understand need National data (ONS, GB Gambling Survey, Gambling Commission, NHS Digital, IMD) triangulated with local data? Local data (support services, crime, venue numbers, advertising) actively collected and used? Stratified by age, sex, area, deprivation and ethnicity? Used to inform commissioning? No use of national or local data to understand gambling harm. Some national data is referenced, but use is minimal and largely reactive. Local data is not routinely collected or used. National and some local data are used and triangulated in some decisions, but data is not yet stratified by key demographics or used systematically. Routine triangulation of national and local data actively drives commissioning and population health strategy, with data stratified by deprivation, ethnicity, age and other key factors. <- choose the level above that matches what currently exists A needs assessment is in preparation, or one exists but is incomplete - lacking inequalities analysis, service mapping or EbE input. Domain 2 - Population Insights & System Improvement Read the four levels, pick the ONE that matches what currently exists, enter 0-3 in the yellow cell and add evidence. If you are between two, take the lower. Maturity bands and gap counts update DOMAIN 2 - Population Insights & System Improvement Is robust data collected, analysed and used to drive continuous improvement? 2.1 (T1) Needs assessment published (JSNA / HNA) JSNA/HNA published or in active preparation? Includes prevalence data, inequalities analysis, service mapping, environmental risk factors, stakeholder and EbE engagement, and recommendations? Recent (within two years) with a scheduled review date? No needs assessment in place and none in preparation. 3 - Leadership Your score (0-3) 1 Evidence / notes Consider 0 - Early Action 1 - Progressing 2 - Embedding 3 - Leadership Your score (0-3) 0 Evidence / notes Currently unaware of any routine regional monitoring infrastructure that might be in place outside of the London Assembly Gambling Related Harms 2024 report; GambleAware Gambling Harm Local Area Profiles; OHID prevalence modelling; Health f l d d bl l h d ll b d h d d d Clear KPIs, a robust outcome framework, routine evaluation and a documented continuous improvement cycle, with published learnings shared across networks. <- choose the level above that matches what currently exists The local drug and alcohol treatment service does record information about gambling support needs within its current client group. This might need to be reviewed to ensure consistency with other service areas to support a coordinated system-wide f bl h d b ff 2.5 (T3) Regional evidence dashboards and shared monitoring frameworks Shared evidence dashboards created to monitor gambling harms at regional/system level? KPIs and monitoring frameworks shared across ICS, NHS, VCFSE and LA partners? Findings disseminated to drive improvement? No regional monitoring infrastructure in place. Some data shared bilaterally with individual partners, but no shared framework or dashboard. A shared monitoring framework in development with partial partner buy-in, or an early-stage dashboard in place but not yet fully operational. A robust regional evidence dashboard operational, with shared monitoring, accountability and systematic dissemination of insights across all partners. <- choose the level above that matches what currently exists Consider 0 - Early Action 1 - Progressing 2 - Embedding 3 - Leadership Your score (0-3) 0 Evidence / notes Consider 0 - Early Action 1 - Progressing 2 - Embedding 3 - Leadership Your score (0-3) 0 Evidence / notes Consider 0 - Early Action 1 - Progressing 2 - Embedding 3 - Leadership Your score (0-3) 0 Evidence / notes Consider 0 - Early Action 1 - Progressing Training delivered to at least one service, but it is one-off, not peer-led, and coverage is very limited. 3.3 (T1) Targeted action to address inequalities in gambling harm High-risk areas or underserved populations identified using data (deprivation, ethnicity, age, venue density)? Interventions targeted at and co-designed with these populations? Culturally appropriate, not just translated? Structural access barriers actively addressed? No targeted action to address inequalities in gambling harm. Some awareness of inequalities exists, but no targeted action taken and high-risk populations not formally identified. High-risk populations identified and some targeted interventions in place, but not consistently co-designed or culturally appropriate for all groups. Comprehensive, evidence-led targeting of high-risk and underserved populations, with culturally appropriate, co-designed interventions and documented reach and impact. <- choose the level above that matches what currently exists Until the need assessment has been completed, there is no basis to act on addressing inequalities other than those known to be factors from national and regional data sets. Engagement with the local SochCare charity which focusses support for those ff d b dd f h h h b b h h d h l h l 3.4 (T2) Awareness and stigma reduction training delivered to frontline services Awareness training delivered to frontline services (mental health, primary care, housing, debt advice)? Evaluated and embedded into standard practice? Peer- led, promoting EbE perspectives and non-judgemental language? Public health framing? Refresher training in place? No awareness training delivered to frontline services. No specific gambling harm support is currently commissioned directly by Hillingdon Council. The local drug and alcohol treatment service is in the process of exploring how it can expand its gambling harm identification and support offer and have b h h l l h ( h ) l h h h h h l d EbE contributors involved in some governance processes with some documented influence, but involvement is not yet consistent or appropriately remunerated across all areas. Structured, ongoing EbE involvement embedded in governance and decision-making, with appropriate remuneration and documented impact on decisions. <- choose the level above that matches what currently exists None currently engaged. A local charity (SochCare) has been contacted with intitial discussions highlighting the ambitions to improve gambling harm response in Hillingdon and a view to engaging people with lived experience into the Hillingdon 3.2 (T2) Community co-production in service design and delivery Services co-produced with communities from the outset? EbE actively involved as co-producers in design and delivery (distinct from the governance role in 3.1)? Documented evidence that community input changed what was designed or delivered? Continuous feedback mechanism? Barriers (language, stigma, digital access, geography) actively removed? No community co-production; services designed without community input. Some consultation has taken place, but it has not yet demonstrably shaped services and there is no regular feedback mechanism. Co-production active in some service areas with evidence of EbE influence, but not yet consistent and not fully accessible to all communities. Strong, inclusive co-production fully embedded in service design, delivery and evaluation, with documented community and EbE influence, a continuous improvement cycle and active removal of barriers. <- choose the level above that matches what currently exists Experts by Experience are consulted at some points, but usually late in the process, and involvement is not yet routinely resourced or remunerated. Domain 3 - Community Engagement & Inclusion Read the four levels, pick the ONE that matches what currently exists, enter 0-3 in the yellow cell and add evidence. If you are between two, take the lower. Maturity bands and gap counts update DOMAIN 3 - Community Engagement & Inclusion Are communities, particularly those most affected, actively engaged in shaping the response to gambling harm? 3.1 (T1) Experts by Experience (EbE) involvement in governance and decision-making EbE contributors formally involved in governance, not just end-of-process consultation? Contributions meaningfully incorporated with documented impact? Appropriately paid and supported? Ongoing and embedded rather than one-off? No EbE involvement in governance or decision-making. 2 - Embedding 3 - Leadership Your score (0-3) 1 Evidence / notes Consider 0 - Early Action 1 - Progressing 2 - Embedding 3 - Leadership Your score (0-3) 0 Evidence / notes Consider 0 - Early Action 1 - Progressing 2 - Embedding 3 - Leadership Your score (0-3) 1 Evidence / notes <- choose the level above that matches what currently exists World Cup Gambling Harm campaign was run during the 2026 World Cup. This identified some useful information that when combined with need assessment data and a communication campaign approach, will be used to develop locally relevent 3.6 (T3) Public awareness campaigns on gambling harm Campaigns co-designed with EbE and targeted at high-risk groups, young people and deprived areas? Evidence-based, regularly delivered and evaluated for reach and impact? Digital and in-person channels used? No public awareness campaigns delivered. At least one campaign delivered, but it was one-off, not targeted to high-risk groups and was not evaluated. Campaigns delivered periodically and targeted to some high-risk groups, but not yet consistently co-designed, evaluated or reaching all priority populations. Ongoing, co-designed, evidence-led campaigns regularly delivered to priority populations and formally evaluated for reach and impact. Options for provision of training of school based staff to support an existing peer mental health programme are being explored but nothing is in place for this yet. Training delivered across several relevant services with some EbE input, but coverage is not yet consistent and refreshes are not in place. Systematic, peer-led training delivered across all relevant services, with regular refreshes and documented reach. <- choose the level above that matches what currently exists Training has taken place within the Drug and Alcohol Treatment Service. Other training options are being considered with training need mapping for front line staff within Hillingdon Council being progressed 3.5 (T2) School and community awareness programmes delivered EbE-informed awareness and prevention programmes in education, youth and community settings? Gambling harm in PSHE or youth programmes? Staff trained to identify and support children and young people? Referenced in safeguarding protocols with trained DSLs? No school or community programmes in place. Minimal or one-off sessions in at least one setting, without EbE input or evaluation. Programmes active in several education or community settings with some EbE input, but not yet systematically delivered and DSLs not yet consistently trained. Established programmes delivered consistently across education, youth and community settings, co-designed with EbE, regularly evaluated, and DSLs trained with gambling harm in safeguarding protocols. <- choose the level above that matches what currently exists Consider 0 - Early Action 1 - Progressing 2 - Embedding 3 - Leadership Your score (0-3) 1 Evidence / notes Consider 0 - Early Action 1 - Progressing 2 - Embedding 3 - Leadership Your score (0-3) 1 Evidence / notes Consider 0 - Early Action 1 - Progressing 2 - Embedding 3 - Leadership Your score (0-3) 2 Evidence / notes Consider 0 - Early Action 1 - Progressing 2 - Embedding 3 - Leadership Your score (0-3) 0 Evidence / notes The requirement for local risk assessments is formalised in gambling pollicy statement with operators being required to consider and mitigate harm. There is a mechanism through licensing and enforcement to check compliance. Details of any d f h l f h f h d l f l l h Public health provides input into some licensing decisions, but this is not yet a consistent, structured process. Regular, systematic collaboration between public health and licensing, with shared data, joint processes and documented impact. <- choose the level above that matches what currently exists Public Health part-funds roles within the licensing, environmental health, and trading standards teams, however, due to capacity within the Public Health Department, this is not regular and systemtic collaboration. This is expected to improve due l f h bl l h f bl l h d dd l d 4.4 (T2) Harm minimisation conditions embedded in licensing frameworks Harm minimisation conditions developed and embedded in licensing policies? Decisions supported by local evidence and data? Compliance visits conducted and best practice expectations outlined for operators? No harm minimisation conditions in place. Conditions have been discussed and are in development, but have not yet been formalised or applied. Conditions are formalised and applied in some cases, but application is inconsistent and compliance is not routinely monitored. Harm minimisation conditions are routinely embedded in all relevant licences, with active compliance monitoring and operator engagement. <- choose the level above that matches what currently exists Informal or ad hoc contact exists but there is no structured process or data sharing. 4.2 (T2) Local area profiles and risk assessments in place Local area risk profile including deprivation, vulnerability and premises density? Recently updated? Actively used to inform licensing and planning decisions with documented links to outcomes? No local risk assessment or area profile exists. A basic or outdated profile exists but is not regularly updated or actively used to inform decisions. A current profile exists and is used in some decisions, but its application is inconsistent across teams. A regularly updated risk profile is routinely used across all relevant licensing and planning decisions, with documented links to outcomes. <- choose the level above that matches what currently exists Hillingdon's statement of gambing policy contains sections on local risk assessments and local area profiles, however, the licensee is the body expected to conduct these, not the local authority 4.3 (T1) Public health input into licensing and planning decisions Public health routinely invited to make representations on applications and variations? Joint processes or shared data between licensing and public health teams? Documented process for PH evidence to licensing committees? No public health collaboration with licensing or planning. Domain 4 - Prevention & Regulation Read the four levels, pick the ONE that matches what currently exists, enter 0-3 in the yellow cell and add evidence. If you are between two, take the lower. Maturity bands and gap counts update Hillingdon has a statement of gambling policy which is focussed on;Preventing gambling from being a source of crime or disorder; Ensuring gambling is conducted fairly and openly; Protecting children and vulnerable persons from being harmed or l d b bl DOMAIN 4 - Prevention & Regulation Is prevention prioritised and regulation used proactively to reduce gambling-related harm? 4.1 (T1) Gambling harm considered in licensing and planning policies Referenced in the Local Gambling Policy Statement? Public health explicitly considered in licensing and planning decisions? Local Plan policy on location/clustering of premises, or cumulative impact addressed? Licences restricted, refused or conditioned on public health grounds? Gambling harm is not considered in licensing or planning policy. Gambling harm is mentioned in at least one policy document, but has not yet changed how decisions are made in practice. Public health is considered in some licensing and planning decisions, but application is inconsistent and not yet standard practice. Gambling harm is routinely considered in all relevant licensing and planning decisions, with documented public health rationale in each case. <- choose the level above that matches what currently exists Consider 0 - Early Action 1 - Progressing 2 - Embedding 3 - Leadership Your score (0-3) 0 Evidence / notes Consider 0 - Early Action 1 - Progressing 2 - Embedding 3 - Leadership Your score (0-3) 0 Evidence / notes Consider 0 - Early Action 1 - Progressing 2 - Embedding 3 - Leadership Your score (0-3) 0 Evidence / notes Consider 0 - Early Action 1 - Progressing 2 - Embedding 3 - Leadership Your score (0-3) 0 Evidence / notes <- choose the level above that matches what currently exists No consideration of gambling harm in Social Value requirements or procurement. 4.8 (T2) Social Value requirements for commissioned services include gambling harm Gambling harm prevention included within Social Value requirements for commissioned services? Providers asked to demonstrate how they will address gambling harm? Social Value assessed in tender evaluation in a way that includes gambling-related health outcomes? No consideration of gambling harm in Social Value requirements or procurement. Gambling harm is considered in at least one contract, but this is ad hoc and not yet a systematic requirement. Gambling harm is included in Social Value guidance and some tender evaluations, but is not yet consistently assessed or evidenced across all relevant contracts. Social Value requirements systematically include gambling harm across all relevant contracts, with provider evidence assessed and impact documented. There is no evidence on the Council intranet site of policies or guidance to reduce gambling harm across the workforce A policy has been adopted and applied to some council-owned spaces or communications, but coverage and enforcement are not yet comprehensive. A formal, implemented policy restricts gambling advertising across all council-owned spaces, communications and events, with specific protections near schools and deprived areas, and clear enforcement. <- choose the level above that matches what currently exists Within the statement of gambling policy, advertising is covered and is considered suitable within the remit of the Gambling Act and with certain conditions that might be applied by licensing in relation to gambling licences such as: not advertising bl h ld d h d l b d f 4.7 (T2) Workplace policies implemented to reduce gambling harm Workplace policies to support staff experiencing gambling harms? Embedded in HR policies and communicated to all staff? No workplace policies or guidance to reducr gambling harm across workforce in place. The council is aware of workplace policies aimed at reducing harm within its workforce and adoption is under consideration, but no formal commitment has been made. A policy has been adopted and HR policies updated, but communication to staff is limited and embedding is not yet complete. Workplace policies reducing gambling harm are fully implemented, HR policies updated, and staff are consistently informed and supported, with evidence of uptake. <- choose the level above that matches what currently exists The issue has been discussed internally and is on the agenda, but no formal policy has been drafted or adopted. 4.5 (T3) Cumulative impact assessments conducted Multisource data used to map risk and vulnerability? Combined impact of clusters of gambling-related premises assessed? Inequalities data incorporated? Cumulative impact data formally integrated into planning and licensing decisions? No cumulative impact assessment has been conducted. Ad hoc or partial assessments carried out in at least one area, but not integrated into decision-making. Cumulative impact assessments conducted for most high-risk areas, but not yet systematically integrated into all relevant decisions. Comprehensive, evidence-led assessments conducted routinely and formally integrated into all relevant planning and licensing decisions. <- choose the level above that matches what currently exists No cumulative impact assessment has been conducted. 4.6 (T3) Local advertising and sponsorship policy restricting gambling promotion Formal policy restricting gambling advertising on council-owned/controlled spaces (bus shelters, billboards, digital screens, websites, social channels)? Extends to council events, sponsorship and partnership communications? Considered voluntary commitments to restrict gambling advertising? Specific protections near schools, youth services and deprived areas? Clear enforcement process? No advertising or sponsorship policy relating to gambling exists. Consider 0 - Early Action 1 - Progressing 2 - Embedding 3 - Leadership Your score (0-3) 1 Evidence / notes Consider 0 - Early Action 1 - Progressing 2 - Embedding 3 - Leadership Your score (0-3) 1 Evidence / notes Consider 0 - Early Action 1 - Progressing 2 - Embedding 3 - Leadership Your score (0-3) 1 Evidence / notes Consider 0 - Early Action 1 - Progressing 2 - Embedding 3 - Leadership Your score (0-3) 1 Staff across several relevant services trained and using AIDE or equivalent, but adoption not yet consistent across all settings. AIDE or equivalent embedded in frontline practice across all relevant services, with ongoing CPD, refresher training and documented implementation rates. <- choose the level above that matches what currently exists Drug and Alcohol Treatment service staff have received gambling awareness traininig but signiicant numbers of other frontline staff within the local system have had no training. A training needs mapping is planned to fully ascertain how many staff ld b f f dd l 5.4 (T1) Routine enquiry introduced in primary care, mental health, housing and debt services Routine screening for gambling harm introduced across primary care, mental health, housing and debt services? Additional training provided to support screening, identification and referral? No routine enquiry in place in any setting. Routine enquiry piloted or introduced in at least one setting, but not extended across the full range of target services. Routine enquiry is in place across several target settings with supporting training, but is not yet consistently adopted in all relevant services. Routine enquiry is systematically embedded across all target settings, with documented training and referral rates. <- choose the level above that matches what currently exists Minimal training delivered to a small number of staff in at least one service, but AIDE or equivalent has not been formally adopted. 5.2 (T1) Referral pathways mapped, documented and communicated Locally available treatment, support and voluntary services identified and mapped? Pathways clear, documented and communicated to frontline staff and residents? Easy to access, monitored and regularly reviewed? No referral pathways have been mapped or documented. Some services identified and informal awareness among a few frontline staff, but pathways are not yet documented or communicated. Pathways are mapped and documented, but communication to frontline staff and residents is limited and pathways are not regularly reviewed. Clear, documented and regularly reviewed pathways are in place, widely communicated and easy to access, with evidence of uptake. <- choose the level above that matches what currently exists Some frontline staff may have awareness of routes into gambling harm support offers such as drug and alcohol treatment service staff. There is no clearly communicated and documented pathway for referral available to all staff 5.3 (T2) Staff trained in screening and brief interventions Staff across health, social care, housing and advice services trained to ask about and identify gambling harms? AIDE model (Ask, Identify, Direct, Explore) or equivalent implemented and embedded? Screening tools adopted consistently? Refresher training and ongoing CPD? No staff training on screening or brief interventions. Domain 5 - Integrated Treatment & Support Read the four levels, pick the ONE that matches what currently exists, enter 0-3 in the yellow cell and add evidence. If you are between two, take the lower. Maturity bands and gap counts update Children's Services, Adult Social Care, MASH arrangements and safeguarding responsibilities, make it highly likely that frontline staff will encounter gambling-related issues indirectly through financial abuse; neglect; domestic abuse; mental health l l b l d d h ldh d d f f l ff d d DOMAIN 5 - Integrated Treatment & Support Are accessible, effective and integrated support pathways in place for people affected by gambling harm? 5.1 (T1) Gambling harm embedded in safeguarding frameworks Safeguarding policies explicitly recognise gambling harms affecting children, young people and families? Safeguarding teams trained to identify gambling harm? Considered in multi-agency safeguarding arrangements (MASH, MARAC)? Gambling harm not referenced in any safeguarding framework or policy. Some awareness of gambling harm in safeguarding teams, but no formal policy reference or training in place. Gambling harm referenced in some safeguarding materials and some staff trained, but not yet systematically considered across all multi- agency arrangements. Fully embedded in safeguarding frameworks with trained staff, clear protocols, and active consideration in multi-agency arrangements. <- choose the level above that matches what currently exists Evidence / notes Consider 0 - Early Action 1 - Progressing 2 - Embedding 3 - Leadership Your score (0-3) 1 Evidence / notes Consider 0 - Early Action 1 - Progressing 2 - Embedding 3 - Leadership Your score (0-3) 1 Evidence / notes Consider 0 - Early Action 1 - Progressing 2 - Embedding 3 - Leadership Your score (0-3) 2 Evidence / notes Consider 0 - Early Action 1 - Progressing 2 - Embedding 5.8 (T1) Children recognised as affected others in safeguarding Do safeguarding, early help and family support consider that a child may be harmed by someone else's gambling (neglect, financial stress, instability, conflict)? Are practitioners prompted to ask about gambling when these signs are present? This is distinct from a child's own gambling, covered in 3.5. Children affected by someone else's gambling are not considered in safeguarding or early help. Some individual practitioners recognise this, but it is not reflected in safeguarding guidance, prompts or training. Recognised in some safeguarding and early-help practice, but not yet consistent across teams or supported by clear prompts and training. drug and alcohol treatment service staff work within the same NHS Trust which provides mental health support services and also which runs a gambling harm clinic. There is some integration and established referral routes for those who meet the high d l bl d h ff d b l f h h h h l l f Pathways strengthened with some partners, and some provision for affected others, but coverage is incomplete and pathways not yet formally assessed. Seamless referral pathways established across all relevant partners, with explicit, assessed provision for affected others and regular improvement cycles. <- choose the level above that matches what currently exists Initial discussions between SochCare and the drug and alcohol treatment service to consider support needs for people affected by gambling of others has begun 5.7 (T3) Gambling harm embedded in NHS mental health and addiction pathways Integrated into NHS mental health and addiction services? Medical practitioners trained to identify, refer and support? Training materials in medical education curricula and CPD? Peer support and EbE involvement built into recovery pathway improvement? No integration into NHS mental health or addiction pathways. Awareness of the need for integration, but no formal changes to NHS pathways, training or protocols made. Gambling harm integrated into some NHS pathways with some practitioner training, but referral protocols and peer support not yet consistent. Gambling harm fully embedded in NHS mental health and addiction pathways, with consistent training, clear referral protocols and EbE involvement in recovery pathway improvement. <- choose the level above that matches what currently exists Some conversations with partners, but no formal agreements or pathways for affected others exist. 5.5 (T2) Gambling harm integrated into wider services (mental health, debt, housing) Wider services aware of treatment and support services and how to refer? Screening or referral part of standard practice? Gambling treated alongside co- occurring harms? Services accessible with reasonable adjustments for language needs, digital exclusion and other barriers? Gambling harm not integrated into any wider services. Some awareness in at least one wider service, but no referral process or screening in place. Several wider services aware and some screen or refer, but integration is partial and not all relevant services have joint protocols or shared training. Gambling harm well integrated across all relevant wider services, with joint protocols, shared training, co-occurring harm approaches and inclusive access. <- choose the level above that matches what currently exists Awareness among staff within the drug and alcohol treatment service. This awareness may exist in isolation or individual practice in other services but no clear and apparent evidence of this being systematic 5.6 (T1) Pathways strengthened for affected others and across partners Partners engaged to establish seamless referrals? Pathways explicitly include affected others (family members, partners)? Referral agreements with NHS and specialist providers? Teachers, safeguarding and youth-facing staff trained to identify and refer? Pathways regularly assessed and improved? No pathway development with partners; no provision for affected others. routine enquiry is being introduced within the drug and alcohol treatment service. This may exist in isolation or individual practice in other services but no clear and apparent evidence of this being systematic 3 - Leadership Your score (0-3) 1 Evidence / notes <- choose the level above that matches what currently exists Within statement of gambling policy there is no requirement to ask for frontline social care staff about gambling when these indicators are present; screen for gambling harm in early help assessments; include gambling within safeguarding prompts; d bl l d f l h h hl l k l h f l ff ll bl l d Routinely recognised across safeguarding and early help, with clear prompts, training and pathways so children harmed by others' gambling are identified and supported. Consider 0 - Early Action 1 - Progressing 2 - Embedding 3 - Leadership Your score (0-3) 0 Evidence / notes Consider 0 - Early Action 1 - Progressing 2 - Embedding 3 - Leadership Your score (0-3) 1 Evidence / notes Consider 0 - Early Action 1 - Progressing 2 - Embedding 3 - Leadership Your score (0-3) 1 Evidence / notes Consider 0 - Early Action 1 - Progressing 2 - Embedding Formal links and some joint planning exist with NHS and some adjacent agenda partners, but integration is incomplete and care pathways are not yet fully joined up. Strong working relationships with NHS and adjacent agenda partners, with fully integrated care pathways, coordinated interventions and joint strategic planning. <- choose the level above that matches what currently exists By nature of the drug and alcohol treatment service being part of the same NHS Trust that runs a specilist gambing harms clinic, some links do exist but these links do not necessarily exist into other service areas 6.4 (T3) Cross-sector connectivity and shared learning forums Partnerships developed across NHS/ICS, VCFSE, universities, debt advice, police, safeguarding boards, schools and youth services? Forums established for networking and shared learning? Successful prevention and support programmes identified and scaled? No cross-sector connectivity beyond immediate partners. Bilateral partnerships exist with some sectors, but there is no systemic connectivity or shared learning infrastructure. Several cross-sector partnerships are active and at least one forum for shared learning has been established, but scaling of effective interventions is not yet systematic. Informal links exist with at least one NHS or adjacent agenda partner, but no formal agreements or joint planning. 6.2 (T2) VCFSE organisations engaged as strategic and delivery partners VCFSE organisations meaningfully and sustainably engaged - commissioned or resourced, not just consulted? Involved in service design, co-delivery and governance? Shared accountability? Co-delivering interventions, not just attending meetings? No VCFSE engagement. At least one VCFSE organisation is engaged, but involvement is minimal, one-off or consultation-only - not resourced or strategic. Several VCFSE organisations are engaged and co-delivering in some areas, but involvement is not yet sustainable, consistently resourced or embedded in governance. Active, strategic VCFSE partnerships with shared accountability, co-design, co-delivery and sustainable, documented resourcing. <- choose the level above that matches what currently exists Early discussions have taken place with SochCare about engaging the charity and its expertise by lived experience to help strengthen Hillingdon's gambling harm reduction approach 6.3 (T1) Links with NHS, treatment providers and adjacent agendas Established relationships and formal referral pathway agreements with NHS and specialist gambling treatment providers? Gambling harm explicitly linked to adjacent agendas (poverty, mental health, substance use, domestic abuse, financial hardship)? Interventions aligned and coordinated? Joint planning and shared strategic approach? No links with NHS, treatment providers or adjacent agendas. Domain 6 - Operational Partnerships Read the four levels, pick the ONE that matches what currently exists, enter 0-3 in the yellow cell and add evidence. If you are between two, take the lower. Maturity bands and gap counts update no formal operational coordination across agencies. DOMAIN 6 - Operational Partnerships Are key stakeholders aligned and working together effectively to reduce gambling harm? 6.1 (T1) Operational multi-agency coordination in place Formal operational partnership or coordination group meeting regularly to plan, coordinate and review delivery? Shared operational workplan with agreed timelines, named delivery leads and regular progress review? Delivery roles clearly allocated across partners? No formal operational coordination across agencies. Informal operational contact exists between some partners, but no structured coordination group, shared workplan or defined delivery roles. A formal coordination group is meeting with most key partners, but a shared operational workplan is not yet in place or not regularly reviewed. Established, well-coordinated multi-agency group meeting regularly with a shared operational workplan, clear delivery roles and documented progress. <- choose the level above that matches what currently exists 3 - Leadership Your score (0-3) 0 Evidence / notes Consider 0 - Early Action 1 - Progressing 2 - Embedding 3 - Leadership Your score (0-3) 0 Evidence / notes <- choose the level above that matches what currently exists No joint training across agencies. 6.5 (T2) Joint multi-agency workforce training coordinated Multi-agency training sessions coordinated to improve awareness, screening and support? Sessions include NHS, housing, debt advice, VCFSE and other partners? Peer-led and informed by EbE? Refresher training and ongoing CPD? No joint training across agencies. At least one joint training session has been delivered, but it is not part of a coordinated programme and is not peer-led. Coordinated multi-agency training sessions are taking place with several partner sectors, but coverage is incomplete, peer leadership is limited and CPD is not yet in place. Regular, well-coordinated multi-agency training covering all relevant partner sectors, with peer-led delivery, EbE input, ongoing CPD and documented training reach. no cross-sector connectivity beyond immediate partners. Comprehensive cross-sector partnerships with established forums for networking, learning and systematic identification and scaling of effective interventions. <- choose the level above that matches what currently exists Foundational (T1) gaps 14 Tier 2 gaps 16 Indicators assessed 39 of 39 Maturity band T1 gaps T2 gaps Scored Early Action 2 3 7 / 7 Progressing 2 2 5 / 5 Early Action 2 3 6 / 6 Progressing 1 4 8 / 8 Progressing 5 2 8 / 8 Early Action 2 2 5 / 5 Updates automatically as you score the Assessment tab. Headline measure: unresolved Tier 1 (foundational) gaps - the priority to close. Tiers: T1 = foundational - T2 = established practice - T3 = advanced. Bands calculate once every indicator in a domain is scored. A score of 3 should carry Results D3 Community Engagement & Inclusion D2 Population Insights & System Improvement D5 Integrated Treatment & Support D6 Operational Partnerships D1 Strategic Leadership & Partnerships Domain D4 Prevention & Regulation

Health and Wellbeing Board report 9 September 2026 SEND JSNA UPDATE Relevant Board Member(s) Sharon Stoltz, Director of Public Health Julie Kelly, Corporate Director of Children’s Services Organisation London Borough of Hillingdon Report author Andy Kimber – Senior Public Health Manager Papers with report None HEADLINE INFORMATION Summary This report updates the Board on a Joint Strategic Needs Assessment for Special Educational Needs and Disabilities Contribution to plans and strategies The production of a SEND JSNA is a key requirement of every Local Authority as set out in the recent SEND Reforms. The SEND JSNA will provide data and analysis to inform local future strategic direction in support of Children and Young People with SEND and their families. Financial Cost N/A Ward(s) affected All RECOMMENDATION That the Health and Wellbeing Board notes the content of the report. Information 1. This report provides notification to the Health and Wellbeing Board that the local area has begun scoping work for a SEND JSNA, with a view to producing a completed SEND JSNA during the autumn and winter of 2026. 2. Joint Strategic Needs Assessments are led by Public Health dep artments in support of general population health, or specific subject matter analysis such as SEND . Health and wellbeing boards are responsible for the development and governance of Joint Strategic Needs Assessments. Background 3. In February 2026 the government published its reforms to the SEND system in England as part of its White Paper, 'Every Child Achieving and Thriving'. 4. The 2026 SEND reforms are designed to ensure children with SEND get the right support earlier, closer to home, and more consis tently across the country. The reforms strengthen inclusion in mainstream schools, introduce clearer support plans, and improve coordination between education, health and care services. Health and Wellbeing Board report 9 September 2026 5. Hillingdon has a substantial population of children and young people with special educational needs and disabilities. The borough's SEND Sufficiency Strategy identifies more than 7,700 children and young people aged 0 –25 with SEND, equivalent to approximately 11.9% of the local 0 –25 population. During 2023/24, 16.6% of pupi ls in Hillingdon were identified as having either an Education, Health and Care Plan (EHCP) or SEN Support, compared with 17.4% in London and 18.1% nationally 6. SEND needs are defined not in one single area of provision or professional discipline, but instead incorporate a combination of Health, Education and Social Care. Within these descriptions there are subsets of each, for example Mainstream and Special Schools, and Clinical, Community and Public Health. 7. A SEND JSNA will identify, report and make recommendations based on data analysis and expressed and felt needs in areas of local need and provision which impact Children, Young People and their families including a. Overall local prevalence, rates and trends b. Identification of need c. Education and Health Care Plans and SEN Support d. Clinical and Community Services e. Educational outcomes f. Assessing and meeting identified needs g. Improving outcomes h. Voice of Children and Young People and their families i. Organisational needs and capacity j. Areas of recommended overall focus Current position 8. Hillingdon has identified the local need to produce a SEND JSNA and has begun to make strategic plans in order to deliver on this requirement 9. A senior team including the Director of Public Health and Director of SEND and Education and their departments have drawn together local expertise in order scope national best practice and review peer examples. 10. Methodology, scope and presentation have been considered with approaches focussing on broad but manageable content; and accessible, graphical presentation. 11. A review of similar best practice identified a number of Local Area SEND JSNAs for consideration, with Camden’s approach, content and presentation identified as a model on which the Hillingdon SEND JSNA may be ideally based. 12. A steering group incorporating expertise in Education, Social Care, Health and data analysis has been convened with a programme of meeting dates scheduled throughout the Autumn and Winter 2026. 13. The proposed timescale is to complete the work prior to Christmas 2026 and to report an update to the Health and Wellbeing Board in December.. Risks and considerations 14. The scale of the available data in the area of SEND is necessarily significant, reflecting the Health and Wellbeing Board report 9 September 2026 wide range of organisations and stakeholders within scope, spanning a. Clinical Health, Community Health, Public Health and Primary Care; b. Mainstream Education, Special Schools and Alternative Provision; c. Children in Need, Children in our care, Youth Justice and Safeguarding d. Adult Social Care in respect of Young People aged 18-25 15. The proposed example SEND JSNA from Camden and examples of similar documents extend to well over 100 pages, and it is a known issue that it is difficult to produce a complete JSNA which is succinct. 16. Such documents can routinely and realistically take up to six months to complete and the available timescale is noted as challenging in the production of this piece of work. Mitigations 17. A comprehensive reference document citing all available reference material and relevant individual datasets within published data sources has been made available to Hillingdon which is expected to reduce the overall timescale to produce the SEND JSNA. 18. Initial undertakings using AI to automate the importation of local and up to date data has been initially effective in reducing some of the administrative burden, and random data checking across samples within the imported data has so far proven accurate. References 19. References: 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.

Health and Wellbeing Board report 9 September 2026 BOARD PLANNER & FUTURE AGENDA ITEMS Relevant Board Member(s) Councillor Susan 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 (reg ular 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 publicati on. As such, they can usually only be considered if they are received by the deadlines set. Any late report (issued after the agenda has been published) can only be considered if a valid reason for its urgency is agreed by the Co-Chairs. Health and Wellbeing Board report 9 September 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 Serv ices 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 clear 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 9 September 2026 APPENDIX 1 BOARD PLANNER 2026/2027 2 Dec 2026 2.30pm Committee Room 6 Business / Reports Lead Timings Reports referred from Cabinet / Policy Overview & Scrutiny (SI) LBH Report deadline: 9am 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: 9am 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