Health & Social Care SC

Minutes HEALTH AND SOCIAL CARE SELECT COMMITTEE 22 May 2024 Meeting held at Committee Room 6 - Civic Centre, High Street, Uxbridge UB8 1UW Committee Members Present: Councillors Nick Denys (Chair), Reeta Chamdal (Vice-Chair), Tony Burles, Farhad Choubedar (In place of Kelly Martin), Philip Corthorne, June Nelson and Sital Punja (Opposition Lead) Also Present: Clinton Beale, Stakeholder Engagement Manager (North West), London Ambulance Service NHS Trust Piers McCleery, Director of Strategy and Planning, Royal Brompton and Harefield Hospitals - Guy's and St Thomas' NHS Foundation Trust Chris Reed, Hillingdon Group Manager, London Ambulance Service NHS Trust Lisa Taylor, Managing Director, Healthwatch Hillingdon Patricia Wright, Chief Executive, The Hillingdon Hospitals NHS Foundation Trust LBH Officers Present: Nikki O'Halloran (Democratic, Civic and Ceremonial Manager) 3. APOLOGIES FOR ABSENCE (Agenda Item 1) Apologies for absence had been received from Councillor Kelly Martin (Councillor Farhad Choubedar was present as his substitute). 4. DECLARATIONS OF INTEREST IN MATTERS COMING BEFORE THIS MEETING (Agenda Item 2) There were no declarations of interest in matters coming before this meeting. 5. MINUTES OF THE MEETING HELD ON 21 FEBRUARY 2024 (Agenda Item 3) RESOLVED: That the minutes of the meeting held on 21 February 2024 be agreed as a correct record. 6. MINUTES OF THE MEETINGS HELD ON 9 MAY 2024 (Agenda Item 4) RESOLVED: That the minutes of the meeting held on 9 May 2024 be agreed as a correct record. 7. EXCLUSION OF PRESS AND PUBLIC (Agenda Item 5) RESOLVED: That all items of business be considered in public. 8. HEALTH UPDATES (Agenda Item 6) The Chair welcomed those present to the meeting. The Hillingdon Hospitals NHS Foundation Trust (THH) Ms Patricia Wright, Chief Executive at THH, advised that she had provided the Committee with a comprehensive update at its meeting in January 2024. The Trust’s 2022-2026 Strategy had set out six priorities and Ms Wright had spoken to Members about the objectives that the organisation had hoped to achieve during the current year. In the final quarter of 2023/2024, the Trust had rated its performance against its objectives for each area of the Strategy as follows: • Quality - deliver consistent high quality, safe and compassionate care; • People - be a great place to work and an exemplar employer; • Performance - we will deliver the right care at the right time for our patients; • Finance - maximise resources available for the benefit of patient care; • Strategic Programme - progress delivery of our strategic programmes; and • Partnerships - be an active system partner leading strategic change. The focus for the year had been on staff and patients whilst not losing sight of performance. Ms Wright believed that the 2023/2034 Quality Account report had highlighted good performance in relation to falls and ulcers. However, it was noted that, following the CQC inspection in August 2023, the final inspection report in February 2024 had revised the rating for THH’s maternity services from ‘Good’ to ‘Requires Improvement’. It was noted that maternity services nationally had seen a change in the acuity of individuals having babies who needed more support for their complex health care needs. Furthermore, it had been recognised that THH had not been as sensitive to the local population’s needs as they could have been. The growth of diversity in the community meant that there was more evidence on the difference in outcomes for black and minority ethnic (BAME) women and THH needed to be clearer about patient communication. Longer appointments were now regularly scheduled at the start of the maternity pathway. Work had started to address these needs as well as the issues raised in the Ockenden Maternity Review report and, to this end, a Maternity Voices Partnership had been set up. The level of scrutiny and the standard of care had been much higher since the Ockenden report. Members were disappointed with the performance of maternity services and queried what had been learnt from the CQC inspection and what action was being taken to improve the service. Ms Wright assured the Committee that the CQC report had included a lot of positive messages and that the ‘Safe’ and ‘Well Led’ domains had been reviewed and an improvement plan had been put in place. Consideration was being given to what people needed to be able to improve the patient experience and conversations would be undertaken with a variety of individuals who had / would have contact with the service. Ms Wright noted that, although the staff engagement response rate had increased by around 8%, the Trust’s scores were not as good as would have been liked and should have been better. She felt that there had been an improvement at THH. Members were advised that THH had ended the financial year in a balanced position but had declared a deficit due to a technical issue. THH had used learning from the introduction of Cerner at other Trusts in North West London (NWL) to effectively implement the new system. All four Acute Provider Collaborative (ACP) Trusts in NWL were now using the same patient record system and would have access across all records. The ACP had been in place since 2022 and work was progressing at pace in relation to things such as the strategy for working together. Ms Wright would bring this back to a future meeting of the Health and Social Care Select Committee. It was noted that the new hospital programme had received full planning permission and was ready to go but had been delayed whilst the governance process had been worked through. Although 78½% of patients in the Emergency Department (ED) had been seen within the four hour target (and this had been sustained during April 2024), this figure had dropped off during May 2024. A plan to maintain this level of performance had been put in place and Ms Wright was determined to stick to it and deliver the required results. It was noted that the number of complaints received by the Trust had also now dropped off. The ED continued to see peaks and troughs in attendance figures. Although there were usually around 350 attendances per day, recently this had increased up to 500 per day. It was recognised that these increases had arisen for a variety of reasons including THH being a receiving hospital for Heathrow Airport (not just the local population). With regard to partnerships, the work of Hillingdon Health and Care Partners (HHCP) had been progressing at pace. Ms Wright noted that HHCP had created two GP hubs which, it was hoped, would reduce the number of people attending the ED who thought that would mean that they would be seen quicker than if they waited for a GP appointment. Although she was unable to speak in detail about GPs, Ms Wright advised that they ensured that patients were seen in the most appropriate environment as quickly as possible. The GP hubs had created greater primary care capacity. Since 2007, the national standard for Accident and Emergency (A&E) was that 95% of patients would wait no longer than 4 hours from arrival to admission, discharge or transfer for A&E treatment. This standard had been seen as a milestone towards returning to the 98% standard. Currently, the target for this national standard was 78%, although it was recognised that it was not always appropriate to move patients on within four hours. Members asked that the information provided by witnesses / partners for discussion the meeting be provided earlier to give them a chance to read and digest it. Ms Wright advised that THH had been regularly meeting with Healthwatch Hillingdon (HH) and noted that the organisation had a statutory right to enter the hospital and had been welcomed in to review issues such as patient experience in the ED. The patient experience leaflets had been checked by the Patient Experience Group (PEG) and catering and cleaning had been reviewed. There was much more that could be done including using incidents and complaints to improve the service received by patients but younger voices / perspectives were still needed on the PEG. In the Trust’s 2023/2024 Quality Account report, reference had been made to readmission with no target or comparison data. Ms Wright advised that the report could still be modified and noted that she would need to check why there were no figures from 2021/22 onwards on page 70 and why the DNA data was not available. Complex health issues had been a thread that ran through Hillingdon Hospital and linked to issues such as demographics, lifestyle, diet and race specific illnesses. The Trust needed to change and adapt to meet patients’ needs. With regard to staffing, Ms Wright advised that there were strict rules specifying that agencies had to be accredited and the staff that they provided had to be trained appropriately. To help fill any vacancies, THH had increased the number of bank staff that it had available. Over the last twelve months, the number of bank and agency staff that had been used had been high as they had been brought in to cover industrial action and staff training on the new patient record system. As there was currently a national shortage of midwives, this had been filled with agency staff where needed. Every effort had been made to ensure that no area was entirely staffed with agency staff and an active recruitment campaign was ongoing with 20 international midwifes recently appointed. Theatre nurses worked in the maternity theatres (not midwives) and effort would be needed to recruit more maternity support workers to share the care of patients with midwives. The Trust was in the process of rolling out DrDoctor within the maternity department. This patient engagement platform was used by clinicians to make data driven decisions, enable patients to book appointments and provide remote care. Ms Wright would provide the Democratic, Civic and Ceremonial Manager with further information about the rollout of DrDoctor for distribution to the Committee. It was recognised that frailty affected people of all ages. Consideration had been given to how patients could be segmented so that the frailty service could target frail patients so that tests were undertaken in a more timely fashion. The interventions that had been put in place (e.g., rapid CT scan, etc) had been effective in getting patients home more quickly. A unit was available for those individuals who needed additional tests over a 72 hour period and very effective work had been undertaken with CNWL and the local authority to identify those individuals who did not need to be in hospital so that the system could be unblocked. Members asked about patients being left in corridors at Hillingdon Hospital. Ms Wright advised that the Emergency Department (ED) was not big enough so there were times when patients were “cohorted” in the corridor under the supervision of a nurse or London Ambulance Service (LAS) staff. Mr Chris Reed, Hillingdon Group Manager at LAS, advised that Hillingdon did not use corridors as much as other hospitals in London and that patients were never left on their own, they always had a clinician with them. Risk assessments were undertaken when wards were full to identify capacity in alternative wards or to change the bed configuration. This approach was often used during winter pressures. Complaints during the winter had increased from around 25 per month to 45 per month. Although these complaints were mostly in relation to ED (this level had now dropped), there had also been complaints in relation to the implementation of the electronic patient record system as it had had a slow start. Ms Wright recognised that the Trust needed to do more. The London Ambulance Service NHS Trust (LAS) Mr Chris Reed, Hillingdon Group Manager at LAS, advised that he was proud of the performance of the LAS and of the Hillingdon Group staff who had produced good work which had resulted in positive outcomes. Members congratulated Mr Reed on the results of the annual staff survey which had improved on the previous year. Mr Reed thanked the Chief Executive at THH as the Trust had been impacted by changes that had been made by the LAS in relation to things such as the stroke pathway and the 45 minute drop off target. Patients identified as FAST-positive had previously been transported to Northwick Park Hospital. However, an app had been introduced in the last couple of weeks which had enabled LAS staff to talk directly to a consultant to determine the best course of action to be taken for an individual patient to ensure that the system was not clogged up unnecessarily. Mr Reed advised that he would provide an update on this initiative at a future meeting. Although the LAS had been centralised, local managers had been given more autonomy so that bespoke care could be provided for patients. Members were advised that the LAS vehicles were out 24/7 and that intelligent resourcing had been used to ensure that staff weren’t brought in on overtime unnecessarily when there were no vehicles available for them to use. The Hillingdon Group had vehicles on standby in strategic locations across the Borough, resulting in Hillingdon vehicles being the quickest in London to reach their destination, with a response time of 7 minutes and 5 seconds for Category 1 calls. The frailty unit in Hillingdon had been receiving very positive feedback. Although the handover could sometimes take time, it was more important to ensure that patients received the most appropriate care. Members asked about the impact on the LAS of the ‘Right Care, Right Person’ initiative introduced by the Metropolitan Police Service. Mr Reed advised that he was pleased overall with the support provided by the police. There were times when police presence could exacerbate a difficult situation but police officers were quick to attend when patients assaulted LAS staff. In the next couple of months, a new LAS mental health car would be located in Hanwell and staff were being asked for expressions of interest in manning it. Although the clinical hub had been created, the mental health car would be able to build on this experience. Mr Reed would provide Members with an update on the mental health car initiative at a future meeting. Mr Reed noted that the LAS received a number of inappropriate calls from members of the public that could be diverted to alternative care pathways but that this did not detract from patients in their hour of need and that compassion and empathy continued to be paramount. However, where appropriate, patients could be diverted to alternative pathways including: the stroke unit, district nurse, midwife, rapid response team and frailty team. LAS staff had been provided with guidelines on what each service would take and training days were held every nine weeks to ensure that the LAS correctly referred patients to alternative pathways with clinician to clinician handovers. The Committee was advised that staff sickness had recently been attributable mostly to stress and musculoskeletal issues. Since Covid, a wellbeing hub had been established with quotas for physiotherapy, psychotherapy, etc, and a robust sickness absence policy had been introduced. Sickness absence data was constantly monitored and the associated trends identified. With regard to recruitment and retention, turnover had stabilised somewhat and Mr Reed noted that there were more LAS staff available now and that he would provide the Democratic, Civic and Ceremonial Manager with the statistics for circulation to the Committee. Meetings were held twice each week to look at resourcing and vacancies / gaps could be covered using overtime (whilst ensuring that the working time directive was not breached). However, it was challenging to get the more experienced staff to stay in a particular role as there were now more career options available both within and outside of the LAS. Mr Clinton Beale, Stakeholder Engagement Manager at the LAS, advised that the Trust had just changed to a new record management system which could read information from all of the hospital systems across London. Over the next couple of months, the Transfer of Care project would be trialled, putting all LAS data into the hospital system. Harefield Hospital (Guy’s and St Thomas’ NHS Foundation Trust (GST)) Mr Piers McCleery, Director of Planning & Strategy at Harefield Hospital, advised that Royal Brompton and Harefield NHS Foundation Trust (RBH) had merged with GST three years ago to create economies of scale on sub-specialisation and was now part of a larger clinical group which had a £2.6bn turnover. Although it was a real challenge, sub-specialisation had resulted in better outcomes and attracted significant clinical talent. Coming together with GST had been a challenge but meant that the Trust now did over three thousand cardiac surgeries each year which provided a significant basis for research and attracted amazing clinicians. A strategy was being put together to reflect the unique selling point of having this depth of knowledge in relation to cardiac and critical care. A new trial had been taking place at Royal Brompton Hospital using microwave energy to destroy lung cancers in hard-to-reach locations in the lungs. This had been a world first. Previously, when a biopsy had been taken manually, it had to be at least 20mm and had resulted in a 65% survival rate. The new robotic system was more precise meaning that tumours could be as little as 6mm and resulted in a 95% survival rate at 5 years. The business case was being concluded for the robot to be used for lung cancer surgery to be undertaken at Harefield Hospital. Proposals were also underway for the robot to be used for cardiac surgery in the next year, subject to the technology being approved for use in Europe for this purpose. Over the last year, Harefield Hospital had undertaken the largest number of heart transplants. Work was also underway to look at the economies of increasing the number of lungs that could be accepted for transplant by introducing new technology. However, work would still need to be undertaken to establish how these development could be financed. Members were advised that the wait list for cardiac surgery (P2) was currently at around 6-8 weeks due to the sheer number of referrals and their complexity (against a target of 4 weeks). However, patients on the wait list were provided with an app so that they could provide an update on their status during their wait. It was noted that, although the size of the wait list was a concern, this volume had been reflected nationally. A new patient record system had been introduced at the Trust called Epic that would enable research to be undertaken in the future. Previously, around 50% of the data on a typical pathway had come from outside the Trust in the form of scanned letters, pdfs, etc. This data needed to have a structured form so that it could be combined with Epic. As staff were still learning the basics of Epic, is was taking longer to do things than before but this was expected to change in the near future. With regard to resourcing, it was noted that there was not enough of a long term strategy for staffing to be able to get upstream. Further work was being undertaken with colleges to develop technical roles which could also go out into private practice. As it was so hard to recruit and retain staff, it was important to be more creative about portfolio activities. A lot of work had been undertaken at GST in relation to the recruitment of Allied Health Professionals (AHPs) technical roles but it was too early to determine the resultant numbers. This would need to be replicated at RBH, specifically targeting the cohorts where there were problems filling roles. Members were advised that Harefield Hospital held an annual open day for sixth forms in the Borough but there was no methodical follow up undertaken afterwards. In addition, as it had been hard to recruit physiotherapists, work had ben undertaken with Brunel University to set up an MSc on cardio physiology (Mrs Derval Russell had been involved in setting this up). It was hoped that these students would come to work at RBH once qualified. Concern was expressed about the impact of RBH being absorbed into GST. Mr McCleery advised that there was a risk that RBH would be slower with its finances / invoice payments but that all of the clinicians were every bit as good as each other. However, the £1.7bn GST merger had brought with it a certain type of management where there was little encouragement for staff to show initiative. That said, GST’s rules based approach had been a good thing to introduce at RBH and had proved enduring through audits. Mr McCleery assured Members that Harefield Hospital was able to undertake surgery that others in the group were unable to with a scale that supported transplants. The hospital was able to have the space for beds that they couldn’t get in central London. The Kings team had been looking at regenerating heart tissue and the clinician championing this would be invited to attend a future meeting of the Committee. Development at Harefield Hospital was also thought to be more economical as a refurb there would cost in the region of £3½-4k per m2 whereas at Royal Brompton Hospital, it would cost £12-14k per m2. Harefield also had great transport links to the rest of the country. Members were advised that GST had a huge amount of estate. Acord ward at Harefield Hospital was a modular build which had been created in 2012 so was now overdue for replacement. A master plan had been developed which had identified all of the building works that were needed at Harefield Hospital. The financing for new ward replacements would likely come from a limited amount of capital, philanthropy and investment. GST could also sell the land and then lease it back over 40+ years, but this could be seen as a burden. Healthwatch Hillingdon (HH) Ms Lisa Taylor, Managing Director at HH, advised that the organisation had introduced a new reporting system and had started a TikTok account. Between January 2024 and May 2024, HH had received 161 enquiries / feedback through the information and sign posting system. The top three issues raised with HH were: 1. access to phlebotomy at Hillingdon Hospital; 2. access to GP appointments; and 3. admin and access to medical records. Members were advised that some residents had been referred to POWER for advocacy advice. A campaign in relation to GP access was currently underway with more than one hundred responses received to date. Further work would be undertaken to increase this response rate. Ms Taylor noted that HH had also been working with Central and North West London NHS Foundation Trust (CNWL) to interview Riverside patients over the last six months. Around 40 patients had been interviewed and feedback had been received from the carers focus group. An improvement plan bad been developed and a review would be undertaken after a year to establish what progress had been made against this plan. HH had been successful in bidding for funding in relation to improvements for children’s mental health and wellbeing. More than 100 responses had been received and more targeted engagement work was being undertaken. Recommendations would be coproduced to help improve access to services. Other work undertaken included HH supporting place inspections at THH. Community engagement and outreach work had been undertaken and the organisations had been working with Brunel in relation to research. Its social media presence was being developed as this format was increasingly being used by residents to engage with HH. HH currently had 13 active volunteers but still needed active Board members. Ms Taylor would forward details of the Board member role / person specification and how to apply to the Democratic, Civic and Ceremonial Manager for circulation to the Committee for wider advertising. The HH shop in the Pavilions had closed and consideration was currently being given to locating the organisation at the Civic Centre as part of the long term plan. In the meantime, working remotely had offered Ms Taylor the opportunity to spend more time in the community and raise HH’s profile. Ms Taylor noted that HH was looking at undertaking a review of pharmaceutical services. In addition, further work would be undertaken on the maternity unit and ED at Hillingdon Hospital. Mental health would also continue to be a focus. The Chair advised that, at the Committee’s next meeting, consideration would be given to its work programme for the year and it was suggested that Ms Taylor provide further information on any topics that might tie in with the work of HH. With regard to GP access, it was suggested that this be focused around the issues that had been faced by some in relation to digital appointment bookings. There had been some residents who had requested a face-to-face appointment but been told that they had to have a digital appointment first. Some residents had said that there was “no point” in contacting their GP for an appointment (so where were they going instead?) or had ended up travelling to the surgery as they could not get through on the telephone. PATCHES had also proved difficult to use which had resulted in some patients attending the ED instead as they wanted to talk to someone face-to-face. Ms Taylor advised that the NHS had been very clear that there was patient choice but that there were concerns that GP practices were not necessarily giving that choice. Concern was expressed that there were residents with complex health issues that had been struggling to get a GP appointment. Older people were more likely to give up trying to get an GP appointment if they were unable to access the GP more easily. It appeared that GPs seemed to prefer online appointments as they could see more patients using this format rather than seeing them in person. Ms Taylor advised that GPs often preferred face-to-face appointments and that Mr Richard Ellis, Joint Local Borough Director at North West London Integrated Care Board, might be able to provide data to support this. It was noted that the new GP hub in Ruislip had relieved some pressure on the ED at Hillingdon Hospital but there were still problems with accessing GPs. Ms Taylor advised that the hub was still relatively new so it was difficult to know if it was making a significant difference (the hubs in Uxbridge and Hayes were not yet open). The NHS still needed to do more work in promoting the hubs and the services provided therein. It was important that feedback was solicited while plans for the Uxbridge and Hayes hubs were being developed so that the patient voice could influence the way that the hubs would work. Although CNWL had not been able to send a representative to attend this meeting, the Trust had provided a report which had been included on the agenda. This report had indicated that there had been an improvement in CAMHS wait times. There had been a reduction in the number of enquiries received by HH in relation to CAMHS. Although the triage system had seemingly reduced the wait time, it was still unclear what the wait time was from triage to treatment. Ms Taylor noted that HH had received feedback from parents that services such as P3 had made a positive difference to their children. A second tranche of mental health practitioners had been introduced in schools in Hillingdon so there had been improvements made but there were also gaps that had been identified. RESOLVED: That: 1. Ms Wright provide the Committee with an update on the progress of the ACP at a future meeting; 2. Ms Wright provide the Democratic, Civic and Ceremonial Manager with further information about the rollout of DrDoctor for distribution to the Committee; 3. Mr Reed provide an update on the stroke app initiative at a future meeting; 4. Mr Reed provide Members with an update on the mental health car initiative at a future meeting; 5. Mr Reed provide the Democratic, Civic and Ceremonial Manager with the statistics for total number of staff and recruitment / retention figures for circulation to the Committee; 6. RBH be asked to invite the Kings team to attend a future meeting of the Committee to talk about the initiative that they had been working on to regenerate heart tissue; 7. Ms Taylor forward details of the Board member role / person specification and how to apply to the Democratic, Civic and Ceremonial Manager for circulation to the Committee for wider advertising; 8. Mr Richard Ellis, Joint Local Borough Director at North West London Integrated Care Board, be asked to provide data to support the suggestion that GPs often preferred face-to-face appointments; and 9. the discussion be noted. 9. CABINET FORWARD PLAN MONTHLY MONITORING (Agenda Item 7) Consideration was given to the Cabinet Forward Plan. RESOLVED: That the Cabinet Forward Plan be noted. 10. WORK PROGRAMME (Agenda Item 8) Consideration was given to the Committee’s Work Programme. Members agreed that they would cancel the meeting on 19 June 2024 and schedule a new meeting for a date in October 2024. The Chair advised that he and the Labour Lead had recently met with Ms Sandra Taylor, the Council’s Corporate Director of Adult Social Care, in relation to the upcoming CQC inspection. Ms Taylor would be providing the Chair and Labour Lead with information in relation to the CQC inspection which would then be shared with Members of the Committee. The CQC was currently at Westminster undertaking an inspection and it was likely that the Hillingdon inspection would take place around July 2024 with the resultant report being available within a couple of months. It was agreed that the Cabinet Member for Health and Social Care and the Corporate Director of Adult Social Care be asked to attend the Health and Social Care Select Committee in either October or November 2024. Consideration was given to possible review topics. It was agreed that Members of the Committee would forward ideas for possible topics to the Democratic, Civic and Ceremonial Manager before the next Committee meeting (by 12 July 2024). The Committee would then look to shortlist one major review topic and up to three single meeting review topics. RESOLVED: That: 1. the meeting schedule for 19 June 2024 be cancelled and the report due to be considered at that meeting be rescheduled for an alternative meeting; 2. the information in relation to the up coming CQC inspection be circulated to Members of the Committee; 3. a new meeting date be scheduled for October 2024; 4. the Cabinet Member for Health and Social Care and the C orporate Director of Adult Social Care be invited to provide an update at the meeting in October or November 2024; 5. Members forward suggestions for review topics to the Democratic, Civic and Ceremonial Manager by 12 July 2024; and 6. the Work Programme, as amended, be agreed. The meeting, which commenced at 6.30 pm, closed at 9.20 pm. These are the minutes of the above meeting. For more information on any of the resolutions please contact Nikki O'Halloran on nohalloran@hillingdon.gov.uk. Circulation of these minutes is to Councillors, officers, the press and members of the public.

Health and Social Care Select Committee – 24 July 2024 Classification: Public CARERS STRATEGY DELIVERY UPDATE Committee name Health and Social Care Select Committee Officer reporting Gary Collier – Adult Social Care and Health Papers with report Appendix 1: Case Studies Appendix 2: Carers Strategy Delivery Actions Influences Appendix 3: Joint Carers Strategy Delivery Plan Actions Ward All HEADLINES 1. The contribution of carers to the health and wellbeing of those they care for is significant and the purpose of a carers’ strategy is to demonstrate what the Council and its partners are doing to support carers in the borough. In Hillingdon the importance of supporting carers is recognised by all health and care partners as being critical to the sustainability of the local health and care system. 2. This report precedes the annual update to Cabinet on the delivery of the Carers’ Strategy Delivery Plan that will be considered in September 2024. The report is intended to give the Committee the opportunity to consider the update before Cabinet so that any comments it may have can be reflected in that report. The Committee is reminded that Cabinet requested an annual update in 2015 and this practice has continued. The Committee has previously agreed to align carers strategy delivery updates to the annual Cabinet reporting cycle. 3. At its November 2023 meeting the Committee considered the draft strategy, consultation on which was delayed but has now concluded. Officers will provide a verbal update to the Committee on feedback received. This report updates the Committee on the implementation of the 2023/24 delivery plan that was aligned to the priorities in the draft strategy. The report also identifies the priorities for 2024/25 for the Committee’s consideration. 4. The work of the Council and partners in supporting carers is illustrated with case studies that can be found in Appendix 1 to this report. Who can be a carer? 5. The Committee is reminded that there are three statutory definitions of who is a carer, and these are as follows:  Parent carer: The Children Act, 1989, defines this term as a person aged 18 or over who provides or intends to provide care for a disabled child for whom the person has parental responsibility.  Young carer: The Children Act, 1989, defines this term as being someone under 18 who helps to look after another person but not under a contract or scheduled voluntary work.  Adult carer: The Care Act, 2014, defines this as an adult, i.e., a person aged 18 or over, who is providing care and/or support for another adult for free but not under a contract or scheduled voluntary work. 6. The Children Act places a duty on the Council to undertake an assessment where it appears that a young carer may have support needs. The Council is required to consider how needs identified from an assessment should be met. There is a similar obligation under the Children Health and Social Care Select Committee – 24 July 2024 Classification: Public Act where a parent carer appears to have support needs or requests an assessment. 7. The Care Act creates a statutory right for adult carers to a carer’s assessment and the Council may have an obligation to assist them even if the person they are caring for does not satisfy the national eligibility criteria. This would be subject to them satisfying the national eligibility criteria for carers. Where the cared for person is eligible for social care assistance from the Council then the support needs of the carer would generally be considered as part of an overall package of care to address their collective needs. 8. The Committee can access more information about the Council’s offer to support carers of all ages by visiting the following link on the Council’s website Social care and wellbeing - Hillingdon Council 9. References to the ‘review period’ in this report means the period from 1 April 2023 to 31 March 2024 unless otherwise stated. 10. The report is structured as follows: A. Strategic Context B. 2023/24 Delivery Plan Update Highlights C. 2024 – 2025 Carer Support Priorities. RECOMMENDATIONS That the Health and Social Care Select Committee: 1. notes progress against the carers strategy delivery plan activity for 2023/24; 2. notes the carer support priorities for 2024/25 (Appendix 3); 3. comments, and question officers and partners, on any aspects of the report; and 4. identifies any comments it wishes to include in the annual delivery plan update report to Cabinet. SUPPORTING INFORMATION A. Strategic Context 11. Unpaid carers play an important role in our society. They provide vital care, and many carers derive satisfaction and pride from their roles. However, caring can come at a personal cost to carers in terms of their own health, financial situation, employment position and personal independence. In Hillingdon we want to enable our residents to recognise and identify their role as a carer, so they know where to access the right support to enable them to continue in their caring role for as long as they are willing and able to do so. 12. There are three main sources of information about the numbers of carers in Hillingdon and these are:  The 2021 census: This is the main source of data about carers in Hillingdon. It showed that there were 22,465 people who identified themselves as carers in March 2021 when the census took place. This was an unexpected drop from 25,905 identified from the 2011 census and reflects the national picture. The Office of National Statistics (ONS) has identified that the co-occurrence of coronavirus lock-down arrangements as well as changes to the questions asked may have influenced how people perceived and managed their provision of unpaid care, and therefore may have affected how people chose to respond. The tables below provide an age-breakdown and comparison with the 2011 census. Health and Social Care Select Committee – 24 July 2024 Classification: Public Age Breakdown of Carers in Hillingdon 2011 and 2021 Censuses Compared Age Breakdown of Carers in Hillingdon 2021 Census Young and Young Adult Age Breakdown Carer Age Group 2011 Census 2021 Census Carer Age Group Number 0 - 24 2,569 1,875 5 - 18 660 25 - 64 18,676 16,625 19 - 24 1,215 65 + 4,660 3,965 25 - 64 16,625 TOTAL 25,905 22,465 65 + 3,965 TOTAL 22,465  The Carer Register: The Carer Register was established by Carers’ Trust Hillingdon and is maintained by them. Registration by carers is entirely voluntary but is a key route by which information can be targeted by Carers’ Trust. There were 1,453 young carers and 5,193 adult carers registered on 31st March 2024, which compares with 1,187 young carers and 4,790 adult carers registered on 31st March 2023. This is positive in that it both enables relevant information to be targeted to carers but also enables partners to obtain a greater understanding about the needs of carers in the borough.  Short and long-term (SALT) return: This is the annual return that the Council is required by law to provide to NHS Digital about people supported (including carers) under its Care Act responsibilities. The return for 2023/24 showed that 590 carers received support from the Council during that year. The main need being supported by this group of carers is learning disability (41%) followed by personal care need related to physical disability (33%).  Carers Allowance recipients: This benefit is available to people providing 35 hours of unpaid care a week or more to a severely disabled person. People providing this level of care are most vulnerable to experiencing a deterioration in their own health and wellbeing without support. Data published by the Department for Work and Pensions showed that in November 2023 (the most recent period for which data is available) there were 4,125 people entitled to receive Carers Allowance (CA) and 4,125 in payment, which represented an increase of 23.5% since 2018. However, the value of CA as an indicator of the number of carers is limited as the 2021 census identified 9,105 carers delivering 35 hours of care or more a week, which suggests that there are a significant number of carers who do not qualify for this additional benefit. 13. Data from the National Carers’ Survey commissioned jointly by the Department of Health and Social Care (DHSC) and Care Quality Commission (CQC) undertaken in November 2023 provides some qualitative information about adult carers already known to the Council who completed the survey. This survey was commissioned by the Department of Health and Social Care (DHSC) and the Care Quality Commission (CQC) and the data sample, which is carers who received a carer’s assessment in the previous twelve month period, and collection methodology are determined nationally. 14. 563 of Hillingdon’s adult carers were sent a survey questionnaire and 30% (170) were returned, which was considered to be statistically valid by DHSC and CQC. The survey return rate was lower than in 2021/22 (4.4%) and also lower than the mean for other English local authorities with Adult Social Services responsibilities (32.2%). The Committee may wish to note that the survey identified that the percentage of carers able to take a break away from caring for Health and Social Care Select Committee – 24 July 2024 Classification: Public more than 24 hours (34%) was higher than in 2021/22 (20.6%) and also higher than the mean for England of 16.7%, which indicates that Hillingdon’s carers are better supported. London and North West London comparisons will not be available until October 2024. The survey is scheduled to be repeated in November 2025. 15. The main actions identified from the survey results are unchanged from the 2021/22 survey and include:  To explore expansion of Personal Budgets for carers, including as Direct Payments.  To work with care home providers to develop flexible short-break options for carers.  To continue to develop the range of social opportunities for carers, including peer support groups. Carer Support Offer Summarised 16. The Committee is reminded that the main offer of support to young and adult carers in the borough comes through the Carer Support Service contract between the Council and Carers Trust Hillingdon and Ealing (CTHE), which is the lead organisation for the Hillingdon Carers’ Partnership. The latter is a consortium of local third sector organisations that has been created to support carers in the borough. In addition to Carers’ Trust, the consortium includes the Alzheimer’s Society, Harlington Hospice (including their homecare arm called Harlington Care) and Hillingdon Mind. The funding for this service, i.e., £670k, is included in the Better Care Fund (BCF). Carers Strategy Group 17. The multi-agency Carers’ Strategy Group (CSG), which is chaired by the Council, has responsibility for overseeing the development and delivery of the Joint Carers Strategy. This includes as members carer representatives in their capacity as experts by experience. B. 2023-24 Delivery Plan Update Highlights 2023/24 Challenges 18. The challenges for carers previously reported to the Committee have not significantly changed and include:  The increase in the number of carers experiencing mental health issues seen during the pandemic continued during 2023/24 and can be seen by the number of carers accessing Hillingdon’s Mind Family Support Service, which increased from 83 in 2022/23 to 207 in 2023/24.  Financial implications of being a carer, e.g., loss of employment income, being exacerbated by the cost of living crisis.  Impact on physical health of carers not taking a break (or not being able to take a break) from their caring responsibilities during the pandemic. This may be a contributing factor to an increase in the number of permanent admissions to care homes seen in 2023/24.  Convergence of pressures on mental health of carers from caring role, anxiety about financial concerns and impact on physical health. 2023/24 Delivery Plan Updates 19. This section includes delivery plan updates additional to what was reported to the Committee in November 2023. Actions are aligned to the outcomes in the draft Joint Carers Strategy. Health and Social Care Select Committee – 24 July 2024 Classification: Public Outcome 1: Carers are identified, recognised and able to make a positive contribution. 20. Re-establish carer leads in six GP Primary Care Networks (PCNs). Completed (Green). The report considered by the Committee in November reported that the number of practices with GP leads had reduced to 33. Since that report all 41 practices that are members of The Confederation have identified leads. Carer Leads in GP Surgeries: The Role Explained Key tasks include: ● Proactively identifying and supporting carers, many of whom do not see themselves as carers. ● Ensuring that a surgery Carer Register is maintained and updated regularly. ● Ensuring the practice provides active signposting to the Hillingdon Carers Partnership. ● Ensuring that standardised packs of information for carers are available within the waiting room. ● Feeding into The Confederation and its partners, e.g., Hillingdon Carers Partnership and the ICB, any gaps in provision or requirements to help practices to support carers further. ● Working with colleagues in the practice to provide enhanced access and flexibility of appointments for carers. ● Considering how else the practice might facilitate improved carer-health, e.g., carer health checks.  Attending any training/information sessions that relate to the support of carers within General Practice. 21. Hillingdon Hospital: Ensure that the Cerner electronic patient record (EPR) system is developed so that asking if a patient has a carer or is a carer is a mandatory aspect of assessment and triggers appropriate care planning (if possible and where appropriate). Slippage (Amber): This is part of a large digital technology project and full implementation is expected to be completed by the end of 2024/25. Outcome 2: Carers have access to quality information and advice at any point in their caring journey and know where to find this. 22. Hillingdon Hospitals: Ensure that the Patient Advisory and Liaison Service (PALS) has the necessary information and resources to signpost carers and patients with carers to access support. Completed (Green): A mechanism has now been put in place to ensure that stocks of the Are you a carer? booklet are maintained. Achievements 23. Partner achievements during the review period that are in addition to the specific actions within the 2023/24 delivery plan are highlighted below for the Committee’s consideration. Council Achievements 24. Carers Assessments (Adults): There were 875 carers’ assessments undertaken in 2023/24, which includes 244 assessments completed by Carers’ Trust. This compares to 851 assessments in 2022/23 and 286 assessments undertaken by Carers’ Trust. Triage assessments are much shorter than the full assessment and are used by Carers’ Trust to help a carer identify whether they are likely to receive support from the Council, which would only be Health and Social Care Select Committee – 24 July 2024 Classification: Public obtainable following a full assessment. In 2023/24 Carers’ Trust referred 35 carers to the Council for a full assessment. 25. Nearly 84% of carers assessments for adult carers were declined in 2023/24, which reflects the pattern of previous years. At the November 2023 meeting the Committee requested that officers look into this in more detail and the intention is to review Hillingdon’s experience from a broader NWL perspective. The Committee is reminded that reasons given previously for declining an assessment include people who consider that the assessed care package for the person they are caring for sufficiently addresses their needs; people not wanting to identify themselves as carers, and those who feel that the services available through the Hillingdon Carers Partnership meets their needs. 26. Options for making the assessment form more accessible for carers are being explored; however, it should be noted that the key purpose of the form is to identify whether a person meets the national eligibility criteria for carers, which therefore impacts on the extent to which it can be simplified. Carers who do not wish to go through the carer assessment process may still access the universal services provided under the Carer Support Service contract previously mentioned. This is also the case with carers assessed as not meeting the national eligibility criteria for carers. 27. Respite and other carer-related service provision: During 2023/24 4,789 carers were provided with respite or another carer service at a cost of £2,442k. This compares to 3,970 Carers being supported at a cost of £2,004k during 2022/23. This includes bed-based respite and home-based replacement care funded arranged via the Council as well as supported provided through the Carer Support Service contract and other voluntary sector provided services. It also includes directly purchased services via Direct Payments. 28. The Committee may also wish to note that 2023/24 saw an increase in the number of carers receiving Direct Payments in their own right to address all or part of their assessed needs from 170 in 2022/23 to 204. More About Direct Payments With Direct Payments the Council’s financial contribution to meeting assessed social care needs is paid directly to the eligible person either in the form of a pre-paid card or directly into a bank account. This gives the eligible person more flexibility and control to directly employ their own care workers or a personal assistant who will, for example:  Be the same person and be available when required.  Speak the same language.  Understand cultural and/or religious needs. Hillingdon Carers’ Partnership Achievements 29. The section of the report summarises some of the achievements of the Hillingdon Carers Partnership in 2023/24. It is important to note that these achievements relate to activity and targets funded through the Carer Support Service contract. 30. New carers registered: 910 new adult carers joined the carers register during 2023/24 against a target of 750 and 438 left. 321 new young and young adult carers joined the register in 2023/24 against a target of 50 and 55 left. 31. Additional income for carers raised: £1,590,549 carer-related benefits were secured against a target of £500k, which benefitted 233 Hillingdon families. This is the largest amount Health and Social Care Select Committee – 24 July 2024 Classification: Public secured in a single year since the start of the Carer Support Service contract in 2016. 32. Replacement care: 106 adult carers were supported with 8,440 hours of replacement care received by adult carers against a target of 7,000 hours to 120 carers. 33. Short breaks (adult carers): 2,596 breaks from caring against a target of 1,000 were provided through carer cafés, trips (e.g., visits to arts, crafts, and cultural activities), social groups, and workshops. 34. Short breaks (young and young adult carers): In 2023/24 there were 2,596 individual breaks from caring including:  4 residential weekends away for 56 young people.  29 different activity sessions as part of CTH school holiday programme.  104 Young Carer and Young Adult Carer Club sessions.  4 whole family trips attended by 144 family members. 35. Psychotherapeutic and family support: Via Hillingdon Mind, 91 carers in 2023/24 received psychological crisis counselling support and 207 carers received family support. 36. Outreach events: 43 outreach events were held in 2023/24. At its meeting in November 2023 the Committee expressed an interest in receiving more information about the outreach work undertaken by the Hillingdon Carers Partnership. HCP partners will be present at the July meeting and will be able to address any queries that the Committee may have. 37. External funding attracted to support carers: In 2023/24 £827k additional funding was secured from external funders, i.e., not local statutory organisations, against an annual target of £100k, and this included £530k from the Big Lottery for adult carers and £189k to support young carers from the Henry Smith Charity, which is an independent charity founded in 1628 to combat disadvantage and poverty. CNWL Community Adult Mental Health Service Achievements 38. Triangle of Care roll out across community mental health teams: £40k was provided by CNWL to fund a post with Hillingdon Mind to support the roll out of the Triangle of Care model (see below) and facilitate CNWL accreditation by Carers Trust UK. The new Carers Engagement Lead started in January 2024 and in the period to 30th June 2024 63 carers of people with mental health needs were referred. Triangle of Care Expanded There are six standards to the Triangle of Care, and these are: 1. Carers and the essential role they play are identified at first contact or as soon as possible thereafter. 2. Staff are ‘carer aware’ and trained in carer engagement strategies. 3. Policy and practice protocols re: confidentiality and sharing information, are in place. 4. Defined post(s) responsible for carers are in place, e.g., Carers’ leads or champions. 5. A carer introduction to the service and staff is available, with a relevant range of information across the care pathway, e.g., an introductory letter from the team or ward explaining the nature of the service provided and who to contact. 6. A range of carer support services is available. 39. Mental health carer welcome pack: CNWL and Hillingdon Mind coproduced a new information pack with mental health carers, i.e., carers supporting people living with serious Health and Social Care Select Committee – 24 July 2024 Classification: Public mental illness. The purpose of the pack is provide mental health carers with the information they need to navigate statutory services as well as making them aware of the support available from third sector organisations. C. 2024/25 Carer Support Priorities 40. Key influences for actions within the strategy delivery plan and supporting 2024/25 priorities are summarised in Appendix 2. Consultation on the draft strategy will have concluded by the time of the July meeting and it will be possible for officers to update the Committee on feedback received. 41. Priorities for 2024/25 that extend beyond business as usual can be found in Appendix 3. PERFORMANCE DATA Current Performance Information 42. The Committee is reminded that there are no comparative metrics in respect of young carers. There are two key sources of comparative data in respect of adult carers. One of these is the carer quality of life measures within the Adult Social Care Outcomes Framework (ASCOF), which is tested via the National Carer Survey referred to earlier in this report. The second source is the national short and long-term (SALT) services return that all local authorities with adult social services responsibilities are required to complete annually. There is always a long time lag between submission of data and the publication of national reports to allow for benchmarking. 43. Consequently, the most recent comparative data is for 2022/23. Chart 1 shows Hillingdon’s position in comparison with other NWL boroughs. This shows a higher rate of carers supported in Kensington & Chelsea, Westminster, Hounslow, and Hammersmith & Fulham than Hillingdon. With the exception of Hounslow and as shown in chart 2 below, these boroughs have much higher actual numbers of carers having their assessed support needs met wholly or partly by Direct Payments. The Committee is asked to note that the data in chart 1 is based on SALT definitions and does not, for example, reflect the carers supported by the Hillingdon Carers Partnership under the Carer Support Service contract. It also does not take into consideration carers who benefit from an adult social care service provided to the cared for person. There is, however, a piece of work to be undertaken to identify if all NWL boroughs are counting carers supported in the same way and also whether there is learning from neighbouring borough practice that could be adopted locally. The Committee can see in Appendix 3 that increasing the numbers of carers receiving their support via a DP is one of Hillingdon’s priorities for 2024/25 and Members may wish to note that numbers increased from 170 in 2022/23 to 198 in 2023/24. 44. The higher numbers of carers supported by the local authorities referred to in paragraph 43 means that by implication they have higher numbers of carers assessments being completed. There are currently no national measures in respect of carers assessments and officers will be discussing with other NWL boroughs scope for agreeing a measure based on the rate of assessments per 1,000 adult carers. Carers assessment practice in other boroughs will also be investigated to see if there is any learning that could be applied in Hillingdon. Health and Social Care Select Committee – 24 July 2024 Classification: Public Source: NHS Digital (09/07/24) Source: NHS Digital (09/07/24) RESIDENT BENEFIT 45. The report identifies how carers have been supported by the Council and partners in 2023/24 and identified priorities for 2024/25. FINANCIAL IMPLICATIONS 46. There are no direct financial implications arising from this report. LEGAL IMPLICATIONS 47. There are no direct legal implications arising from this report. BACKGROUND PAPERS 2022 – 2025 Joint Health and Wellbeing Strategy 2024 – 2029 Draft Joint Carers Strategy 26 16 55 16 22 61 101 75 0 20 40 60 80 100 120 Chart 1: Carers Supported per 1,000 18 + Carers 14 7 53 8 8 8 93 67 0 20 40 60 80 100 Chart 2: Carers Needs Met Fully/Partly by Direct Payments Rate per 1,000 18 + Carers Health and Social Care Select Committee – 24 July 2024 Classification: Public Appendix 1 – Case Studies A is 10 and cares for his mother (Ms A) who is a single parent and has physical disabilities and mental health issues. A has a club foot and has undergone a number of operations to improve his mobility. The family were referred to Carers Trust by A’s school due to his poor attendance. When Carers Trust first began supporting the family, they were sleeping on the floor in A's grandmother's flat, having been evicted from temporary housing in another London borough. Ms A was struggling to cope with day-to-day life, was facing a potential custodial sentence due to not attending community service and A’s school attendance was 25%. The family had a social worker but Ms A was very mistrusting of professionals and was reluctant to work both with Carers Trust and Social Services. Ms A experienced frequent periods of depression leading to A having to provide support to ‘calm mum down and help her to stop crying’. When Ms A was unable to function, A would make simple meals for them both, which is something that he had done since a very young age. As Ms A has a bad back, A has had to do all the carrying and lifting for her. Actions:  Carers Trust undertook a home visit and gradually built a relationship with Ms A and A.  A legal aid solicitor was sourced to work with Ms A to resolve their long-standing housing issue, which ultimately resulted in the Council agreeing to accept responsibility to house the family.  Ms A was supported to view potential properties and helped to furnish the accommodation with the provision of hardship grants.  Carers Trust also liaised with the Community Service Team to arrange for Ms A to complete her community service hours during school hours so that she was still available for A when needed.  A has recently undergone another foot surgery which further affected his attendance and Ms A's ability to safely get him to and from school. Carers Trust worked with the school to ensure he had work sent home weekly and also to ensure that there was regular communication between school and Ms A.  Carers Trust organised a wheelchair so that A could return to school as soon as possible. His school was 20 minutes walk away and not accessible by public transport. A relative took him to school whilst he was in plaster and non-weight bearing but the wheelchair supported him after this period. Outcomes:  Ms A has been offered a voluntary role with the possibility of progression to a paid permanent position, and she is absolutely delighted as she has been out of work since A was born.  A's school attendance is now 70% and Carers Trust continue to work with the family to improve this further.  Both A and his mum have their own space at home and feedback is that they feel positive about the future. B is 16 and is a dual carer for both her mother (Mrs B) who has physical disabilities and mental health needs, and her 2 younger siblings who have Special Educational Needs and Disabilities Case Study A: Young carer for mother with disabilities Case Study B: Young adult carer with dual caring responsibilities Health and Social Care Select Committee – 24 July 2024 Classification: Public (SEND). As a result of her needs Mrs B has frequent periods where she is unable to keep up with household chores, provide meals and wash clothes for the family and B undertakes these tasks. Mrs B, who is divorced from B’s father, is also frequently unable to take her younger children to school, which B does on her behalf and with the result that she is then late for school. Being very busy at home B was unable to find time for herself and this has impacted on her mental and physical health. This has shown in her over eating and gaining excess weight, which has also contributed to her depression. Difficulties with sleeping also means that she constantly felt tired. B came to Carers Trust its School Outreach Project. Actions:  During their school support sessions Carers Trust focused on B making time for herself and managing her own wellbeing and studies. As a result, she decided to use her passion for baking and cooking to try to make healthier meals.  Carers Trust worked with B to agree achievable goals for her including participation in exercise to aid her physical and mental health.  Through partnership working with the School Outreach Project, intensive family support and pastoral staff, Carers Trust were able to provide on-going support and praise to B. Outcomes:  B has made significant efforts and is now feeling the benefits - she has lost weight, feels fitter and her sleep has improved.  B particularly responds to regular catch ups at school which provides a space for her to be herself, to talk about herself, discuss her feelings, and stay on top of her goals. Mr C self-referred to the Alzheimer’s Society, one of the organisations within the Hillingdon Carers Partnership. Mr C is 35 years old and cares for his mother who has been diagnosed with dementia and with whom he lives. He works full-time from home but was finding it difficult to juggle both work and caring for his mother who needed constant supervision. Mr C contacted Alzheimer’s Society because he was struggling in his work and wanted help for his mother to enable him to keep his job. He felt without support he would have to stop working. Mr C’s mother needs help with personal care and all other day-to-day tasks. She was unable to tell whether something was hot or cold and was therefore at risk of harm. She was also prone to Case Study C: Adult carer of person living with dementia About the School Outreach Project This project offers:  School staff training.  A comprehensive information pack including materials for School notice boards.  1:1 sessions with young carer pupils.  Small group work with wellbeing and personal development sessions.  Support for Schools to achieve national accreditation through the Young Carers in School Programme (YCiS).  A mentoring programme for young carer pupils including 1:1 tutoring sessions.  Referral to our range of carers services including whole family support.  Home-School liaison. Health and Social Care Select Committee – 24 July 2024 Classification: Public wandering. Mr C explained that both he and his mother were becoming isolated and they were only seeing family members when they visited. He was reluctant to ask family members for help as he felt it was his responsibility to look after his mother but due to the difficulties of living with and supporting his mother Mr C felt overwhelmed in his caring role. Social isolation was a major part of this as he was not going out with his friends as before. Actions:  The Alzheimer’s Society visited Mr C and his mother at home and undertook a full assessment. Mr C was advised of his options, including support available through Social Services.  The possibility of other family members providing support for him was explored with him.  He was also advised of the benefits that he could access such as Attendance Allowance and Council Tax discount but felt able to complete the applications himself without assistance.  Mr C was given details of local services such as the Dementia Café and Friends Coffee Group. Outcomes:  Mr C was able to arrange a package of care for his mother and is now able to focus on his work without feeling overwhelmed or worried about giving it up.  Mr C’s mother now attends social activities, with the help of a paid carer, which also enables him to have a break.  Mr C’s family agreed to support him to allow him to go out socially when he wants to.  Both the Attendance Allowance and Council Tax discount are now in place. Ms D is the carer for her adult daughter who has mental health needs. Ms D is living with depression and was referred to Hillingdon Mind. Ms D also has her adult son living with her. She is not working at the moment as she is concentrating on caring responsibilities. During the initial assessment Ms D identified that there was a lack of understanding around her daughter’s mental health condition and the impact of this on day-to-day functioning. One of her goals was to understand more about her daughter’s mental health need and how best to communicate and support her during psychotic episodes. Ms D felt that there were issues related to the standard of care received by her daughter and wanted advice on relevant advocacy support. Her daughter felt unsupported in the community and Ms D wanted to understand what support was available and how to access it. Ms D identified that she had her own care needs and felt that she was neglecting her own self- care – she wanted to access activities to help her wellbeing. Actions:  To learn more about her daughter’s mental health issue and how to support her in a crisis, Ms D was supported by Mind’s Family Support Service to attend the peer support group, i.e., the ‘Check-in and Chat Group’, to meet other carers sharing similar experiences. Outcomes:  Ms D has reported that she feels more confident when supporting her daughter during a recent psychotic episode. She drew on her learning from the workshop and the psycho- educational resources provided by Mind and, as a consequence, reported that she was able to manage the situation better than before the intervention of the Family Support Case Study D: Adult carer of person with mental health needs Health and Social Care Select Committee – 24 July 2024 Classification: Public Service.  Ms D also stated that she was more aware of the support available in the community and contacted the Crisis Café for help ensuring timely support for her and her daughter.  Through accessing support from peers at the weekly “Check in and Chat” group, Ms D reported that she felt “less alone” coping with her caring role. She continues to attend the peer support group and is now supporting others caring for someone in a similar situation.  Ms D shared information about support available in the community with her daughter. As a result, the daughter self-referred to an employment support service and is now receiving support to volunteer and engage in meaningful activities as part of her recovery. Mrs E is a carer to her adult daughter, Ms E, who has a learning disability. Recently there have been safeguarding concerns about a relationship Ms E has with her partner. There is strong evidence that this maybe a domestically abusive relationship. After raising this with the Adult Learning Disability & Autism Service, a series of safeguarding home visits took place in order to meet with both Mrs E and Ms E and to build a relationship of trust with them. Both of their views were taken jointly and separately. It was identified by the social worker that while the relationship concerns are being addressed with Ms E, Mrs E would benefit from a carer’s assessment. This carer’s assessment took place with an interpreter, as Mrs E’s first language is not English. Mrs E greatly appreciated having this assessment directly with a social worker who knew her situation in her own home, rather than needing to tell her story once again to Carer’s Trust Hillingdon, to whom carers are usually signposted. In the assessment Mrs E was able to tell her story candidly, outside of the earshot of her daughter and she found the opportunity to speak at length and talk about the impact of her caring role on her life to be therapeutic. She was given information on the services offered by the Carer’s Trust but also the Disablement Association Hillingdon (DASH), our local disability charity who can provide benefits assistance and advocacy. Outcome:  Mrs E was provided with a Direct Payment that has enabled her to take a break from her caring role.  The referral to Carers Trust has enabled Mrs E to also access a peer support group.  This intervention has provided some support to Mrs E, while Ms E’s needs and mental capacity is assessed and appropriate interventions can be considered and made. Mrs F is the main carer for her 19 year son who has learning difficulties and autism. He is physically very strong and has the energy expected of a person of his age but no sense of risk or danger. He seeks to build relationships and closeness with others, including on social media and in person, and this has led to abuse and exploitation by his peer group that has resulted in Police involvement. His high risk taking profile means that he cannot be left alone and needs a lot of help to plan his daily living activities. He has an active Education Health and Care Plan (EHCP) in place, which reflects that he needs a lot of help to explain how he can do things that he wishes to do as safely as possible. As well as looking after her son, Mrs F is also coming to terms with a diagnosis of Multiple Case Study E: Adult carer of person with a learning disability. Case Study F: Parent carer of person with learning difficulties and autism Health and Social Care Select Committee – 24 July 2024 Classification: Public Sclerosis (MS) that she received in 2023 and the related treatment to manage some of the symptoms. Mrs F informed the Council’s Preparing for Adulthood Team that managing her own health needs contributed to her feeling increasingly overwhelmed and depressed. Mrs F’s husband does share some of the caring responsibility for their son when he can but he works full-time and the scope for him to do so is limited. Actions:  Mr F junior was reassessed and a direct payment offered to include home based respite. The reassessment included an assessment of Mr and Mrs F’s needs and a separate carer’s direct payment was offered to enable Mrs F to take a break away from the home.  Mrs F was referred to Carers Trust Hillingdon to explore other support options.  Although Mr and Mrs F are prepared to support their son until he is ready to progress the planning process has started for him to move into supported living with people closer to his own age. Mr F junior is involved in this planning process. Outcomes:  Feedback from Mrs F is that she feels less overwhelmed as she is now able to get breaks from caring.  Mrs F has also reported that her GP has been very supportive following her MS diagnosis.  The referral to Carers Trust has enabled Mrs D to access a peer support group and she finds being able to talk to other people in similar circumstances therapeutic.  Mr D junior is also receiving support with accessing educational activities that assist with independent living skills as part of a progress plan to supported living. Health and Social Care Select Committee – 24 July 2024 Classification: Public Appendix 2 - Carers Strategy Delivery Actions Influences Health and Social Care Select Committee – 24 July 2024 Classification: Public Appendix 3 - Joint Carers Strategy 2024/25 Delivery Plan Key CTH Carers Trust Hillingdon HCP Hillingdon Carers Partnership LBH London Borough of Hillingdon THH The Hillingdon Hospitals Trust Outcome 1: Carers are identified, recognised and able to make a positive contribution. Activity Lead Organisation 1.1 Implement the Carers Card Plus + project funded through the Accelerating Reform Fund for Adult Social Care LBH/CTH 1.2 Expand the number of GP practice members of The [GP] Confederation with identified carer leads. The [GP] Confederation 1.3 In consultation with adult carers and parent carers, review needs assessment process to simplify it as much as possible. LBH 1.4 Make changes to the new electronic patient record system at Hillingdon Hospitals to support identification of carers. THH 1.5 Continue the roll out of ‘open visiting’* across wards at Hillingdon Hospitals. THH *Open visiting refers to the principle of unrestricted visiting hours in a hospital setting to enable carers, relatives, and friends to visit at any time. Outcome 2: Carers have access to quality information and advice at any point in their caring journey and know where to find this. Activity Lead Organisation 2.1 Include information about support for carers on web pages of 100% GP practice. The Confederation More About the Accelerated Reform Fund This is non-recurrent government funding to support innovation projects developed collaboratively with others such as the NHS, care providers, voluntary and community sector groups to support priority groups such as unpaid carers. Health and Social Care Select Committee – 24 July 2024 Classification: Public 2.2 Develop a programme to ensure that information and advice is accessible to Hillingdon’s diverse communities. CTH Outcome 3: The physical and mental health and wellbeing of carers is supported and have a life alongside caring. Activity Lead Organisation 3.1 Retender the Carer Support Service contract to comply with procurement regulations and secure service stability for up to eight years. LBH 3.2 Explore options for increasing the percentage of adult carers supported by the Council having needs met via Direct Payments. LBH Outcome 6: Young carers are supported from inappropriate caring and provided with the support they need to learn, develop, and thrive and enjoy being a young person. Activity Lead Organisation 6.1 Working with young carers, review the young carer assessment process to ensure that it is fit for purpose. LBH 6.2 Increase the number of schools participating in a young carer recognition programme. CTH 6.3 Support schools to develop their own support provision for young carers. CTH 6.4 Develop and deliver support sessions in school for the most disadvantaged young carers, e.g., those caring for a parent with mental ill health and/or substance misuse. CTH

NHS England Health and Social Care Select Committee – 24 July 2024 Classification: Public MOUNT VERNON CANCER CENTRE STRATEGIC REVIEW Committee name Hillingdon Health and Social Care Select Committee Officer reporting Jessamy Kinghorn, Head of Partnerships and Engagement, NHS England Papers with report Appendix A – Work Programme Ward All HEADLINES To remind and update Committee Members on proposals for changes to Mount Vernon Cancer Centre services, and what this might mean for Hillingdon patients. To update the Committee with proposals to proceed to public consultation on plans for the future of Mount Vernon Cancer Centre (MVCC) services. This follows a number of previous papers to this Committee (and its predecessor) that have provided early briefings on the case for change, the development of proposals and the involvement of patients and the public. RECOMMENDATIONS That the Health and Social Care Select Committee: 1. notes the progress of the Mount Vernon Cancer Centre review and the plans to move forward to consultation; 2. considers how it wishes to be involved in this process and confirm it wishes to participate in a Joint Health Overview and Scrutiny Committee (JHOSC) later this year; and 3. considers the role of vice chair on the JHOSC. SUPPORTING INFORMATION 1. Background NHS England has been working jointly with the NHS and other partners in Hertfordshire, North West London, Bedfordshire, Buckinghamshire, East Berkshire and North Central London, to lead a review of Mount Vernon Cancer Centre services. This followed the report of a 2019 Independent Clinical Advisory Group which stated: “There is increasing concern as to whether high quality, safe and sustainable oncology services can continue to be delivered within the existing organisational framework and there is an urgent need to address this concern.” They made several findings, including:  Maintaining safety of patients cannot be guaranteed in the near future – status quo is not an option – there is a need for urgent action. NHS England Health and Social Care Select Committee – 24 July 2024 Classification: Public  To provide modern oncology care, comprehensive medical and surgical support services including ITU are needed – this is not now available at MVCC.  Deskilling of existing inpatient nursing staff as acutely unwell patients transferred out. Loss of ability to undertake practical interventions on site, e.g., draining ascites.  Need for an inpatient integrated service in order to manage acutely unwell patients (due to unpredictable toxicities of immunotherapies, intensive chemotherapy / radiotherapy regimens and comorbidities). Concern about the quality of integrated care for patients currently transferred out to non-specialist district general hospitals (DGHs) impacting upon patient management  Dividing up the existing catchment to surrounding providers would be unacceptable due to disrupted patient flows, insufficient capacity and access concerns, loss of workforce cohesion and commitment. 2. Response to the independent clinical review The response to the report culminated in the development of a proposed solution to relocate the Mount Vernon Cancer Centre to an acute hospital site, with Watford being identified as the preferred solution. This followed a significant amount of patient and public involvement and has been presented to this committee previously. However, at that time no source of capital had been identified and there was no agreement to move towards public consultation. The independent panel also recommended the cancer centre should be run by a specialist cancer provider and not a DGH as at present. Following a process, UCLH was identified as the preferred future provider to manage the service once capital had been identified to proceed with the relocation. UCLH is working with commissioners and East and North Hertfordshire NHS Trust (the current provider) to develop proposals for the future. 3. Clinical Senate The East of England Clinical Senate reviewed the proposals in 2021. Their subsequent report supported the recommendation for a new, single-site specialist cancer centre on the Watford Hospital site, as well as improved local access to services such as chemotherapy and radiotherapy at linked sites. The Clinical Senate made recommendations around IT, access to services and transport, and the addressing of social and health inequalities which have been taken forward by the programme team. This has included:  An IT workstream looking at the digital infrastructure;  The launch of a chemotherapy at home service to improve access;  A transport pilot in Luton; and  Extensive work to understand and identify and response to health inequalities, such as the inclusion of a heavily weighted criteria to reduce health inequalities as part of the decision making process on networked radiotherapy. 4. Capital Funding During the summer of 2021, the Department of Health and Social Care announced that all new hospital capital requests were to be made through the New Hospital Programme and invited Expressions of Interest from schemes. In September 2021, UCLH submitted an expression of NHS England Health and Social Care Select Committee – 24 July 2024 Classification: Public interest which, after 18 months of consideration, was unsuccessful when the additional schemes were announced in May 2023. Discussions have continued with national colleagues. These have included a thorough assessment of potential alternatives and of the implications of not proceeding. The capital costs associated with the relocation, including networked radiotherapy, are in the region of £400m at 2024 prices. Assessment of the costs of dispersing the service to cancer centres in Cambridge, Oxford and London showed a similarly high level of capital would be required as the capacity is not currently available elsewhere. Capital funding routes for the preferred option continue to be explored and a national planning committee has now agreed that this is a priority and that the proposals should be consulted on in public so that detailed planning can take place on urgent short-term and long-term changes to the services whilst the capital issue is resolved. 5. About the Cancer Centre The Mount Vernon Cancer Centre in Northwood, Middlesex provides non-surgical specialist cancer care for patients across Hertfordshire, North London, Bedfordshire and parts of Buckinghamshire and East Berkshire. The main services it provides are radiotherapy, including brachytherapy and Systemic Anti-Cancer Therapies (SACT), which is mainly chemotherapy and immunotherapy. The services are run by East and North Hertfordshire NHS Trust, which is a district general hospital trust within the Mount Vernon catchment area. They cover a population of more than two million people with approximately 13,000 patients attending the centre each year. 6. Impact on Hillingdon The North West London Integrated Care Board (NWL ICB) is a significant partner in the development of the proposals, with around 32% of the total MVCC patient population (4,147 NWL patients in 2023/24). The majority of these patients received chemotherapy (849 patients), radiotherapy (1,359 patients) or outpatient appointments (4,028 patients). Service NWL number of patients NWL activity MVCC total patients MVCC total activity Chemotherapy 849 5,583 2,706 17,940 Radiotherapy 1,359 18,634 4,623 58,825 Outpatient - attendance 2,635 9,115 8,224 25,918 Outpatient – telephone appointment 3,428 14,011 10,519 44,093 Outpatient – procedure 399 2,119 1,053 5,277 Total 4,147 63,290 12,958 178,022 The majority of these patients are from the former Hillingdon and Harrow CCG areas, with 1,866 Hillingdon patients and 1,089 Harrow patients attending MVCC. In 2023/24, the 1,866 Hillingdon patients, had 29,084 interactions with MVCC between them. NHS England Health and Social Care Select Committee – 24 July 2024 Classification: Public North West London has seen a notable increase (12%) in radiotherapy activity since 2019, against a marginal increase elsewhere in the catchment (with the exception of an increase of 19% in Buckinghamshire and decrease of 17% in Bedfordshire, Luton and Milton Keynes). The table below shows patient figures from all areas for the 2023/24 financial year. Region: Number of patients 2023/24 (former CCG footprints) Hertfordshire and West Essex ICB 5,549 West and South Hertfordshire 3,682 East and North Hertfordshire 1,862 Bedfordshire, Luton and Milton Keynes ICB 1,491 Bedfordshire 790 Luton 685 North West London ICB 4,147 Hillingdon 1,866 Harrow 1,089 Brent 648 Ealing 509 North Central London ICB 139 Barnet 106 Frimley Health ICB 397 East Berkshire 392 Buckinghamshire, Oxfordshire and Berkshire ICB 967 Buckinghamshire 930 All other areas 345 TOTAL 12,972 7. Care Closer to Home Watford General Hospital is the closest hospital site to the current Northwood site and the most central to the catchment overall. In evaluation it was the only site that met all of the criteria for clinical co-location and patient access. Travel mapping shows that Watford was the site with the fewest journey times over 45 minutes and that, on average, Hillingdon residents would have travel times of under 30 minutes, one of the shortest in the Mount Vernon Cancer Centre catchment. However, this is longer than the average journey time to the current site and so plans have been developed to increase options for care closer to home and reduce the need to visit the new site. For patients from Hillingdon, this includes:  A new chemotherapy at home service. This was launched for appropriate patients on one of four chemotherapy treatments in 2023 with the potential to roll out further.  A new chemotherapy unit at Hillingdon Hospital to enable Hillingdon residents to have non-complex chemotherapy and some immunotherapy treatments at Hillingdon Hospital instead of MVCC.  Additional radiotherapy at Hammersmith Hospital for patients in the South of Hillingdon who would find Hammersmith easier to access than Watford. NHS England Health and Social Care Select Committee – 24 July 2024 Classification: Public  Arrangements to ensure blood tests for MVCC patients can be carried out at Hillingdon Hospital to reduce the need for patients to travel long distances for minor tests and procedures. This will involve shared care arrangements between the two organisations and improvements to digital patient records. 8. Summary of Proposals The key proposals of the Mount Vernon Cancer Centre review are summarised below.  From 2024/25*: Increased chemotherapy facilities at Northwick Park so that more patients can have chemotherapy nearer to where they live;  From 2024/25*: Increased radiotherapy capacity at Hammersmith Hospital to extend choice of treatment provider to patients in Brent, Ealing and the South of Hillingdon;  From 2027/28*: An additional networked radiotherapy unit serving the north of the area – at either Luton or Stevenage, opening ahead of the new MVCC when the next Linear Accelerators are due to be replaced;  From 2030*: A new chemotherapy service at Hillingdon Hospital – upon opening of the new Hillingdon Hospital;  Proposal for the preferred option of relocation of the specialist cancer centre into a purpose-built facility on a main hospital site in Watford as soon as funding is made available; and  Bringing the haematology service for the population back into the area (to Watford from UCLH), once a new MVCC is constructed, and creating an acute haematology ward within MVCC for Watford General Hospital patients *Best current estimate. Dates are subject to range of external factors and the availability of capital. 9. Plans for Public Consultation An engagement and consultation planning group has been established with three regional sub- groups to plan public consultation. These include involvement from a broad range of partners. Throughout the consultation, a wide range of activities will take place across the Mount Vernon Cancer Centre catchment area. This will include:  Face to face and virtual public meetings  Consultation hearings where people can present evidence to the panel  Events and focus groups  Roadshows at the cancer centre  Consultation documents and surveys at public libraries, hospitals, etc.  Videos and other digital material to support information and decision making  Individual or organisational responses and submissions  MVCC review website A dedicated resource is to be sought to support the consultation, which will also be subject to a Quality Assurance process from the Consultation Institute. Some further pre-consultation engagement will take place following the general election and prior to the start of the public consultation which is anticipated to be November 2024. The pre-consultation engagement began with a meeting of the patient reference group on Monday 8 July 2024. Consultation documents and materials are currently being drafted. NHS England Health and Social Care Select Committee – 24 July 2024 Classification: Public 10. Health Scrutiny A Joint Health Scrutiny Committee is being established and councils in former CCG areas referring more than 100 patients to MVCC will be asked to consider how they would like to be consulted through the public consultation. There are 13 scrutiny committees that fit this criteria:  4 in the East of England  4 in the South East  5 in London This includes the London Borough of Hillingdon. An initial meeting with officers has been held, with 11 of 13 scrutiny committees represented, including Hillingdon Health and Social Care Select Committee. Hertfordshire County Council will chair the Joint HOSC as more than half the patients are from Hertfordshire. The local authority with the next largest number of patients is Hillingdon, who, subject to agreement of the Council, will take on the role of vice-chair. The Hertfordshire Head of Scrutiny has proposed an approach that would see the JHOSC meet to discuss different themes, with the possibility that some local authorities opting in to participate in individual themes that are of interest to them without having to attend every meeting. Such themes could include radiotherapy and transport and access. Smaller numbers of patients come from authorities across England and beyond (for example, Yorkshire and the Isle of Wight). There will be formal communication with these authorities although they will not be asked to participate in the JHOSC. 11. Patient and Public Engagement Various surveys and more than 100 focus groups have been held in the development of these proposals. This has been reported previously to this Committee. Further information can be found here: https://mvccreview.nhs.uk/6506/widgets/19100/documents/60532. There will be further opportunities for Hillingdon residents to get involved before, during and after the consultation. A patient reference group has been running for a number of years with regular attendance from Hillingdon representatives, and Healthwatch Hillingdon has been involved both on the Programme Board and the Engagement and Communications Group. Further information about the background to the review, why things need to change, what is happening, and how to get involved, can be found at www.mvccreview.nhs.uk. 12. Recommendations Hillingdon Health and Social Care Select Committee is asked to note the progress of the Mount Vernon Cancer Centre review and the plans to move forward to consultation. The Committee is also asked to consider how it wishes to be involved in this process and confirm it wishes to participate in a Joint Health Overview and Scrutiny Committee (JHOSC) later this year. The Committee is further asked to consider the role of Vice Chair on the JHOSC.

Health and Social Care Select Committee – 24 July 2024 Classification: Public ADULT SOCIAL CARE MARKET POSITION STATEMENT Committee name Health and Social Care Select Committee Officer reporting Jan Major – Adult Social Care and Health Gary Collier – Adult Social Care and Health Papers with report Appendix 1: Draft Adult Social Care Market Position Statement Ward All HEADLINES 1. The purpose of this report is to give the Committee the opportunity to consider and comment on Hillingdon’s draft Adult Social Care Market Position Statement (MPS). 2. Local authorities with adult social care responsibilities are encouraged under statutory guidance issued under the Care Act, 2014, to develop one or more MPSs to inform an ongoing dialogue with providers of care and support services1. This is intended to support local authorities in meeting their market shaping obligations under section 5 of the Care Act, the objective of which is to ensure a sufficient supply of quality services to meet the assessed adult social care needs of local residents. The draft Hillingdon document also reflects the Council’s commitment to support early intervention and promotion of self-help and independence for all residents. 3. An MPS is intended to:  Provide information about the current demand for care and support services and describe how this is being met.  Give projections of future demand; and  Consider opportunities for the to develop to provide the range and level of support that will be required. 4. Hillingdon’s draft Adult Social Care MPS is attached as Appendix 1 and its content reflects the Council’s current intentions for the period 2024 to 2027, which is based on the information currently available. It is intended to be a live document that will be updated in response to evolving circumstances, such as changes in legislation and national or local policies. It does not represent a commitment from the Council to take a particular course of action. 5. The MPS is intended to be read by:  Existing providers undertaking regulated activities under the Health and Social Care Act, 2008 (Regulated Activities) Regulations, 2014, of health and social care services in Hillingdon and the North West London sector.  Service providers and organisations not currently providing services to Hillingdon residents.  Voluntary and community organisations (also known as ‘third sector’).  People currently in receipt of adult social care services. 1 Para 52 Care and support statutory guidance - GOV.UK (www.gov.uk) Health and Social Care Select Committee – 24 July 2024 Classification: Public 6. Officers are currently consulting with stakeholders on the content of the draft MPS to gather feedback prior to publication. RECOMMENDATIONS That the Health and Social Care Select Committee notes the content of the report and questions officers on any aspect. SUPPORTING INFORMATION Strategic Context 7. The MPS must be seen within the context of the vision within the Council’s Adult Social Care and Health Plan, Independent and Fulfilled Lives, shown below. 8. During 2023/24 3,951 people were supported with long-term services and of these 1,492 were aged between 18 and 64 and 2,459 aged 65 +. The chart below shows the trend over the last five years in the number of people aged 18 + accessing long-term Adult Social Care services. 87% of the increase in numbers of people receiving long-term care services in 2023/24 compared to 2022/23 was attributed to people aged 65 and over with personal care needs attributed to physical disabilities. Adults of working age with physical disabilities and people with learning disabilities accounted for the remainder. 2020/21 and 2021/22 were the pandemic years, which influenced the willingness of families to accept the support offer from the Council, e.g., staff from homecare agencies coming into their homes. Source: Short and Long-term Service (SaLT) (LBH Digital & Intelligence 10.07.24) 9. The Committee is reminded that access to support from the Council in meeting assessed care and support needs is subject to a person meeting the requirements of the National Eligibility Criteria for Adult Social Care and on the outcome of a financial assessment, i.e., 3,772 3,733 3,715 3,786 3,951 3,550 3,600 3,650 3,700 3,750 3,800 3,850 3,900 3,950 4,000 People aged 18 + accessing long-term services during the year People Aged 18 + Accessing Long-term Services In-year 2019/20 - 2023/24 Compared 2019/20 2020/21 2021/22 2022/23 2023/24 Adult Social Care and Health Plan Vision Care and support will be personalised and will prevent, reduce, and delay needs. Residents will be enabled to live independent and fulfilled lives, supported within and by their local networks wherever possible. Health and Social Care Select Committee – 24 July 2024 Classification: Public people with income or capital valued at £223,250 or more must fund their own care support services. 10. As with most other local authorities in England with adult social care responsibilities, approximately 80% of the Council’s ASC spend is on services provided by the independent sector, i.e., ‘for profit’ and ‘not for profit’ organisations. This reflects a trend that started in the 1980s. Hillingdon’s People: Demand and Diversity 11. The chart below provides the Committee with information about the demographics of the borough that illustrates its diversity. Long-term projections are not due to be provided until 2025 but Hillingdon, as with many other local authorities, will be experiencing an expanding older people population. The percentage growth in the 65 + population referred to in the chart below was just over 7,200 people and the increase in the 55 to 59 age group nearly 5,000. Hillingdon’s Care and Support Market: Key Issues 12. Some of the key issues facing Hillingdon’s care and support market now and over the lifetime of the draft MPS include:  Changing demographics and impact on demand for services, e.g., ageing population that is increasingly diverse.  Cost pressures, e.g., wage inflation and increasing utility costs.  Care Quality Commission (CQC) regulatory change and resource implications, i.e., moving away from key lines of enquiry to quality statements linked to what matters most to people who use health and care services.  Workforce, i.e., recruitment and retention in a high employment area.  Public expectations and tensions between personalisation, critical mass, and economies of scale.  Opportunities and challenges presented by new technologies. Health and Social Care Select Committee – 24 July 2024 Classification: Public Adult Social Care Markets 13. The social care markets considered by the MPS include:  Information, advice, and advocacy.  Supported housing.  Preventative and community services.  Care homes, i.e., residential care homes with and without nursing.  Homecare.  Carer support 14. Spend on care homes, supported accommodation and homecare accounted for 83% of Adult Social Care expenditure in 2024/25. Overarching Messages for Hillingdon’s Care and Support Market 15. The overarching messages to the market include:  Mixed market: There is currently a mixed provider market in Hillingdon that includes a combination of services that the Council delivers directly and those provided by independent sector companies comprising of both for profit and third sector, ‘not for profit’ organisations. It is proposed that this mix will continue.  Partnership-based relationship with providers: The Council is seeking relationships with providers based on mutual trust and risk sharing. This means changing assumptions about the willingness and/or ability of providers to deliver better services at reduced costs. It also means moving away from assumptions that costs can and will be borne by the Council.  Different approaches to ensure a diverse market of quality services: Our approach to securing services to ensure that residents have choice and control over how their needs are met and access to a range of support to address cultural diversity will be flexible. Where tendering is the most appropriate route to comply with the council’s legal obligations, this will be undertaken using the procurement portal. Different approaches also includes working with the West London Alliance (WLA) where this will provide cost effective solutions to addressing local need, e.g., by securing critical mass and economies of scale.  Smaller number of more strategic providers rather than large numbers of lower value contracts: This aids more effective contract management that reduces risk to residents and therefore safeguards their interests as well as giving the strategic providers some consistency, builds relationships and trust and allows for innovation development. It is the preferred approach.  Integrated commissioning: Over the period of the MPS providers can expect to see examples of integrated commissioning between the Council, other councils within the North West London (NWL) sub-region, and the NHS where this approach will lead to better outcomes for residents. For the Committee’s information, the other councils within the NWL sub-region include Brent, Ealing, Hammersmith & Fulham, Harrow, Hounslow, Kensington & Chelsea and Westminster.  Preference for long-term contracts: Long-term contracts, e.g. up to eight years, give providers financial stability and allow for longer-term planning, which in turn can help Health and Social Care Select Committee – 24 July 2024 Classification: Public secure better service quality for residents. This is the proposed approach that will be taken going forward unless there is a good reason not to. Commissioning Intentions 16. The Council's proposed Adult Social Care and Health commissioning intentions for the 2024 – 2027 period of the MPS are detailed in Appendix 1. This section of the report provides examples of the range of commissioning intentions in the MPS for the Committee’s consideration. The Committee is reminded that the intention is that new contracts offered to providers will be for a period of up to eight years, unless there is a good reason not to. 17. Information and advice single point of access tender: This is intended to combine a range of information and advice service contracts into a single service. 18. Personal assistant (PA) market: The Council will work with WLA partners to explore options for increasing the PA market to improve choice and control flexibilities for eligible people. 19. Carer Support Service tender: The model of provision for the single point of access for carers has been reviewed and will be tendered as required under procurement r2egulations. 20. Supported housing strategy: The Council will work with NHS partners and in liaison with users of services, their families, and service providers to develop a strategy that complies with requirements under the Supported Housing (Regulatory Oversight) Act, 2023. 21. Nursing home provision: The Council may explore options for directly managing a nursing care home. 22. Care homes for people with learning disabilities: The Council will develop two smaller care homes in compliance with updated CQC requirements to address limited local supply and provide in-borough solutions to addressing need. Market Sustainability 23. This section of the MPS states the Council’s commitment to the sustainability of the market through the introduction of rates identified through the Fair Cost of Care exercise undertaken in 2022/23. This links to the Council’s Market Sustainability Plan submitted in 2023, which can be found via the following link Market sustainability and fair cost of care - Hillingdon Council. The Committee may wish to note that the Council has allocated the £4,554k provided via the Government’s Market Sustainability and Improvement Fund (MSIF) to supporting fair rates for providers to maintain service supply and quality of provision. This is in accordance with grant conditions. 24. This part of the MPS also addresses the Council’s approach to managing our relationship with contracted providers, e.g. frequency of contact meetings, which is based on a combination of risk factors such as contract value and performance, including quality of provision. Health and Social Care Select Committee – 24 July 2024 Classification: Public PERFORMANCE DATA Current Performance Information 25. Tables 1 and 2 below provide comparative current CQC ratings for care home and domiciliary care providers across NWL and enables the Committee to see Hillingdon’s position in the context of other boroughs within the sector. The Committee may wish to note that at 44 Hillingdon has the third highest number of care homes in the sector but the second highest number of care home beds after Ealing. Table 1: NWL Care Homes CQC Ratings Compared (Percentage) Borough Outstanding Good Requires Improvement Inadequate TOTAL Brent 0% 84% 16% 0% 100% Ealing 0% 60% 40% 0% 100% Hammersmith & Fulham 11% 78% 11% 0% 100% Harrow 2% 94% 4% 0% 100% Hillingdon 0% 84% 16% 0% 100% Hounslow 14% 69% 17% 0% 100% Kensington & Chelsea 11% 89% 0% 0% 100% TOTAL 5% 80% 15% 0% 100% Source: CQC Table 2: NWL Domiciliary Care Providers CQC Ratings Compared (Percentage) Borough Outstanding Good Requires Improvement Indadequate TOTAL Brent 0% 85% 15% 0% 100% Ealing 2% 76% 21% 2% 100% Hammersmith & Fulham 8% 64% 28% 0% 100% Harrow 0% 90% 10% 0% 100% Hillingdon 0% 85% 15% 0% 100% Hounslow 4% 70% 24% 2% 100% Kensington & Chelsea 7% 87% 7% 0% 100% TOTAL 3% 80% 17% 1% 100% Source: CQC RESIDENT BENEFIT 26. The MPS described in this report shows how the Council will ensure a sufficient supply of quality services to meet the assessed adult social care needs of local residents and prevent or delay the demand for more intensive care and support in more restrictive settings. FINANCIAL IMPLICATIONS 27. There are no direct financial implications arising from this report. Health and Social Care Select Committee – 24 July 2024 Classification: Public LEGAL IMPLICATIONS 28. There are no direct legal implications arising from this report. BACKGROUND PAPERS None. Health and Social Care Select Committee – 24 July 2024 Classification: Public Adult Social Care Market Position Statement 2024-2027 www.hillingdon.gov.uk/socialcare Appendix 1 2 Contents 1. Introduction 4 – 1.1 Purpose of the Market Position Statement 4 – 1.2 Who the Market Position Statement is for 4 – 1.3 Engagement with Providers 4 – 1.4 About Hillingdon 5 – 1.5 Hillingdon’s Adult Social Care and Health Plan – Independent and Fulfilled Lives 5 – 1.6 Overarching Messages for the Market 6 – 1.7 Care and Support Directory 6 2. Information, Advice and Advocacy 7 – 2.1 Current Position 7 – 2.2 Issues 7 – 2.3 Commissioning Intentions 8 3. Preventative and Community-based Services 9 – 3.1 Current Position 9 – 3.2 Issues and Challenges 10 – 3.3 Commissioning Intentions 11 4. Homecare 12 – 4.1 The Hillingdon Care Market 12 – 4.2 Commissioned Services 12 – 4.3 Market Challenges 13 – 4.4 Commissioning Intentions 13 5. Supported Housing 14 – 5.1 The Hillingdon Care Market 14 – 5.2 Commissioned Services 15 – 5.3 Demand 16 – 5.4 Issues and Challenges 16 – 5.5 Commissioning Intentions 17 3 6. Care Homes 18 – 6.1 The Hillingdon Care Market 18 – 6.2 Commissioned Services 19 – 6.3 Demand 19 – 6.4 Market Issues and Challenges 19 – 6.5 Commissioning Intentions 20 7. Carer Support 21 – 7.1 Current Position 21 – 7.2 Demand 21 – 7.3 Issues and Challenges 22 – 7.4 Commissioning Intentions 22 8. Market Sustainability 23 – 8.1 Market Sustainability 23 – 8.2 Quality Monitoring 23 – 8.3 Workforce 23 9. Conclusion and Feedback 25 Appendix 1 Hillingdon’s Geography (Localities and Wards) 26 4 1. Introduction 1.1 The Purpose This Market Position Statement (MPS) describes the current market for care and support services in Hillingdon and the council’s intentions to support the early intervention and promotion of self- help and independence of all residents, including those with adult social care needs. The content of this MPS reflects the council’s intentions over the 2024 to 2027 period based on the information currently available. It does not represent a commitment from the council to take a particular course of action, which may need to change in response to national and local drivers, such as new legislation or market developments. 1.2 Who the Market Position Statement is for This MPS is intended to be read by: • Existing providers undertaking regulated activities under the Health and Social Care Act, 2008 (Regulated Activities) Regulations, 2014 of health and social care services in Hillingdon and the North West London sector. • Service providers and organisations not currently providing services to Hillingdon residents. • Voluntary and community organisations, also known as ‘third sector’ organisations. • People currently in receipt of adult social care services, sometimes referred to as ‘eligible residents’ or ‘eligible people’, and also people who may use adult social care services, including unpaid carers. The sections in this document describe current demand and capacity as well as our expectations of future requirements and commissioning intentions. This document is structured in sections addressing each market specialism in Hillingdon. 1.3 Engagement with Providers The council has set out an overarching strategy for supporting residents and some key components of this include how residents will be supported to be safe, in strong communities; living in a thriving economy; thriving healthy households; in a green and sustainable borough that is digitally enabled, modern and well run. Providers of social care services or third sector support to residents engage with the council to establish and build partnership arrangements, gain support and help with market shaping. Engagement takes place through a variety of ways, including: • Care Home Managers Forum • Domiciliary Care Forum • Supported Living Forum • Registered Care Managers Group (includes reps from Skills for Care and CQC) • Quarterly provider newsletter Additionally, the Supplier Relationship Team will be hosting two provider events in 2024 to promote the council and social care priorities for the coming 12 months. This will be replicated for each year of this MPS. The council currently uses Capital E-Sourcing as its procurement portal platform. This is used to publish Prior Information Notices (PINs), Invitations to Tender, communications with registered providers and auditable document exchanges. 5 1.4 About Hillingdon Hillingdon is the second largest of London’s 32 boroughs geographically and is home to an estimated population of 305,900 (Office of National Statistics (ONS) 2021) residents. It is the third least densely populated of the 32 London boroughs. The map below shows the location of Hillingdon in the context of its neighbours. This shows that the borough is the most westerly London borough. It adjoins London Heathrow airport to the southwest of the borough and East Berkshire to the west. Major transport links cross the borough; motorways, i.e. the M4, M25, and M40 (A40), rail services, including HS2 construction, and London Underground routes: the Metropolitan, Piccadilly, Elizabeth, and Central lines. Hillingdon is part of a commissioning collaborative with other London boroughs called the West London Alliance and the map above shows the local authority members of this group. Hillingdon is divided into three localities. In order of the proportion of the borough’s population that live there, these are Hayes and Harlington (36%), North Hillingdon (33.3%), and Uxbridge and West Drayton (30.7%). Hillingdon’s localities, wards, and the dissection points of the M4 and A40 are illustrated in Appendix 1. As of December 2023, Hillingdon’s adult social care service supported 2,963 adults with long- term care needs. Approximately 354 had a support reason of memory and cognition, 709 residents with learning disabilities, 1,544 residents with physical and sensory disabilities and 347 residents with mental health needs. We assess and review around 6,531 residents per year. 1.5 Hillingdon’s Adult Social Care and Health Plan - Independent and Fulfilled Lives Our vision for Adult Social Care is that care and support will be personalised and will prevent, reduce, and delay needs. Residents will be enabled to live independent and fulfilled lives, supported within and by their local networks wherever possible. 6 1.6 Overarching Messages for the Market • Mixed market: The council supports the continuation of a mixed provider market in Hillingdon that includes a combination of services that it delivers directly and those provided by independent sector companies comprising of both for profit and third sector organisations. Approximately 70 per cent of Adult Social Care spend is on independent sector provided services. • Partnership-based relationship with providers: The council wishes to have relationships with providers based on mutual trust and risk sharing. This means that we want to move away from assumptions being made that all costs will be borne by the council. Equally, we will move away from assumptions about the willingness and/or ability of providers to provide better services at reduced costs. • Different approaches to ensure a diverse market of quality services: To ensure that residents have choice and control over how their needs are met and a range of support to address cultural diversity, our approach to securing services will be flexible. Where tendering is the most appropriate route to comply with the council’s legal obligations, this will be undertaken using the procurement portal. • Smaller number of more strategic providers rather than large numbers of lower value contracts: This is the council’s continued preference as it aids more effective contract management that reduces risk to residents and therefore safeguards their interests as well as giving the strategic providers some consistency, builds relationships and trust and allows for innovation development. • Integrated commissioning: Over the period of the MPS providers can expect to see examples of integrated commissioning between the council and the NHS where this approach will lead to better outcomes for residents. • Preference for long-term contracts: The council recognises that long-term contracts, e.g. up to eight years, give providers financial stability and allow for longer-term planning, which in turn can help secure better service quality for residents. This is the approach that will be taken going forward unless there is a good reason not to. The council has a register of Adult Social Care contracts. This shows what contracts we have in place and when they are due to expire. This information is publicly available and can be accessed at www.hillingdon.gov.uk/fair-cost-of-care 1.7 Care and Support Directory Hillingdon’s local care and support directory covers council services and those provided by the independent sector, as well as local support groups. It can be accessed at careandsupport. hillingdon.gov.uk 7 2. Information, Advice, Guidance and Advocacy 2.1 Current Position Information and Advice The council has an information and advice contract with Hillingdon and Ealing Citizens Advice Bureau (CAB). A contract is also in place for the provision of information, advice, guidance, and wellbeing support with Bell Farm Christian Association based in Yiewsley. Many third sector organisations provide information, advice, and guidance as part of a broader range of services that they are delivering. Organisations providing information, advice and guidance include the H4All third sector consortium, which comprises Age UK (Hillingdon, Harrow, and Brent), Carers Trust Hillingdon, Disablement Association Hillingdon (Dash) and Hillingdon Mind. A specialist welfare benefits and debt advice service for people with mental health needs is provided by CAB through a contract that they have with the council. Advocacy The council has a contract with POhWER for an Integrated Advocacy Service until 31 March 2025. This includes provision of the following statutory services: Independent Mental Capacity Advocacy (IMCA), Relevant Person’s Paid Representative Service (RPPR), Independent Mental Health Advocacy (IMHA) and Care Act Advocacy (CAA). The Integrated Advocacy contract also includes non-statutory advocacy provision for residents with mental health issues, learning disabilities and/or physical disabilities. POhWER also deliver an advocacy service to support people making complaints against the NHS. This is under the pan-London NHS complaints advocacy consortium contract that ends in March 2025. The council has a long history of supporting the Metropolitan Police in situations where they have a vulnerable person in custody and require the presence of an Appropriate Adult to comply with requirements under the Police and Criminal Evidence Act, 1984 to enable them to interview the person. A contract is in place with the Appropriate Adult Service that ends in March 2025. The provision of this service for adults is not statutory. 2.2 Issues A key issue for residents is that they must go to different places to access information and advice about different things. It is often difficult for residents to know where to go to get what they need. Access to information and advice is critical to empowering residents to understand the options available to them and to make informed decisions about their care and support needs. Advocacy services ensure that the voices of those less able to make their wishes known are heard. Information, Advice and Guidance Explained Information: Providing factual, current, and impartial information to our residents. Advice: Presenting facts and ideas in an accessible form for our residents to consider and recommending a course of action. Guidance: Defining and providing routes support which assist our residents to reach their requirements. 8 2.3 Commissioning Intentions • 2024/25: The council will tender for an information and advice single point of access. It is not expected that this would include carers, which will be subject to a separate contract. • 2024/25: The council will re-tender the Integrated Advocacy contract. • 2024/25: Appropriate Adult provision arrangements will be reviewed. 9 3. Preventative and Community-based Services 3.1 Current Position There are a range of services that the council has in place intended to support the wellbeing and independence of our residents and prevent, delay, or reduce the need for care and support services. Home-based Intermediate Care Services The council contracts with Comfort Care Services to deliver its Reablement Service. Reablement is a short and intensive service, which is designed to help people progress their recovery after illness or disability, by learning or re-learning the skills necessary for daily living, whilst promoting maximum independence. This service works closely with the Community Rehabilitation Service provided by the Central and North West London NHS Foundation Trust (CNWL) and is generally provided for a very short period. Service users often meet their goals within the first four weeks, with an optional further two weeks if their aims and goals are achievable. The service supports approximately 900 people a year, 33 per cent of which are from the community. The other 67 per cent are people discharged from hospital. The contract for this service is in place until April 2026, but with the option to extend for up to two further years. Assisted Independent Living The council is part of the Pan-London Community Equipment Consortium, which includes 22 London boroughs and aligned Integrated Care Boards, and currently has a contract in place with NRS Healthcare Limited to deliver a community equipment service to support residents to live as independently as possible in their own homes. The service is funded jointly by the council with the ICB and the contract is in place until March 2028, but with the option to extend for up to two further years. The council identifies the use of Assistive Independent Living Technology in the form of telecare as fundamental to maximising the independence of vulnerable residents in the community. Telecare is basically a range of sensors, detectors and alarms linked to a control centre through the telephone system. Since 2018 the council has installed 50 to 70 units per month to our residents and there are currently 7,680 users of the service, 69 per cent of which are aged 75 and above. Telecare is supported by an emergency responder service for people who do not have a family member or friend who can act as a first responder, or who may not be available when a crisis occurs, and this is delivered by Comfort Care Services. The equipment is purchased through a government framework agreement and the control centre is provided by Anchor Housing. Wellbeing Services The council has a contract in place with Age UK to deliver a wellbeing service to older residents until March 2025. This includes support to access community resources to address loneliness that can be associated with social isolation. In addition, the service seeks to assist older people in keeping active in the area where they live, and this can be through pursuing volunteering opportunities. The Care Act, 2014 places a duty on local authorities with adult social care responsibilities to arrange for the provision of services, facilities, or resources to prevent or delay the need for care and support. 10 Hillingdon Mind delivers an early intervention and prevention programme service under contract with the council. The focus of this service is applying the Mental Health Recovery Star approach to wellbeing, i.e. managing mental health, physical health and self-care, daily living skills, social networks, relationships, responsibilities, identity and self-esteem, etc. This contract is in place until March 2025. Access to and retention of employment is a key factor in supporting the wellbeing of people with mental health needs. There is a contract in place with CNWL to deliver an employment support service and this is in place until March 2025. There is an emphasis on building relationships with local employers and employment agencies. The service includes occupational therapist interventions during access to or return to work processes e.g. around stress management, self-management at work and managing concentration difficulties. The service is also part funded by CNWL. Day Opportunity Services The council seeks to support residents with adult social care needs to make best use of community assets and funds outreach support, where appropriate, to address personal needs when required to facilitate access to these services. However, where more specialist providers are required to meet assessed need then provision is spot purchased. The council is currently spot purchasing with 29 providers. This approach reflects the council’s current and future direction. The council retains one in-house specialist service to provide meaningful activities for people with learning disabilities and autistic people with complex needs and this is the Queens Walk Resource Centre. Self-directed Support With Direct Payments (DPs) the council’s financial contribution to meeting assessed social care needs is paid directly to the eligible person usually in the form of a pre-paid card. DPs give the eligible person more flexibility and control to directly employ their own care workers or a personal assistant who will, for example: • be the same person and be available when required • speak the same language • understand cultural and/or religious needs. This is particularly pertinent to people living in the parts of the borough with more diverse populations, e.g. the Hayes and Harlington Locality (see Appendix 1). There are currently 618 people (including carers) in receipt of DPs. To provide advice and support to people considering DPs about issues such as pay roll and rights and responsibilities as an employer, the council has a DP Support Service recommended list in place. Companies on this list have been checked by the council. Providers on the list are not in contract with the council and eligible residents are able to go to other companies for DP support if they wish. 3.2 Issues and Challenges The following are among the issues and challenges identified: • Assistive living technology modernisation: New digital technology is available that impacts on what is currently provided, as well as providing greater opportunities for supporting the independence of residents in the future. This also has to be linked to the prevention offer at a Neighbourhood Team level. There is a new project underway to review the current offer, i.e. telecare equipment and out of hours support. To inform this project the council has been 11 successful in a match funding application for Proactive Care Funding to start a pilot with the provider of ‘Intelligent Lilli’, an interactive assessment tool that monitors a resident’s daily habits in their home environment to produce a ‘pattern of life’. • Queens Walk Resource Centre: The facility is under-utilised, and we would like to work with third sector and other partners to ensure best use of this resource, including evening and weekend usage. • Personal assistant market: The availability of people willing to be personal assistants in Hillingdon is limited, which results in many eligible people on DPs having to go to established care agencies. • Personalised solutions and critical mass: It is not always possible to meet the needs of eligible people in the way that they would wish where there is low volume demand. The council recognises that in a difficult market the absence of critical mass can make it uneconomic for suppliers to develop and provide what may be requested. There may, however, be a market development opportunity with neighbouring boroughs to address this. 3.3 Commissioning Intentions • 2024/25: Assisted living technology pilot – A trial will be undertaken using the Intelligent Lilli interactive assessment tool to determine its effectiveness and inform Hillingdon’s future assisted living technology model. • 2024/25: Wellbeing services – The scope of the current wellbeing services will be reviewed and the future model determined. The outcome of the review will inform future provision options, which may include a competitive tender for a longer contract or contracts. • 2025/26: Personal assistant (PA) market – The council will work with its West London Alliance partners to explore options for increasing the PA market to improve choice and control flexibilities for eligible people. • Ongoing: Market development opportunities – The council will identify a mechanism for capturing data about service preferences of eligible people that the local market has not been able to satisfy and explore with West London Alliance (WLA) partners scope for collaborative approaches to market development. 12 4. Homecare 4.1 The Hillingdon Care Market There are 60 registered providers in Hillingdon delivering (according to Capacity Tracker) approximately 337,642 hours of care a week. In February 2024, Capacity Tracker tells us that they were doing this with 2,740 staff. The market comprises of a diverse range of providers with an overwhelming presence of single branch operations. Except for one small franchise, none of the national brands have a presence within the borough. The nature of the local market is such that there are companies with their registered offices in neighbouring boroughs that deliver homecare to Hillingdon residents. This is predominantly to self-funders and operates across boundaries with Ealing, Harrow, and Hounslow. There is no evidence of similar cross-borough activity on Hillingdon’s western border. The CQC ratings for borough-based providers are shown in the table below. Hillingdon Based Homecare Providers CQC Ratings Rating Provider Number % Inspected National Comparison Outstanding 0 0% 4% Good 40 85% 81% Requires Improvement 7 15% 14% Inadequate 0 0% 1% Not Inspected 13 N/A N/A Total 60 100% 100% From the above table it can be seen that the Hillingdon market is performing above the national average performance. It should be noted that the council’s homecare contracts include a requirement for providers to have an overall CQC rating of a minimum of ‘Good’ for placements to be made under normal circumstances. 4.2 Commissioned Services The council commissions approximately 1 million hours of homecare a year and expects this to remain reasonably static during the period of this MPS. To meet this demand, the council has put into place the following portfolio of commissioned homecare and outreach services to address the needs of our residents: • Lead Providers – There are two lead providers - one covers the north of the borough and the other the south, with the A40 broadly being the dividing line. They are expected to accept 70 per cent of all new referrals within their area of operation, are paid a fixed fee for the service they deliver and are not block contracted service. They have a strategic relationship with the council due to the levels of demand expectations placed on them. • Dynamic Purchasing System (DPS) – This is a framework of 10 providers that started in January 2023. Referrals to providers on the DPS are made electronically. Good quality homecare is a vital component of the care and support needed to enable residents to live independently in their own home. Homecare agencies must be registered with the Care Quality Commission and assist people with the tasks of daily living. 13 Council Contracted Homecare Providers Lead Providers DPS Providers North: Comfort Care Services • AMI Homecare South: Care Outlook • Kamil Education • Lalis Direct Care • London Quality Care Services • Oasis Care (OCTA) • Oasis Group London • Sahan Cares • S.C.S Hotline • Support Direct (Opportunity for All) • Thames Homecare The council also contracts with Comfort Care Services to deliver a Bridging Care Service to support early discharge from hospital as soon as possible after a person has been identified as no longer meeting the Criteria to Reside. Funding streams within Hillingdon’s Better Care Fund pay for 500 hours care a week for an intended five-day length of stay in the service pending referral onto the Reablement Service, ongoing care or alternative support arrangements where ongoing care is not required. 4.3 Market Challenges The following are among the issues faced by providers that they have reported to us: • Challenges in the recruitment of new staff and are using the Health and Social Care Visa to recruit staff, which is now a significant focus for homecare providers. • There are direct costs associated with international recruitment, for example, the cost of the sponsorship licence, skills surcharge, etc. There are also costs that can come from staff time managing the administration, providing pastoral support and support with other difficulties, such as finding accommodation. • Hillingdon is also a high employment area with competition coming from retail and Heathrow Airport. 4.4 Commissioning Intentions • Annually: We will continue to review uplift requests based on evidence of increased costs. • Ongoing: We will continue to use electronic call monitoring systems (ECM) as the basis for payment based on actual hours provided rather than hours commissioned. • 2025/26: We will review the option to extend the Lead Provider (North) contract for up to two further years from April 2026. • 2026/27: We will review the option to extend the Lead Provider (South) contract for two further years from July 2027. 14 5. Supported Housing 5.1 The Hillingdon Market Since 2012, the council has had an extensive supported accommodation programme that has included schemes it has developed itself as well as those developed with the independent sector. The council is now seeking to maximise the benefit of existing supported housing stock by ensuring that service users can step down to less supported environments and is open to considering benefit share options to incentivise this outcome. Sheltered Housing (Rent) There are currently 41 sheltered housing schemes in Hillingdon supporting a minimum of 1,484 people mainly aged 60 and above. Twenty-one schemes are owned and run by the council and support 840 tenants. The other 20 schemes are owned and run by a range of housing associations and support 644 tenants. Although there is some variation in service models across provider, generally all schemes have a scheme manager who will help with advice, information, or assistance including arranging for a GP to visit or putting tenants in touch with other local services. Sheltered Housing (Leasehold) In addition to sheltered housing for rent there are also six leasehold schemes in the borough owned by six housing associations and supporting a minimum of 247 people aged mainly over 60. Extra Care The council has invested in the development of three extra care schemes for rent in the borough for people aged 55 and above, which is intended to avoid admissions into care homes. A fourth scheme, Cottesmore House, is owned by The Guinness Trust. A nomination agreement with The Guinness Trust grants the council 100% nomination rights in perpetuity. These schemes are summarised below. Extra Care Schemes in Hillingdon Scheme Name Number of Apartments Cottesmore House 48 Grassy Meadow Court 60 Parkview Court 88 Triscott House 57 Total 243 Supported Living and Supported Housing (Learning Disabilities, Autism and Mental Health Needs) Council investment has seen the development of three (Church Road, Glenister Gardens and Swan House) new self-contained supported living schemes for people with learning disabilities since 2013 and one (Sessile Court) new self-contained supported housing scheme for people with ‘Supported housing’ is an umbrella term and covers situations where accommodation is provided alongside support, supervision, or care to help people live as independently as possible in the community. Accommodation is under a lease or tenancy. Where accommodation is provided with care this is often referred to as supported living. The different types of supporting housing offer a range of options for addressing need that are less restrictive than moving into a care home. 15 mental health needs. The table below summarises the total provision in the borough. Building ownership is split between local authority and registered providers, including housing associations. Supported Accommodation for People with Learning Disabilities and/or Mental Health Needs Summarised Service User Group Number of Schemes Number of People Supported Learning Disabilities 23 170 Learning Disabilities and Mental Health 32 195 Mental Health 27 154 Seven of the schemes for people with learning disabilities and five of those for people with mental health comprise of self-contained apartments. All of the other schemes comprise of shared accommodation. The council also owns and manages two supported living schemes for people with learning disabilities (Chapel Lane and Goshawk Gardens) and these are shared houses and support 12 people between them. Hillingdon Shared Lives The Hillingdon Shared Lives (HSL) scheme offers a long-term placement in a family setting in the community as an alternative to living in a residential care home, a supported living scheme with several other people, a hospital or to living alone, where they may be at risk of social isolation and the loneliness that can be associated with it. This scheme is intended for adults and young people aged 16 and above who have a learning disability, and/or who have a mental health need and are in recovery, and/or a physical or sensory disability. It can also support older people who would prefer to live in a family setting rather than the alternative. The scheme is currently supporting 22 people and in the last 12 months has provided 236 nights of respite to 11 people, which has enabled their carers to take a break. 5.2 Commissioned Services The council has a range of block contracts in place with three providers for the provision of care and/or support in supported housing schemes in the borough, and this is summarised in the table below. The contracts are based on a core and flexi model. Building-based Block Contracts Summary Provider Number of Schemes Service User Group Numbers Supported Comfort Care Services 10 Complex Learning Disability 91 Ability Housing Association 3 Mental Health 43 Support for Living (Certitude) 6 Complex Learning Disability 45 Total 19 179 16 The council also has a block contract with Ability Housing to deliver 350 hours a week floating support for people with mental health needs. An additional 32 hours a week has recently been commissioned to support the discharge from hospital to their usual place of residence of people with mental health needs. This is a pilot to test proof of concept and is funded through the Better Care Fund. The council funds Shared Lives Carers and this is a cost-effective way of meeting need. 5.3 Demand Between April 2023 and February 2024, there were 85 placements made in supported living provision made by the council’s Brokerage Team and it is expected that there will be 100 placements by the end of 2023/24. Of placements made, 55 per cent were of people with learning disabilities and 45 per cent people with mental health needs. 49 per cent of placements were made in borough. Although some out of borough placements would have been appropriate to address specific need, there is an apparent mismatch between demand and supply. The council does not currently have any plans to develop further supported living schemes comprising of self-contained flats for people with learning disabilities or people with mental health needs. However, provision of shared accommodation for people with complex needs in receipt of section 117 aftercare, i.e. ‘dry house’ for people alcohol and/or drug dependency, is insufficient to meet demand. Projections suggest that the number of adults aged 18 to 64 living with moderate to severe (and including severe) learning disabilities will increase from approximately 1,506 in 2023 to 1,553 in 20301. New demand for Adult Social Care services will either come from people transferring from Children’s Services or from new household migration into the borough. 5.4 Issues and Challenges The following are among the issues and challenges identified: • Right support, right care, right culture guidance: Under this statutory guidance the CQC has stated that it will not register new supported living services for people with learning disabilities or autistic people that have capacity for more than six people. • Supported Housing (Regulatory Oversight) Act, 2023: This act will introduce the power for local authorities to introduce oversight regimes for supported housing schemes that are currently not part of a regulatory regime. It will also require local authorities to review supported housing supply and develop strategies. The publication of new regulations is awaited to provide clarity about the requirements for local oversight schemes and supported housing strategies. • Suitability of Shared Lives settings: The council is seeking to recruit more Shared Lives Carers but one of the challenges is the mismatch between the needs of the people who would be suitable for the scheme and the accommodation that is available. Core and Flexi Model Explained Core cost: Cost of meeting minimum safe staff required. This is subject to block contract. Flexi cost: This additional cost for meeting assessed need over and above that met by core service. 17 5.5 Commissioning Intentions • 2024/25: Supported Living and Floating Support for people with Mental Health Needs – The council will re-tender this contract to establish new arrangements for up to eight years. • 2024/26: ‘Dry house’ for people alcohol and/or drug dependency – The council will explore options for addressing current gap in capacity. • 2025/26: Supported housing strategy – Working with NHS partners and in liaison with users of services, their families, and providers we will develop a strategy in accordance with national requirements. • 2026/27: Care and Wellbeing Service in Supported Living for Adults with Learning Disabilities and/or Autism and Mental Health Needs. Campion Close, Cedar House, Silver Birches, Sweetcroft Lodge, Thornhill Road – The council will re-tender this contract to establish new arrangements for up to eight years. • 2026/27: Care and Wellbeing Service in Supported Living for Adults with Learning Disabilities Church Road, Swan House, Glenister Gardens, Honeycroft Hill – The council will re-tender this contract to establish new arrangements for up to eight years. 18 6. Care Homes 6.1 The Hillingdon Care Market There are currently 44 active registered care homes providing 1,365 beds. There is a mix of small and national providers, both ‘for profit’ and third sector. The seven largest care home providers in the borough account for 45.9 per cent of all beds. Of the current 44 active homes, 26 are Older People’s Residential and Nursing Care homes and 18 are working age residential care homes (focused on mental health or learning-disabled residents). These are detailed in the following tables: Registered Beds – Older People Care Homes (65 +) Type Number of Homes Nursing Beds Residential Beds Flexible Beds Total Dual Home 8 249 160 31 440 Nursing Homes 7 330 0 0 330 Residential Homes 11 0 435 0 435 Total 26 579 595 31 1,205 % 48% 49% 3% 100% Source: Capacity Tracker Registered Beds – Care Homes (18-64) Type Number of Homes Nursing Beds Residential Beds Flexible Beds Total Residential Homes 18 0 160 N/A 160 Total 18 0 160 160 % 0 100% 100% Source: Capacity Tracker Analysis in November 2023 confirmed a 2019 study that showed that 45 per cent of Hillingdon’s older people care home provision was utilised by self-funders, thus leaving the remaining 26 per cent to be funded by other local authorities and the NHS. The following table summarises the current position of CQC ratings for Hillingdon as of December 2023, whilst national statistics are taken from the State of Care report published in October 2023. Hillingdon Borough Homes Residential and Nursing Care Homes CQC Ratings CQC Rating Nos % National Comparison Outstanding 0 0 5% Good 38 86% 74% Requires Improvement 6 14% 20% Inadequate 0 0 1% Feedback from our residents is that for most people admission to a care home is the option of last resort. Community-based alternatives to supporting independence in people’s own homes means that future demand for care home placements is likely to be from people with higher levels of need. This impacts on the future shape of Hillingdon’s care home market. 19 Total 44 100% 100% Source: CQC 6.2 Commissioned Services The council currently has a block contract with two providers for 15 short-term nursing and nursing dementia beds across two settings to support timely discharge from hospital for people no longer meeting the Criteria to Reside. A tendering process is intended to establish longer-term block arrangements (see Commissioning Intentions below). The council currently owns two care homes for people with learning disabilities that it manages directly. These are 3 Colham Road (13 beds) and Hatton Grove (20 beds) In December 2023, the council was spot purchasing 600 long term placements of which 361 (60 per cent) in Hillingdon and 239 (40 per cent) out of borough. Beds purchased in the borough represented 29 per cent of the bed-base for older people. In the period between April 2023 and January 2024, the council made 117 spot short-term placements to support hospital discharge. 6.3 Demand The council expects demand from the self-funder market to expand due to the increase in the older people population and the fact that Hillingdon is a relatively prosperous borough as suggested by us being ranked 23rd most deprived out of London’s 32 boroughs and at 77 per cent, high levels of owner occupation amongst the 65 and over population. Although ONS population projections based on the 2021 census will not be available until 2025, the census showed a 34 per cent i.e. 4,607 residents, increase (45per cent i.e. 1,943 residents, in the Hayes and Harlington locality) in the 55 to 59 age group, thereby indicating a significant increase in the older people population over the next 15 years. The council anticipates that during 2024/25 it will purchase approximately 330 long term residential and 150 nursing home beds for older people and 50 long term beds for people of working age. The development of options support people longer in the community means that the demand for residential provision for older people, i.e., without dementia, from the council is likely to continue to decline. There will be a continuing need for residential dementia beds but the greatest demand is likely to be for people requiring placements in care home settings registered to support nursing and nursing dementia needs. 6.4 Market Issues and Challenges The following are among the issues and challenges identified: • High occupancy levels: Capacity Tracker shows that the average occupancy level for Hillingdon Care Homes is 96 per cent. However, when taking into consideration the provision focussed on the self-funder market and specialist provision, i.e. retired actors and nuns, the occupancy level is higher. The average occupancy level across the NWL sector is 89 per cent and the average for London is 88 per cent. • Duration of placements impacts occupancy levels and an analysis of council long-term placements undertaken in December 2023 showed an average length of stay across all bed types of 2.25 years and as expected, a shorter period of just under two years for provision supporting people living with dementia. 20 • Proportion of older people care home beds owned by national providers: 36 per cent of registered beds in care homes for older people in the borough are owned by national providers. As commercial decisions for homes owned by national companies will usually be made centrally, this leaves local managers with limited autonomy and impacts on the scope for bilateral discussions. • Care homes for people with learning disabilities/autistic people: Limited existing capacity in the borough can necessitate out of borough placements. Changes to CQC requirements and the publication of their new guidance for registration in the spring of 2022 ’Right Support Right care Right culture’ meaning that new homes should be smaller in size and able to evidence services can provide person-centred care in line with current best practice. This means that the council needs to look at options to ensure that compliant capacity is in place. 6.5 Commissioning Intentions • Ongoing: NHS London Care Record (LCR) – We will continue to work with the ICB to support care homes to complete the Digital Security and Protection Toolkit to ensure to maximise the number of homes able to access and utilise the LCR. • 2024/25: Short-term nursing beds – Working jointly with the ICB and the Borough-based Partnership, the council will tender for 15 short-term nursing beds located in the borough to support hospital discharge. • 2024/25: Nursing home provision – The council will explore options for directly managing a nursing care home. • 2024/25: West London Alliance (WLA) Residential and Nursing Homes DPS – The WLA has updated the contractual documentation used for its DPS which will be based on quality and this will become operational in September 2024. • 2024/27: Care homes for people with learning disabilities – The council will develop two smaller care homes that are compliant with updated CQC requirements. 21 7. Carer Support Who can be a carer? In a nutshell: Anyone providing care and/or support to another person not under a contract of employment. Types of Carers • Young Carer: Aged under 18 caring for another person. • Parent Carer: An adult caring for a disabled child. • Adult Carer: An adult caring for another adult. 7.1 Current Position The Carer Support Service contract is critical to the delivery of the local strategy for supporting carers. This includes access to information, advice, and guidance as well as facilitation of peer support groups and short break opportunities. The contract is currently held by Carers Trust Hillingdon as the lead organisation for the Hillingdon Carers Partnership, and through this model carers can access replacement care as well as specialist mental health support via Hillingdon Mind and the Alzheimer’s Society. Carer’s assessments under the Care Act are also undertaken on behalf of the council under the contract. There are a range of options currently offered to carers in need of a break from their caring role these include: • The council directly own and deliver a nine bedded respite service (Merriman’s House) and a day resource service (Queens Walk Resource Centre) for adults with learning disabilities, physical disabilities, complex health needs and autism. • The council spot purchases respite for older adults or people with disabilities within a registered nursing or registered care home setting (dependent on the cared for person’s needs). • Spot purchase of specialist building-based respite for those with very complex needs, such as challenging behaviour/autism. • Home care provision for those wishing to remain within their own home. • Day provision for older adults with dementia (Dementia Resource Service at Grassy Meadow Court extra care scheme). • Direct Payments (DP): The council’s identified financial contribution to meeting the needs of adult carers as identified from a carer’s assessment undertaken as required under the Care Act in the form of a DP, which would ordinarily by paid through a pre-paid card. This would give a carer more flexibility about how a carer wishes to take a break, e.g. a holiday with support for the cared for person instead of a building-based service. 7.2 Demand Unpaid carers represent both a source of demand for support services as well as a means of controlling demand from people who would otherwise need Adult Social Care services, or Carers say that supporting someone to live an independent life at home, in the community they know, can be very rewarding. However, the cost to carers in terms of their own health, financial situation, employment position and independence can be considerable. Not supporting carers can have a detrimental impact on their health and wellbeing as well as the people they are caring for and increase costs for the health and care system.

Health and Social Care Select Committee – 24 July 2024 Classification: Public CABINET FORWARD PLAN Committee name Health and Social Care Select Committee Officer reporting Nikki O’Halloran, Democratic Services Papers with report Appendix A – Latest Forward Plan Ward As shown on the Forward Plan HEADLINES To monitor the Cabinet’s latest Forward Plan which sets out key decisions and other decisions to be taken by the Cabinet collectively and Cabinet Members individually over the coming year. The report sets out the actions available to the Committee. RECOMMENDATION That the Health and Social Care Select Committee notes the Cabinet Forward Plan. SUPPORTING INFORMATION The Cabinet Forward Plan is published monthly, usually around the first or second week of each month. It is a rolling document giving the required public notice of future key decisions to be taken. Should a later edition of the Forward Plan be published after this agenda has been circulated, Democratic Services will update the Committee on any new items or changes at the meeting. As part of its Terms of Reference, each Select Committee should consider the Forward Plan and, if it deems necessary, comment as appropriate to the decision -maker on the items listed which relate to services within its remit. For reference, the Forward Plan helpfully details which Select Committee’s remit covers the relevant future decision item listed. The Select Committee’s monitoring role of the Forward Plan can be undertaken in a variety of ways, including both pre-decision and post-decision scrutiny of the items listed. The provision of advance information on future items listed (potentially also draft reports) to the Committee in advance will often depend upon a variety of factors including timing or feasibility, and ultimately any such request would rest with the relevant Cabinet Member to decide. However, the 2019 Protocol on Overview & Scrutiny and Cabinet Relations (part of the Hillingdon Constitution) does provide guidance to Cabinet Members to:  Actively support the provision of relevant Council information and other requests from the Committee as part of their work programme; and  Where feasible, provide opportunities for committees to provide their input on forthcoming executive reports as set out in the Forward Plan to enable wider pre -decision scrutiny (in addition to those statutorily required to come before committees , i.e. policy framework documents – see paragraph below). As mentioned above, there is both a constitutional and statutory requirement for Select Committees to provide comments on the Cabinet’s draft budget and policy framework proposals after publication. These are automatically scheduled in advance to multi-year work programmes. Health and Social Care Select Committee – 24 July 2024 Classification: Public Therefore, in general, the Committee may consider the following actions on specific items listed on the Forward Plan: Committee action When How 1 To provide specific comments to be included in a future Cabinet or Cabinet Member report on matters within its remit. As part of its pre-decision scrutiny role, this would be where the Committee wishes to provide its influence and views on a particular matter within the formal report to the Cabinet or Cabinet Member before the decision is made. This would usually be where the Committee has previously considered a draft report or the topic in detail, or where it considers it has sufficient information already to provide relevant comments to the decision-maker. These would go within the standard section in every Cabinet or Cabinet Member report called “Select Committee comments”. The Cabinet or Cabinet Member would then consider these as part of any decision they make. 2 To request further information on future reports listed under its remit. As part of its pre-decision scrutiny role, this would be where the Committee wishes to discover more about a matter within its remit that is listed on the Forward Plan. Whilst such advance information can be requested from officers, the Committee should note that information may or may not be available in advance due to various factors, including timescales or the status of the drafting of the report itself and the formulation of final recommendation(s). Ultimately, the provision of any information in advance would be a matter for the Cabinet Member to decide. This would be considered at a subsequent Select Committee meeting. Alternatively, information could be circulated outside the meeting if reporting timescales require this. Upon the provision of any information, the Select Committee may then decide to provide specific comments (as per 1 above). 3 To request the Cabinet Member considers providing a draft of the report, if feasible, for the Select Committee to consider prior to it being considered formally for decision. As part of its pre-decision scrutiny role, this would be where the Committee wishes to provide an early steer or help shape a future report to Cabinet, e.g., on a policy matter. Whilst not the default position, Select Committees do occasionally receive draft versions of Cabinet reports prior to their formal consideration. The provision of such draft reports in advance may depend upon different factors, e.g., the timings required for that decision. Ultimately any request to see a draft report early would need the approval of the relevant Cabinet Member. Democratic Services would contact the relevant Cabinet Member and Officer upon any such request. If agreed, the draft report would be considered at a subsequent Select Committee meeting to provide views and feedback to officers before they finalise it for the Cabinet or Cabinet Member. An opportunity to provide specific comments (as per 1 above) is also possible. 4 To identify a forthcoming report that may merit a post- decision review at a later Select Committee meeting As part of its post-decision scrutiny and broader reviewing role, this would be where the Select Committee may wish to monitor the implementation of a certain Cabinet or Cabinet Member decision listed/taken at a later stage, i.e., to review its effectiveness after a period of 6 months. The Committee should note that this is different to the use of the post-decision scrutiny ‘call-in’ power which seeks to ask the Cabinet or Cabinet Member to formally re-consider a decision up to 5 working days after the decision notice has been issued. This is undertaken via the new Scrutiny Call-in App members of the relevant Select Committee. The Committee would add the matter to its multi- year work programme after a suitable time has elapsed upon the decision expected to be made by the Cabinet or Cabinet Member. Relevant service areas may be best to advise on the most appropriate time to review the matter once the decision is made. Health and Social Care Select Committee – 24 July 2024 Classification: Public BACKGROUND PAPERS  Protocol on Overview & Scrutiny and Cabinet relations adopted by Council 12 September 2019  Scrutiny Call-in App

Ref Scheduled Upcoming Decisions Further details Ward(s) Final decision by Full Council Cabinet Member(s) Responsible Relevant Select Committee Directorate / Lead Officer Consultation related to the decision NEW ITEM Public or Private (with reason) 221 Award of contracts: short-term care home beds Cabinet will be asked to approve an award of contract for the provision of short-term nursing care home beds to support hospital discharge for a period of three years. N/A Cllr Jane Palmer - Health & Social Care Health & Social Care AS - Gary Collier Private (3) SI Carers Strategy Update Cabinet will receive a progress report on the Carers Strategy and Delivery Plan and the priorities going forward. All Cllr Jane Palmer - Health & Social Care Health & Social Care AS - Sandra Taylor / Gary Collier Public SI Public Preview of matters to be considered in private A report to Cabinet to provide maximum transparency to residents on the private and confidential matters to be considered later in Part 2 of the Cabinet meeting and agenda. TBC All Cabinet Members All C - Democratic Services Public SI Reports from Select Committees Reports, findings and recommendations for consideration by the Cabinet, when referred from the appropriate Committee. All All TBC C - Democratic Services TBC Public SI Standard Items taken each month by the Cabinet Member Cabinet Members make a number of non-key decisions each month on standard items - details of these are listed at the end of the Forward Plan. Various All TBC C - Democratic Services Various Public SI Standard Items taken each month by the Cabinet Member Cabinet Members make a number of non-key decisions each month on standard items - details of these are listed at the end of the Forward Plan. Various All TBC C - Democratic Services Various Public SI Better Care Fund Section 75 Agreement A standard annual report to Cabinet regarding the agreement under section 75 of the National Health Service Act, 2006, that will give legal effect to the Better Care Fund plan, including financial arrangements. The Better Care Fund supports local systems to successfully deliver the integration of health and social care in a way that supports person-centred care, sustainability and better outcomes for people and carers. All Cllr Jane Palmer - Health & Social Care Health & Social Care AS - Sandra Taylor / Gary Collier Public SI = Standard Item each month/regularly Council Directorate/Service Areas: AS = Adult Services & Health P = Place C = Central Services R = Resources CS= Children's Services D = Digital & Intelligence AUGUST 2024 - NO CABINET MEETING Cabinet meeting - Thursday 12 September 2024 (report deadline 23 August) Cabinet meeting - Thursday 25 July 2024 (report deadline 8 July) Cabinet Member Decisions expected - July 2024 1 Ref Scheduled Upcoming Decisions Further details Ward(s) Final decision by Full Council Cabinet Member(s) Responsible Relevant Select Committee Directorate / Lead Officer Consultation related to the decision NEW ITEM Public or Private (with reason) SI = Standard Item each month/regularly Council Directorate/Service Areas: AS = Adult Services & Health P = Place C = Central Services R = Resources CS= Children's Services D = Digital & Intelligence SI Older People's Plan update Cabinet will receive its yearly progress update on the Older People's Plan and the work by the Council and partners to support older residents and their quality of life. All Cllr Ian Edwards - Leader of the Council / Cllr Jane Palmer - Health & Social Care Health & Social Care AS - Sandra Taylor Older People, Leader's Initiative Public SI Public Preview of matters to be considered in private A report to Cabinet to provide maximum transparency to residents on the private and confidential matters to be considered later in Part 2 of the Cabinet meeting and agenda. TBC All Cabinet Members All C - Democratic Services Public SI Reports from Select Committees Reports, findings and recommendations for consideration by the Cabinet, when referred from the appropriate Committee. All All TBC C - Democratic Services TBC Public SI Standard Items taken each month by the Cabinet Member Cabinet Members make a number of non-key decisions each month on standard items - details of these are listed at the end of the Forward Plan. Various All TBC C - Democratic Services Various Public 079 Carer Support Services Cabinet will consider a contract for Integrated Carer Support Services for adults and children. Such services support carers within the Borough, make it easier for them to access advice, information and support for the valued role they undertake. N/A Cllr Jane Palmer - Health & Social Care Health & Social Care AS / R - Sandra Taylor / Gavin Fernandez / Sally Offin Private (3) SI The Annual Report Of Adult and Child Safeguarding Arrangements This report provides the Cabinet with a summary of the activity undertaken by the Safeguarding Children Partnership Board and the Safeguarding Adults Board to address the identified local priorities. The Cabinet will consider this report and approve the activity and the local priorities for the two boards. All Cllr Susan O'Brien - Children, Families & Education / Cllr Jane Palmer - Health & Social Care Health & Social Care / Children, Families & Education CS / AS - Alex Coman / Sandra Taylor Select Committees Public SI Public Preview of matters to be considered in private A report to Cabinet to provide maximum transparency to residents on the private and confidential matters to be considered later in Part 2 of the Cabinet meeting and agenda. TBC All Cabinet Members All C - Democratic Services Public Cabinet meeting - Thursday 10 October 2024 (report deadline 23 September) Cabinet Member Decisions expected - September 2024 Cabinet Member Decisions expected - October 2024 2 Ref Scheduled Upcoming Decisions Further details Ward(s) Final decision by Full Council Cabinet Member(s) Responsible Relevant Select Committee Directorate / Lead Officer Consultation related to the decision NEW ITEM Public or Private (with reason) SI = Standard Item each month/regularly Council Directorate/Service Areas: AS = Adult Services & Health P = Place C = Central Services R = Resources CS= Children's Services D = Digital & Intelligence SI Standard Items taken each month by the Cabinet Member Cabinet Members make a number of non-key decisions each month on standard items - details of these are listed at the end of the Forward Plan. Various All TBC C - Democratic Services Various Public SI Public Preview of matters to be considered in private A report to Cabinet to provide maximum transparency to residents on the private and confidential matters to be considered later in Part 2 of the Cabinet meeting and agenda. TBC All Cabinet Members All C - Democratic Services Public SI Reports from Select Committees Reports, findings and recommendations for consideration by the Cabinet, when referred from the appropriate Committee. All All TBC C - Democratic Services TBC Public SI Standard Items taken each month by the Cabinet Member Cabinet Members make a number of non-key decisions each month on standard items - details of these are listed at the end of the Forward Plan. Various All TBC C - Democratic Services Various Public SI The Council's Budget - Medium Term Financial Forecast 2025/26 - 2029/30 (BUDGET FRAMEWORK) This report will set out the Medium Term Financial Forecast (MTFF), which includes the draft General Fund reserve budget and capital programme for 2025/26 for consultation, along with indicative projections for the following four years. This will also include the HRA rents for consideration. All Proposed Full Council adoption - 20 February 2025 Cllr Martin Goddard - Finance All R - Andy Evans Public consultation through the Select Committee process and statutory consultation with businesses & ratepayers Public SI Public Preview of matters to be considered in private A report to Cabinet to provide maximum transparency to residents on the private and confidential matters to be considered later in Part 2 of the Cabinet meeting and agenda. TBC All Cabinet Members All C - Democratic Services Public SI Reports from Select Committees Reports, findings and recommendations for consideration by the Cabinet, when referred from the appropriate Committee. All All TBC C - Democratic Services TBC Public SI Public Preview of matters to be considered in private A report to Cabinet to provide maximum transparency to residents on the private and confidential matters to be considered later in Part 2 of the Cabinet meeting and agenda. TBC All Cabinet Members All C - Democratic Services Public SI Reports from Select Committees Reports, findings and recommendations for consideration by the Cabinet, when referred from the appropriate Committee. All All TBC C - Democratic Services TBC Public Cabinet meeting - Thursday 9 January 2025 (report deadline 9 December 2024) Cabinet meeting - Thursday 12 December 2024 (report deadline 25 November) Cabinet meeting - Thursday 7 November 2024 (report deadline 21 October) Cabinet Member Decisions expected - November 2024 3 Ref Scheduled Upcoming Decisions Further details Ward(s) Final decision by Full Council Cabinet Member(s) Responsible Relevant Select Committee Directorate / Lead Officer Consultation related to the decision NEW ITEM Public or Private (with reason) SI = Standard Item each month/regularly Council Directorate/Service Areas: AS = Adult Services & Health P = Place C = Central Services R = Resources CS= Children's Services D = Digital & Intelligence SI Standard Items taken each month by the Cabinet Member Cabinet Members make a number of non-key decisions each month on standard items - details of these are listed at the end of the Forward Plan. Various All TBC C - Democratic Services Various Public SI The Council's Budget - Medium Term Financial Forecast 2025/26 - 2029/30 (BUDGET FRAMEWORK) Following consultation, this report will set out the Medium Term Financial Forecast (MTFF), which includes the draft General Fund reserve budget and capital programme for 2025/26 for consultation, along with indicative projections for the following four years. This will also include the HRA rents for consideration. All Proposed Full Council adoption - 20 February 2025 Cllr Ian Edwards - Leader of the Council / Cllr Martin Goddard - Finance All R - Andy Evans Public consultation through the Select Committee process and statutory consultation with businesses & ratepayers Public SI Public Preview of matters to be considered in private A report to Cabinet to provide maximum transparency to residents on the private and confidential matters to be considered later in Part 2 of the Cabinet meeting and agenda. TBC All Cabinet Members All CS - Democratic Services Public SI Reports from Select Committees Reports, findings and recommendations for consideration by the Cabinet, when referred from the appropriate Committee. All All TBC CS - Democratic Services TBC Public SI Standard Items taken each month by the Cabinet Member Cabinet Members make a number of non-key decisions each month on standard items - details of these are listed at the end of the Forward Plan. Various All TBC CS - Democratic Services Various Public SI Public Preview of matters to be considered in private A report to Cabinet to provide maximum transparency to residents on the private and confidential matters to be considered later in Part 2 of the Cabinet meeting and agenda. TBC All Cabinet Members All CS - Democratic Services Public SI Reports from Select Committees Reports, findings and recommendations for consideration by the Cabinet, when referred from the appropriate Committee. All All TBC CS - Democratic Services TBC Public SI Standard Items taken each month by the Cabinet Member Cabinet Members make a number of non-key decisions each month on standard items - details of these are listed at the end of the Forward Plan. Various All TBC CS - Democratic Services Various Public Cabinet meeting - Thursday 13 February 2025 (report deadline 27 January 2025) Cabinet Member Decisions expected - February 2025 Cabinet Member Decisions expected - January 2025 Cabinet meeting - Thursday 13 March 2025 (report deadline 24 February) Cabinet Member Decisions expected - March 2025 Cabinet meeting - Thursday 10 April 2025 (report deadline 24 March) 4 Ref Scheduled Upcoming Decisions Further details Ward(s) Final decision by Full Council Cabinet Member(s) Responsible Relevant Select Committee Directorate / Lead Officer Consultation related to the decision NEW ITEM Public or Private (with reason) SI = Standard Item each month/regularly Council Directorate/Service Areas: AS = Adult Services & Health P = Place C = Central Services R = Resources CS= Children's Services D = Digital & Intelligence SI Public Preview of matters to be considered in private A report to Cabinet to provide maximum transparency to residents on the private and confidential matters to be considered later in Part 2 of the Cabinet meeting and agenda. TBC All Cabinet Members All C - Democratic Services Public SI Reports from Select Committees Reports, findings and recommendations for consideration by the Cabinet, when referred from the appropriate Committee. Various All TBC C - Democratic Services Various Public SI Standard Items taken each month by the Cabinet Member Cabinet Members make a number of decisions each month on standard items - details of these standard items are listed at the end of the Forward Plan. Various All TBC C - Democratic Services Various Public SI Reports from Select Committees Reports, findings and recommendations for consideration by the Cabinet, when referred from the appropriate Committee. Various All TBC C - Democratic Services Various Public SI Public Preview of matters to be considered in private A report to Cabinet to provide maximum transparency to residents on the private and confidential matters to be considered later in Part 2 of the Cabinet meeting and agenda. TBC All Cabinet Members All C - Democratic Services Public SI Standard Items taken each month by the Cabinet Member Cabinet Members make a number of decisions each month on standard items - details of these standard items are listed at the end of the Forward Plan. Various All TBC C - Democratic Services Various Public SI Urgent Cabinet-level decisions & interim decision-making (including emergency decisions) The Leader of the Council has the necessary authority to make decisions that would otherwise be reserved to the Cabinet, in the absence of a Cabinet meeting or in urgent circumstances. Any such decisions will be published in the usual way and reported to a subsequent Cabinet meeting for ratification. The Leader may also take emergency decisions without notice, in particular in relation to the COVID-19 pandemic, which will be ratified at a later Cabinet meeting. Various Cllr Ian Edwards - Leader of the Council TBC C - Democratic Services TBC Public / Private CABINET MEMBER DECISIONS: Standard Items (SI) that may be considered each month Cabinet Member Decisions expected - April 2025 Cabinet meeting - Thursday 22 May 2025 (report deadline 2 May) Cabinet Member Decisions expected - May 2025 5 Ref Scheduled Upcoming Decisions Further details Ward(s) Final decision by Full Council Cabinet Member(s) Responsible Relevant Select Committee Directorate / Lead Officer Consultation related to the decision NEW ITEM Public or Private (with reason) SI = Standard Item each month/regularly Council Directorate/Service Areas: AS = Adult Services & Health P = Place C = Central Services R = Resources CS= Children's Services D = Digital & Intelligence SI Release of Capital Funds The release of all capital monies requires formal Member approval, unless otherwise determined either by the Cabinet or the Leader. Batches of monthly reports (as well as occasional individual reports) to determine the release of capital for any schemes already agreed in the capital budget and previously approved by Cabinet or Cabinet Members TBC Cllr Martin Goddard - Finance (in conjunction with relevant Cabinet Member) All - TBC by decision made various Corporate Finance Public but some Private (1,2,3) SI Petitions about matters under the control of the Cabinet Cabinet Members will consider a number of petitions received by local residents and organisations and decide on future action. These will be arranged as Petition Hearings. TBC All TBC C - Democratic Services Public SI To approve compensation payments To approve compensation payments in relation to any complaint to the Council in excess of £1000. n/a All TBC R - Iain Watters Private (1,2,3) SI Acceptance of Tenders To accept quotations, tenders, contract extensions and contract variations valued between £50k and £500k in their Portfolio Area where funding is previously included in Council budgets. n/a Cllr Ian Edwards - Leader of the Council OR Cllr Martin Goddard - Finance / in conjunction with relevant Cabinet Member TBC various Private (3) SI All Delegated Decisions by Cabinet to Cabinet Members, including tender and property decisions Where previously delegated by Cabinet, to make any necessary decisions, accept tenders, bids and authorise property decisions / transactions in accordance with the Procurement and Contract Standing Orders. TBC All TBC various Public / Private (1,2,3) SI External funding bids To authorise the making of bids for external funding where there is no requirement for a financial commitment from the Council. n/a All TBC various Public SI Response to key consultations that may impact upon the Borough A standard item to capture any emerging consultations from Government, the GLA or other public bodies and institutions that will impact upon the Borough. Where the deadline to respond cannot be met by the date of the Cabinet meeting, the Constitution allows the Cabinet Member to sign-off the response. TBC All TBC various Public The Cabinet's Forward Plan is an official document by the London Borough of Hillingdon, UK 6

Health and Social Care Select Committee – 24 July 2024 Classification: Public WORK PROGRAMME Committee name Health and Social Care Select Committee Officer reporting Nikki O’Halloran, Democratic Services Papers with report Appendix A – Work Programme Ward All HEADLINES To enable the Committee to note future meeting dates and to forward plan its work for the current municipal year. RECOMMENDATION That the Health and Social Care Select Committee: 1. considers the report and agrees any amendments; and 2. agrees one major review topic and up to three single meeting review topics. SUPPORTING INFORMATION The meeting dates for the 2024/2025 municipal year were agreed by Council on 18 January 2024 and are as follows: Meetings Room Wednesday 19 June 2024, 6.30pm - CANCELLED TBA Wednesday 24 July 2024, 6.30pm CR5 Wednesday 11 September 2024, 6.30pm CR6 Wednesday 9 October 2024, 6.30pm* CR5 Tuesday 12 November 2024, 6.30pm CR5 Thursday 23 January 2025, 6.30pm CR5 Tuesday 25 February 2025, 6.30pm CR5 Wednesday 19 March 2025, 6.30pm CR5 Tuesday 29 April 2025, 6.30pm** CR5 At the Health and Social Care Select Committee meeting on 22 May 2024, it was agreed that the Democratic, Civic and Ceremonial Manager liaise with the Chair to schedule a new meeting date in October 2024*. This meeting has been arranged for Wednesday 9 October 2024. Furthermore, it has been suggested that the meeting scheduled for Wednesday 23 April 2025 be rearranged for Tuesday 29 April 2025**. Future Review Topics At the meeting on 22 May 2024, Members were asked to identify possible review topics. It was agreed that ideas for possible topics be forwarded to the Democratic, Civic and Ceremonial Manager before the next Committee meeting so that they could look to shortlist one major review topic and up to three single meeting review topics at this meeting. Health and Social Care Select Committee – 24 July 2024 Classification: Public Implications on related Council policies The rol e of the Select Committees is to make recommendations on service changes and improvements to the Cabinet, who are responsible for the Council’s policy and direction. How this report benefits Hillingdon residents Select Committees directly engage residents in shaping policy and recommendations and the Committees seek to improve the way the Council provides services to residents. Financial Implications None at this stage. Legal Implications None at this stage. BACKGROUND PAPERS NIL.

2024/25 2025/26 May June (CANCELLED) July August September October November December January February March April May 22 19 24 No meeting 11 9 12 No meeting 23 25 19 29 No meeting Review A: ??? Topic selection / scoping stage Topic Selection Selection Scoping Report Witness / evidence / consultation stage Witness Session Witness Session Findings, conclusions and recommendations Findings Final review report agreement Final report Target Cabinet reporting Cabinet Review B: ??? Single Meeting Review Review C: ??? Single Meeting Review Regular service & performance monitoring Quarterly Performance Monitoring X Annual Report of Adult and Child Safeguarding Arrangements Carers Strategy Update (prior to Cabinet) Older People's Plan Update (prior to Cabinet) Mid-year budget / budget planning report (July/September) X Cabinet's Budget Proposals For Next Financial Year (Jan) X Cabinet Member for Health and Social Care X X Cabinet Forward Plan Monthly Monitoring X X X X X X X X X One-off information items Public Health Update Autism Strategy Consultation X Crisis Recovery House Update Family Hubs Carer Support Services - Cabinet report (079) X Commissioning Model for delivery of health and social care services X Adult Social Care Market Position Statement MOVED TO JULY X Health External Scrutiny Police & Mental Health Attendance at A&E X Mount Vernon Cancer Centre Strategic Review Update X Hillingdon Hospital Redevelopment Update Health Updates X X X Quality Accounts (outside of meetings) X Past review delivery Review of Children's Dental Services 2021/22 X Making the Council more autism friendly 2020/21 X CAMHS Referral Pathway 2023/24 X Health & Social Care Select Committee MULTI-YEAR WORK PROGRAMME