There has been a strong focus on Measles across London and our patch is no exception. Vaccine hesitancy is recognised nationwide as a significant challenge.

Engagement with community groups is taking place, building on earlier work and with a focus on Ealing and Brent.

In Ealing, conversations were held with Somali community groups to answer questions about the vaccine. There was also coverage in Ealing News. The engagement team spent time with the baby group at Uxbridge family hub to talk about immunisations and shared information at the Health & Inequalities Roadshow in Northolt.

In Brent, Immunisation coordinator Rebecca Wilson joined Brent’s Cllr Nerva, the Cabinet Member for public health and adult social care, and Rhoda Ibrahim, director of local Somali Women’s charity SAAFI, to talk to the BBC politics show about work on the ground to support communities with the MMR vaccine.

A dedicated NW London Measles webinar was attended by over 260 people. This work will continue to be a priority and work is going on at national level to address the challenge of vaccine hesitancy.

We have now completed the ‘engagement’ phase of our organisational design programme. We received over 1,000 pieces of feedback and we would like to thank everyone who has responded.

A number of changes are being made to our draft proposals following the engagement feedback. Our local care and acute trams are merging into a single team, as are performance and planning. Additional resource has been found for clinical leadership. Each director is reconsidering their draft structure in light of the comments received as we develop final proposals for consultation with affected staff. 

We will also be consulting staff on a proposal to reduce the number of ICB offices to three: reduced space at Marylebone Road, plus office at Heart of Hounslow and Sudbury House. 

We expect staff consultation to start in mid-February and run for 30 working days.

The Barriers to Leadership project within our Addressing Structural Racism work stream has delivered its preliminary report, based on findings from listening circles, 1:1 interviews and the survey. The stakeholder engagement is beginning to share the findings and agree an action plan.

The Population Health Management (PHM) Academy is up and running, and training dates have been set for initial cohorts from February to June in co-production and Health Economics / Value-based Care. There will be traditional applied learning sessions, drop-in clinics and peer support options, providing access to real time support for those actively doing work in these areas.

In our healthy living programme, the ICB is encouraging our residents to consider stopping smoking in line with the NHS’s Better Health campaign. The Integrated Care Partnership have identified cross-system priorities for prevention as child oral health, cancer screening, and vaccination and immunisation. We are working with partners across public health and the NHS on these, with a focus on how we can tackle inequalities in outcomes and uptake.

Significant progress that has been made over the past year around volunteering, and a paper was presented at the ICB Board meeting, including an update on:

· Volunteer to Career initiative, which aims to enhance diverse, local NHS recruitment;

· Back to Health initiative, which supports people in areas of deprivation who are on the waiting list or recently discharged to avoid readmission and reduce DNAs; 

· Refugee and SEND volunteering initiatives that aim to enhance inclusivity by providing volunteering opportunities within health sector for refugees, asylum seekers without work rights and individuals with special educational needs and disabilities.

The paper includes real life insights and feedback showcasing the profound impact on individuals, staff and patients. 

The paper also outlines the work carried out to embed the voluntary sector as an effective and strategic partner within the ICS. 3ST (Third Sector Together) are now a legal entity and has representation on system boards. Infrastructure building work is looking to improve the communication with VCS organisations and support smaller organisations to work with us, and developing an impact framework so that we can better understand the impact of initiatives on key metrics.

The Anchor Programme in partnership with West London Alliance is hosting an Employment Expo (Job fair) at the Brent Civic Centre on the 9th February 2024 to attract people from the Core20Plus communities to gain employment across the sector.

There is ongoing work looking at the health of the Core 20 population, specifically the prevalence of long term conditions (LTC). This shows that the Core 20 group has a higher prevalence of LTCs compared to the other 80, and mental health and learning disability prevalence have the greatest difference between the two groups.

NW London was represented at the first Women’s Health Summit.  Key note speakers included the Rt Hon Victoria Atkins MP and Dame Lesley Regan as the National Women’s Health Ambassador. Women’s Health Champions from across the country were in attendance, with best practice and innovation being shared, which will be fed into the NW London ICS development of plans to improve access to women’s health care.

Consultation continues on the future shape of acute mental health services in Westminster and Kensington and Chelsea. There has been a good deal of public engagement activity and we have agreed to extend the consultation to allow more time for responses.

NW London and Rethink Mental Illness have been shortlisted for a Health Service Journal (HSJ) Partnership Award in the category of Best Mental Health Partnership with the NHS. The shortlisting panel highlighted the quality of this partnership’s work with Experts by Experience to develop an effective suicide prevention approach. 

As part of our suicide prevention activities with Rethink Mental Illness, a facilitated workshop about suicide prevention amongst black men will take place at the National Suicide Prevention Alliance conference on 31 January. This will be delivered in collaboration with two additional voluntary sector partners working with this cohort: Man On! Harrow, and Breaking the Silence.

NW London has commissioned a service to support people with a learning disability to co-design some services. The provider will facilitate expert reference groups and co-delivered training to enable the ICS to draw on the lived experience of people with a learning disability to better plan and adapt mainstream services to reduce health inequalities and improve outcomes and access for this population.

NW London ICB has recently reviewed its service specification and is now conducting a procurement for Any Qualified Provider (AQP) Audiology services across seven NW London boroughs. The services provide hearing loss assessments and fitting/maintenance of hearing aids for adult patients. Contracts are due to be awarded to successful bidders in March, and work is also in progress to expand the service to all eight boroughs.

The bridging service is live in all eight boroughs and there has been great work collaboratively across the sector looking at increasing utilisation- this work from the Discharge team will support the flow in our hospitals over the winter.

NW London Virtual hospital has had the highest number of admissions since the programme began, and is now sitting at 51% utilistaion - this has been a difficult and intensive change in the way we manage patients who are acutely unwell- great work from the Virtual wards team and our system partners.

The palliative care team have been undertaking local borough engagement events with the proposed new model of care for adult (18+) community-based specialist palliative care services across the whole ICS. There has been strong engagement and the proposed model has been really well received.

Following the RM Partners run insight gathering with local populations and communities, insight commission and feedback over July and August 18 local and voluntary organisations have been directly commissioned to address the barriers to accessing cancer screening. The ask is for them to develop resources and approaches, working with their communities to address these barriers to screening and target the intervention to support individuals to take up the offer of screening when invited. This is a key ambition of the early diagnosis programme for cancer to support residents to participate in the national screening programmes, especially in communities which are historically underrepresented.

NW London ICB has recently set out a commitment to reducing waiting lists for our children and young people across a range of services, where there are known significant waits and pressures. There are further areas of improvement needed across the ICS, however the benefits of the funding being made available will take start to take effect as we increase our staffing capacity to reduce down waiting lists.

This includes funding to reduce waiting lists for children's therapies services across Harrow, Hillingdon and Hounslow as well as looked after children's services across all outer North West London boroughs. We have also committed funding to Harrow MASH (Multi Agency Safeguarding Hub) and asthma support in Brent schools.

In line with the refresh of the Children and Young People’s Mental Health Transformation Plan, options to ensure that all schools in NW London can access school-based mental health support in 2024/25 have been discussed by the CYP Mental Health Steering Group. The ambition is to ensure that any child in NW London can access mental health support at their school if they need it – this will support earlier identification of needs, thereby improving outcomes.

A workforce inequalities metric has been now added to the ICB performance report. This aims to monitor the ICB ambition to ensure BAME staff are promoted equitably, with a target of ensuring 50% of the workforce band 7 and above are BAME by March 2025. Performance is increasing with 42.1% of staff band 7 and over within a BAME group, against a local target by year end of 45%.  This is being achieved through a range of workforce initiatives, targeted training packages, and ensuring recruitment is equitable.

The local target is for 60% or more of people with diabetes to have received the nine care processes in the last 15 months. NW London performance and all boroughs are performing above the targeted trajectory. 

80% of eligible female patients to have received Cervical Cancer Screening within the last 3.5 years for ages 25-49. Cervical screening (aged 25-49) rate is at 57.7%, lower than the London average of 60.9%. Variation between borough performance with outer boroughs (average 60%) performing better than inner boroughs (average 53.8%). 

In November, 51.4% of children (17 or under) with asthma, have had a completed asthma check against a 48% target. NW London performance for, H&F (39.5%) and Hillingdon (47.3%) are currently not meeting target although there has been improvements across all boroughs.  

42% of people over the age of 14 on a doctor's learning disability register should have had an annual health check (by November 2023). This is an accumulative target. Performance was at 44% in October meeting the target, however there is variation of 34% in Hammersmith & Fulham to 50% in Westminster.  

66.7% of those aged 65 years and over estimated to have dementia should have a coded diagnosis of dementia. Performance at 63.6% against England average of 62.2%.

60% of people with severe mental illness (SMI) should have received a full physical health check. NW London performance is at 67.9%, with all Borough apart from H&F (57.5%) achieving target rate. 

The local target is for 90% of urgent rapid response referrals to be seen within 2 hours (national target 70%). NW London performance is at 93% with all borough meeting or exceeding target. 

No greater than 11.2% of patients admitted into hospital will have a length of stay of 14 days or more and no greater than 5.9% of patients admitted into hospital will have a length of stay of 21 days or more, targeting improvement of 5% from previous year. Discharge of 14+ days and 21+ days remains a challenge with performance below targets however 14 + day performance has improved in recent months.  

The Brent Health Matters (BHM) pharmacy team were shortlisted for HSJ 2023 awards in category of Medicines, pharmacy and prescribing initiative of the year a ‘record-breaking’ 1,456 nomination entries were received for this year’s awards. The nomination ‘Mind The Gap: The pharmacist’s role in reducing health inequalities’ reflects the fantastic impact pharmacists have on reducing health inequalities by supporting people to get the most from their medicines and stay well.

By engaging with patients who are “lost” in the system, either through non-engagement or other reasons, the team builds a rapport and tailors healthcare to individual needs via a holistic approach. Through effective signposting, the team continually strives to close the ever-increasing gap on health inequality. As BHM pharmacists, they provide medicines reconciliation, structured medication reviews and medicines support services to patients.

There are huge cost-savings attributed to the work that the team do. For example, stopping unnecessary medications, prescribing more cost-effective medications, and informing GP practices of major non-adherence all contributes to saving money and improving the quality of life of patients.

Following SCC approval of the revised Estates Strategy, the ICB Estates team are working with Boroughs, Trusts, local authorities and a number of other key ICS stakeholders to continue developing an underpinning delivery plan over the next 5-10 years.

Work continues with local authorities and NHS stakeholders to inform the eight infrastructure delivery plans (IDPs), ensuring alignment to our overarching strategic ICS priorities, inequalities projections and population needs. ICB Estates continue to work with partners and local authorities to review available and expiring s106 (a developer contribution) and CIL (Community Infrastructure Levy) funding. So far, significant sums are in the process of being bid for, secured and allocated to estates activity.

Expressions of interest for 24/25 London Improvement Grant (LIG) funding closed in November 2023. The Estates team are now working with Primary Care teams across boroughs to finalise supported schemes which can progress to NHSE’s due diligence phase. The grant offers funding for GP practices to improve the condition of premises as aligned to the Estates Strategy and Six Facet Condition Survey recommendations.

Following Executive approval, HQ estate rationalisation activity is underway across NW London boroughs. A hub and spoke HQ model across MBR, Heart of Hounslow and Sudbury Health Centres continues to be progressed.

A new Community Diagnostic Centre (CDC) in Wembley is close to completion. This follows the recent opening of another CDC at Willesden Centre for Health last year. These new facilities form part of a wider hub and spoke model being delivered by Imperial College Healthcare Trust across Brent and Ealing. 

The Estates team are exploring opportunities with ICS stakeholders to repurpose existing space to improve service offerings and accessibility to healthcare for communities, whilst reducing vacant and unused bookable at Heart of Hounslow, St Charles, Alexandra Avenue, Willesden Centre for Health, Feltham and other locations.

Work continues to expand primary care offerings at Grand Union Village Health Centre, Ealing, and at the refurbished old vinyl factory in Hillingdon. Both projects are set to complete by quarter 3 of the next financial year. Work also continues on the Chiswick Health Centre Rebuild in Hounslow, which will offer over 2,348 sqm of multi-service healthcare in improved, fit-for-purpose and compliant premises.

Ealing Care Homes Summit for End of Life Palliative Care was well attended by local care homes and colleagues from LNWUHT, ECP, WLT, Meadow House, Ealing borough team and the local authority Local Authority. 

There was a really good mix of nursing homes and residential homes. The summit was held to listen to the experience of care homes in managing patients who are at the end of life and to increase the awareness of the support available to them in the community. 

We had very open and honest discussions and that led to clear actions for Ealing BBP partners to take away and to work on which include specific support to smooth out the pathway for residential homes in particular to administer pain relief medication as quickly as possible and refresher training on areas such as End of Life decisions, Palliative care communications, Emotional support, Pain Management and others. The team will follow up on these actions in the monthly steering group. 

Interim findings on the Man Van pilot has shown that the pilot detected 16 people with confirmed prostate cancer that may not have otherwise been found. Potentially resulting in earlier detection and better health outcomes, these patients can now get the treatment, help and support they need. 

Ealing BBP has been working to establish 3 Integrated Neighbourhood teams across the borough.  Given the experience over the last 2 years of developing the leadership and operational teams the partnership wanted to share its experiences and the challenges in making such a programme a reality with the International Conference for Integrated Care 2024 (ICIC24) which is being held in Belfast in April this year.  The 3 teams cover:

• Central and East of Ealing

• North Ealing

• Southall

Central to the success of the Ealing INT initiative is the cultivation of a shared vision and a comprehensive understanding among all partners of the potential benefits and challenges for all. Developing inter-organisational partnerships emerges as a pivotal strategy, fostering an environment where all partners are regarded as equals. The INT approach supports preventive action with the incorporation of population health data to support the identification of priorities based on the needs of the local population, which allows for localisation whilst working collectively to improve outcomes and reduce inequalities.  

During 23/24, whilst each INT has had its own priorities, there have been collective priorities in establishing the IT infrastructure to allow the teams to work effectively together along with a focus on people who are identified as High Intensity Users of services.

The first round of Research Equalities Network (REN) funding has successfully engaged with a wide range of people across different boroughs. The second round of funding will be based on a data-driven approach within Hillingdon, focusing on Hypertension within each PCN and will be delivered through a roadshow model to support wider engagement which Hillingdon have implemented very successfully.

To avoid duplication, patient fatigue and staff fatigue with roadshows, Hillingdon have teamed up with the Confederation to combine this with what would have been the Winter PCN health roadshows. A total of 5 roadshows are going ahead over the coming months with a focus on the hypertension education element that is being delivered by a MyHealth clinical facilitator, by focussing more on education we hope this will inform patients when going to get their BP/BMI read at the PCN stall.

(The Research Equalities Network (REN) project, a NW London wide project between NHS England and the Imperial College to engage with minority communities and residents around barriers they have towards taking part/engaging with research as well as tying into health inequalities.)

NW London recently set out a commitment to reduce waiting lists for our children and young people across a range of services, where there are known significant waits and pressures. There are further areas of improvement needed across the ICS, however the benefits of the funding being made available will take start to take effect as we increase our staffing capacity to reduce down waiting lists.

This includes funding to reduce waiting lists for children's therapies services across Harrow, Hillingdon and Hounslow as well as looked after children's services across all outer North West London boroughs. We have also committed funding to Harrow MASH (Multi Agency Safeguarding Hub) and asthma support in Brent schools. 

Hillingdon Local Authority and the ICB have been working together to identify additional funding to help reduce waiting times for Speech and Language Therapy (SaLT), and Occupational Therapy (OT) for children and young people in Hillingdon. Meeting the needs of children and young people and tackling the increased waiting times that are the result of an increase in demand, and delays arising from the impact of the Covid pandemic, remains a high priority for both organisations, and we continue to work together with our Providers to ensure we can respond creatively and effectively. Further funding being provided will be used to fund additional therapeutic support between now and April. The Local Authority, ICB, and CNWL, continue to work collaboratively looking at longer term solutions to meet the growing demand, so that children and young people can continue to have their needs met in a timely way.

A project that identified people with undiagnosed hypertension by conducting blood pressure checks in barber shops, hair salons, and nail salons was recently awarded the Most Innovative Project at the CLCH Quality Improvement Event. It has also been chosen as one of three projects to be showcased at the ICHP NW London CVD Innovation Webinar.

Harrow West INT held an engagement event with staff from CLCH, CNWL, voluntary sector, Primary Care, Local Authority and Adult Social Care.  The purpose of the event was to:

• introduce the concept of neighbourhood teams and what we can achieve through them for our staff and citizens;

• understand who is part of the team and have the opportunity to meet each other;

• understand more about the population we are serving;

• explore opportunities where staff can make a difference as a neighbourhood team