September has been a significant month in ICB transition, as our teams moved in to their new structures.

I want to thank colleagues across the system for your support and understanding during our period of organisational design and transition.

I am attaching a brief slide deck about the ICB, which has also been shared with all our staff. It includes:

• A core narrative that we will use to explain to others what we do
• The 9 ICS priorities set out in our Joint Forward Plan
• Our operating model and related new ways of working
• Our updated values, developed with the OD Staff Engagement Group following feedback that the previous values were too wordy
• Background information about North West London.

I hope that this is helpful and look forward to working with you in our new organisational form.

As part of our organisational redesign, the local care team is merging with the UEC and Elective (planned) Care Teams to form the Integrated Pathways Team. This merger will enable integration of work and efforts across acute and community planned care, urgent and emergency care and discharge, and business operations - leading to more effective end to end focus on improving pathways across acute and out of hospital care. 

All of NW London NHS Trusts are accredited as London Living Wage Employer. LNWHT accredited in September 2024.​ We are the first London ICS to achieve this.

In order to address inefficiencies and overlap between Gold meetings and the UEC Board and Clinical Advisory Group, the following changes are being made to the governance of urgent and emergency care in North West London.

• Creation of a monthly System Flow Optimisation Board, driven by data from Business Intelligence, to oversee system flow with a focus on operational delivery and feeding into strategic decisions
• The UEC Board will now meet quarterly with a focus on strategic issues rather than operational updates
• Gold meetings will only take place during incidents such as for long emergency department waits or ambulance handover delays.

The ICB is working with local GPs and primary care networks to improve access to primary care services.

Plans developed earlier in the year with a focus on ‘same day access’ to services have been reconsidered following concerns expressed by some patients and GPs. We recognise, however, that access to primary care – including getting GP appointments - is often a challenge for residents and patients – indeed, it is the issue people raise with us most consistently when we talk to local communities.

Under the new plans, each of our 45 primary care networks will be invited to hold at least two events to discuss access to services with their patients and local communities. Our expectation is that one event would be face to face and one would be virtual. These events will be preceded by a survey sent out by practices to their patients, with the aim of getting a clear picture of patient experience in each area. The surveys will be supplemented by feedback from our community outreach work and input from other bodies who talk regularly to the public, including Healthwatch and voluntary sector organisations.

Shaw Trust has mobilised their employment advisers in the Talking Therapies service, in partnership with CNWL and West London NHS Trust, providing support to residents with common mental health needs who are looking for employment, unable to work due to sickness or facing difficulties in workplace. 93% of their staff (39 employment advisers/senior employment advisers) are in post and have begun supporting people resulting in 74 people engaging with the service and seven people gaining employment.

Work has started to draw on the views and experiences of people with lived experience and our voluntary sector partners to shape a service specification for a NW London peer-led support service for autistic and ADHD children and young people and their families. The service will be based on the recommendations from a scoping and engagement exercise completed in the third quarter of 2023/24 and aim to improve the diagnostic pathway by providing support for children and young people and their families, to wait well and to understand their diagnosis and what it means for them.

ICB funding is supporting a Harrow Early Supported Discharge Service for stroke patients (newly diagnosed with mild to moderate impairment), operated by London North West University Healthcare NHS Trust, as well as establishment of community-based specialist neuro-rehabilitation provision within the existing community rehabilitation service. The service is due to commence in September 2024 and will provide much needed care in the community for stroke patients, regardless of disability. The service will offer a holistic, coordinated pathway supporting the long-term needs of stroke patients and their carers/families.

The NW London Big Case Find supported the detection of hypertension, with 12 primary care networks completing a three-week campaign focused on blood pressure recording and engagement with patients in high-risk hypertension groups. They recorded 575 blood pressure readings, identified 149 cases of high blood pressure and engaged with 131 high-risk patients and 94 under-engaged patients.

We have launched a comprehensive digital platform to manage long-term conditions (LTCs) like cardio-vascular disease (CVD) and diabetes for 610,000 residents. The platform, featuring Know Diabetes (KDS), My Health London (CVD), and Preventing Diabetes (PD), has 50,130 registered users - 72% from BME backgrounds and 5,227 from deprived areas. It provides easy access to medical records, self-monitoring tools, and educational resources, empowering patients to effectively manage their conditions.

1. Know Diabetes Service (KDS): https://www.knowdiabetes.org.uk/
2. My Health London (CVD): https://www.myhealthlondon.nhs.uk/ 
3. Preventing Diabetes (PD): https://www.preventingdiabetes.org.uk/ 

Aligned with the NHS Long Term Plan, we are actively supporting NHS providers in delivering pulmonary rehabilitation to improve outcomes for chronic respiratory patients. This programme integrates exercise, education, and support to enhance breathing and quality of life. In NW London, referrals have increased by 37.5% compared to Q1 last year, with 346 completions - a 31.06% rise.

NHS NW London is the first ICB to go live with a pilot enabling London Ambulance Service Crews on scene with patients to directly refer appropriate patients into Pharmacy First for the specified seven clinical conditions. The pilot has been a collaborative approach between London Ambulance Service, Local Pharmaceutical Committee and NHS NW London. Once evaluated, if successful, the aim is to continue thus as business as usual in NW London then look to roll out across other areas of London.

Our utilisation of our virtual wards is now the best in London at 77% utilisation, compared to London average of 67% and national average of 72%. This is on the back of plans set out by trusts and local care to meet KPI targets and continue to drive improvements. A virtual ward allows patients to get the care they need at home safely and conveniently, rather than being in hospital.

One-off personal health budgets are available to provide people with the support they need to leave hospital safely. The personal health budget should enable earlier discharge by at least two days and be agreed between patient and or carer and the person responsible for the discharge. Within NW London all four hospital Trusts are using one off discharge personal health budgets, with an average of 4 bed days being saved per patient that would otherwise still be in hospital when they are ready to be discharged. Lesley Watts will be presenting this work nationally on a call with the Secretary of State, Wes Streeting.

Colleagues from the Hounslow Borough Based Partnership (BBP) came together for a workshop to share the findings from the voluntary and community sector (VCSE) led engagement on Core20Plus5. Over the last year, the borough-based partnership has conducted data analysis to build an understanding of our Core20Plus5 cohorts including who they are and their met and unmet health and wellbeing needs.

In addition, 9 VCSE groups were funded to speak to residents in these areas to gather their views on what impacts health and wellbeing, and what could help improve their lives. The work from the data analysis and the VCSE groups has provided deep insights into the challenges faced by those living in the most deprived areas of Hounslow (CORE20 areas). This event presented the findings from these activities, emphasising the voices of residents. Over 90 people signed up.

Feedback following the event showed that:

• All respondents say they now feel their understanding of Core20Plus5 is high or very high.
• 96% respondents feel confident or extremely confident to apply Core20Plus5 in their own work.
• Everyone felt like they are likely or very likely to apply Core20Plus5 approaches to their work.

Find out more about the project here.

Following an engaging discussion at the Integrated Care Partnership meeting earlier this month, proposals have been developed to increase capacity and build links between local dentists and community organisations, including family hubs, to improve access to dentistry for children and young people and for families living in emergency accommodation. This work will be complemented by an action plan, developed with local oral health leads, to support a whole-systems approach to improving oral health. The final plan, to be agreed across our eight local authorities, includes initiatives aimed at designing information tailored to our communities, training for our workforce, engagement with schools, and work to promote tooth brushing from an early age.

In Westminster, we have expanded health support services within the Family Hubs, strategically located in the most disadvantaged areas. By utilising local authority and ARRS-funded positions, along with Family Health Navigators, we are focusing on reaching the most vulnerable families. Our goal is to ensure they have access to local services, receive early identification for any special educational needs, and are clearly directed to emotional and wellbeing support services.

The successful role out of the pilot model in Westminster has enabled residents to access local dental care, gain awareness of healthy weight and oral hygiene, and receive assistance with the broader social determinants of health, such as housing, finances, food, and employment. Although the pilot programme has been running for a short period, it is already successfully identifying and supporting many families who previously lacked access to necessary support. Building on our success with this delivery model we are now working with our partners in the Royal Borough of Kensington and Chelsea and hope to roll out a similar model in the near future

Following successful delivery of warm hubs which have now transitioned into community hubs, Voluntary Action Harrow have secured additional funding through Cadent’s Centres for Warmth Programme. The core area of funding we have focused on is the issuing of advice, tackling loneliness and isolation, and raising awareness of gas safety to residents in Harrow. Through the funding, an advice partner will be selected and designated centres will be able to provide advice, issue carbon monoxide monitors and provide slow cookers. The centres will run from September 2024 till March 2026.

Over 100 events are taking place in NW London as part of the RM Partners summer grant fund programme. Voluntary and community groups are hosting sessions to improve health and wellbeing and raise awareness of cancer.

All NW London boroughs have activities taking place, including: 

• Health and wellbeing fairs and events
• Get together days to play bingo and chess
• Coffee mornings
• Garba dancing to help elderly women keep fit.
• Sound meditation 

RM Partners began rolling out its lung health check programme into Kensington and Chelsea. Almost all GP practices in K&C have signed up to participate. First invites have been going out in September to patients in the PCNs with the highest smoking rates. They will then go out to all eligible patients (those aged 55-74 with any history of smoking) as the roll out across the borough continues. The project is live in all other NW London boroughs except Westminster and Harrow, with planned roll out to these areas starting in December 2024 and January 2025.

Work continues to conclude the revised NW London Estates Infrastructure Plan and NW London ICS Estates Strategy, with a particular focus on hub development across boroughs and making the most effective use of our existing Department for Health estate. Estates are working closely with local authorities and internal ICS partners to scrutinise data and prioritise projects that will enable ICS priorities, whilst ensuring our estate remains sustainable, fit-for-purpose and provide improved access to health and social care. A first round of internal socialisation took place over August and September with key internal stakeholder groups led by the Estates Senior Responsible Owner and Associate Director of Estates. Further engagement on progress will continue from late September/October.

Following the completion of moves in Hounslow and Harrow, further estates rationalisation activity continues across boroughs this quarter as permanent bases are prepared for the Hillingdon, Brent and Ealing Borough teams.

Work progresses with ICS partners to inform local authority Local Development Plans and their respective Infrastructure Delivery Plans (IDPs). Work has now concluded on Hounslow borough (Aug 2024) and engagement has started for Harrow and Brent.

NHS NW London Estates continue to meet regularly with NHS property companies (NHS PS and CHP) to undertake audits and review occupancy, lease management and charging across all sites. Dedicated work is being undertaken at a number of sites. Feasibility and utilisation studies are commencing at St Charles, Heart of Hounslow, Willesden Centre for Health and The Meadows to explore new opportunities for optimisation and reducing significant void costs to the ICB. 

Estates projects due to complete this financial year include the Hillcrest Surgery relocation and refurbishment (Dec 24/Jan 2025 - Ealing), expansion of primary care and reduction in underutilised space at Grand Union Village (Dec 24 - Ealing), and the delivery of a new primary care facility in South Kilburn (Mar/Apr 25 - Brent).

Applications for London Improvement Grant funding for the 2024/25 financial year are now moving through final due diligence stages towards approval to deliver. Reserve schemes have now been invited to advance through due diligence process, led by the London Estates Delivery Unit (LEDU).

This quarter, the Estates team will welcome their new Director of Estates alongside two new project managers who will begin to work closely with Boroughs and Trusts on the delivery of the strategy.