The Health and Wellbeing Board met on Wednesday 17 June 2026 to discuss the integrated health and wellbeing performance report, the joint health and wellbeing strategy update, and the Better Care Fund plan. Key discussions included improvements in hospital flow and discharge, mental health crisis care, and community-based services, alongside challenges in A&E demand and hospital bed days. The Board reviewed feedback on the draft Joint Health and Wellbeing Strategy and was asked to approve the Better Care Fund plan for 2026/27.

Integrated Health and Wellbeing Performance Report and Service Update

Sean Bidewell, representing the West and North London ICB, presented an update on the integrated health and wellbeing performance, highlighting tangible improvements in several areas. Hospital flow and discharge have seen positive changes, with more people able to leave hospital safely and promptly. The Lighthouse service, which provides mental health crisis care, has seen a significant increase in patient numbers, with the majority being supported back home within 24 hours. Care closer to home has also been enhanced through initiatives like the mobile diagnostic service, which allows tests to be conducted in patients' homes.

Despite these improvements, challenges remain. Hospital demand, particularly A&E attendances, continues to be above target, with an 8% increase in activity in April. The length of stay for some patients in hospitals is also longer than planned. Work is ongoing to improve performance in managing long-term conditions, such as hypertension, with a delivery plan in place to meet the target of 16% by December.

The report also detailed year-on-year reviews, showing significant increases in the volume and use of primary care appointments, contributing to managing patients within primary care and reducing hospital pressure. Urgent emergency care has seen improvements, with a reduction in daily patient numbers and better treatment times. Same-day emergency care has grown significantly, and there has been a reduction in emergency department attendances and admissions for care home residents and vulnerable groups.

Integrated Neighbourhood Teams are now operational across all localities, bringing together GPs, community services, mental health, and social care. The Reactive Care programme has seen significant changes, including the introduction of a coordination hub and an enhanced urgent community response service. In the Best Start in Life initiative, there has been a notable improvement in reducing the neurodevelopmental waitlist, and the expansion of mental health support teams in schools is ongoing. The Thrive website, a central online hub for children's and young people's mental health support, has also been launched.

Gary Collier, the Council's Health and Social Care Integration Manager, provided further details from the end-of-year reporting template submitted to NHS England. While the target for emergency admissions for the 65-plus population was not met, the council came close. Discharge delays showed a mixed picture, with the percentage of people discharged on their ready date not met, but the number of delayed days exceeding targets. The target for permanent admissions to care homes was achieved. Financially, expenditure was 98% against plan, with a £1.9 million underspend in the disabled facilities budget. An additional allocation of £446,000 was received in quarter four. There was an overspend of £671,000 in the NHS additional allocation due to increased costs for the community equipment contract.

During the discussion, Councillor Sandra Taylor raised concerns about the increase in A&E attendances, questioning the reasons behind it. Sean Bidewell explained that the increase was not sustained and was being analysed by primary care networks. He believed that some patients were not using available services and were going directly to the hospital. Alan, from The Hillingdon Hospitals NHS Foundation Trust, acknowledged the improvements made by Hillingdon Hospital in its A&E performance, noting it was among the best in London. He also highlighted a significant increase in footfall across North West London, with no clear narrative for the cause.

Sharon Stoltz commented on the need to review prevention services, suggesting a focus on midlife to encourage independence and delay frailty. She also celebrated the success of the Best Start in Life initiative, noting that Hillingdon was outperforming North West London, but expressed concern about its short-term, non-recurrent funding. Amanda Carey-McDermott added that there was capacity to book urgent same-day appointments and redirect from urgent care centres, but that some cultural norms in specific neighbourhoods led to direct hospital visits.

Councillor Susan O'Brien asked about the manageability of current priorities and the likelihood of achieving them by September. Sean Bidewell expressed confidence in the existing plans, noting progress in sustaining No Criteria to Reside targets, translating frailty into bed-day reductions, mobilising the reactive care hub, and initiating hospital to community transformation.

Joint Health and Wellbeing Board Strategy Update

Gary Collier presented an update on the draft Joint Health and Wellbeing Strategy 2026-2031, which sets out the direction for supporting residents' health and wellbeing. The consultation, involving residents and professionals, received overwhelmingly supportive feedback. Key themes from residents included concerns about joined-up care and communication, inconsistent access to timely help, digital exclusion, and quality and accountability of private providers. Residents were supportive of local hubs but sought clarity on access and transport. Carer support and advocacy were also raised as areas needing better awareness.

Proposed amendments include changing the Best Start in Life heading to Start Well to align with the World Health Organisation's life-course model, and refining Key Performance Indicators (KPIs), such as increasing the percentage of infants exclusively breastfed at 6-8 weeks to 70%. The report recommended that the Board note the consultation outcomes, approve the proposed amendments, and delegate authority to the Corporate Director of Adult Social Care and Health to approve the final strategy.

During the discussion, Councillor Keith Spencer noted that the feedback was consistent with long-standing issues and highlighted a tension between building services around residents and meeting staff needs. Samreen Nawshin, Operations Manager at Healthwatch Hillingdon, resonated with the findings on repeated stories and the gap in joined-up services, emphasizing the need for specific actions to improve communication and measure progress from a patient perspective. Keith Spencer further elaborated on the cultural resistance to breaking down barriers and the challenges of implementing a one referral model. Dr Amanda Carey-McDermott agreed, highlighting successful multi-disciplinary team meetings for frailty and the ongoing trial of a new referral process. Councillor Sandra Taylor suggested creating a common strategy for publicising how residents can access services.

The Board was asked to note the consultation outcomes, approve the proposed amendments, and delegate authority to the Corporate Director of Adult Social Care and Health to approve the final strategy.

2026/27 Better Care Fund Update

Gary Collier provided an update on the Better Care Fund (BCF) plan for 2026/27, noting that the total value of the plan increases to £76.3 million. This includes a 4.4% increase in the NHS minimum contribution to adult social care. The plan is shaped by three key drivers: the full-year effect of savings from the 2024/25 BCF review, the impact of inflation on provider costs, and the priority of shifting care from hospitals to the community (left shift ).

The priorities within the plan align with those previously discussed, focusing on admission prevention rather than acute care. The three national metrics for 2026/27 remain the same: emergency admissions for those aged 65+, discharge delays, and permanent admissions to care homes. Targets have been set to be achievable. The report also included a summary of the Equality and Human Rights Impact Assessment, identifying actions to be delivered.

Regarding finances, underspends from 2025/26, such as in the disabled facilities grant, count against the local authority's additional contribution for 2026/27.

Gary Collier also mentioned potential future changes to the BCF, with consultation expected in autumn 2026, possibly leading to its incorporation into neighbourhood health plans from 2028/29. He suggested reviewing the current BCF spending in light of potential national changes and its alignment with ICB investments.

The Board was asked to approve the 2026/27 Better Care Fund Plan, delegate authority for amendments, and note the actions from the Equality and Human Rights Assessment.

Occupational Therapy Service Update

Gary Binstead provided an update on the Occupational Therapy (OT) service for children with Special Educational Needs and Disabilities (SEND). He reported that despite national shortages of OTs, Central and North West London NHS Foundation Trust (CNWL) would have fully recruited to its OT service by the end of June. All young people had received their due contacts year-to-date. The report highlighted that funding had been secured until the end of June 2026 to address the backlog, and recruitment efforts were ongoing.

Councillor Susan O'Brien noted concerns raised by residents regarding OT provision and expressed hope that funding and workforce issues would be resolved. The discussion also touched upon the increasing demand for EHCPs and the need for clear commissioning arrangements. The SEND reforms were mentioned as a factor that would influence future demand for therapies.

A joint strategic needs assessment (JSNA) for SEND was proposed to support the SEND reforms and commissioning work. This would be a new style of JSNA, incorporating data and customer experience.

The Board was asked to note the update on the occupational therapy service and welcome the progress shown.

Board Planner and Future Agenda Items

The Board discussed its planner and future agenda items. It was agreed that the results of the consultation on the Joint Health and Wellbeing Strategy, an update on the 2026/27 Better Care Fund Plan, and an update on the occupational therapy service would be included in future meetings. The Board also agreed to discuss the SEND reforms and the place operating model.

The meeting concluded the public part of its proceedings.