The Health and Wellbeing Board met on Wednesday 20 March 2024 to discuss updates on the Harrow Borough Based Partnership, health protection, preventative health strategies, and the implementation of the Right Care, Right Person initiative. The Board noted reports on these key areas, with discussions focusing on service integration, public health challenges like measles, strategies for promoting physical activity and preventing falls, and the impact of the new police response model for mental health incidents.

Update from the Borough Based Partnership

Lisa Henschen, Managing Director of the Harrow Borough Based Partnership (BBP), presented an update on the partnership's activities between December 2023 and March 2024. The primary focus during this period was the implementation of the Winter Plan, aimed at ensuring smooth system flow, managing increased demand, and developing robust plans for admission avoidance. Alongside this, the partnership continued to deliver key programmes, including the integration of children and young people's services, integrated neighbourhood teams, and integrated intermediate care services. The Healthy Harrow Programmes are progressing, with planning underway for the Partnership Delivery Programme in 2024/25 and for delegated funding for inequalities in the same year.

The Board sought clarification on the integration of services, with Ms. Henschen advising that it was working effectively in some areas, particularly for older people's services, but that further embedding of changes was needed for seamless integration. The geographical element of social care referrals was discussed, with the advice that referrals are linked to patients' GP registrations. Regarding pressure on reducing pathway discharges, an update on discharge rates, including the impact on Harrow and specifically discharges from Woodland Hall, will be provided in April 2024, as data is reported weekly. The Board also inquired about the reporting of outcomes, such as children's tooth decay, and mitigation programmes. It was explained that A&E attendance for children under 12 and other indicators are used, and a supervised dental programme in schools is helping to reduce tooth decay.

Health Protection Update

The Board received an update on health protection in Harrow, a core public health function focused on protecting individuals, groups, and populations from infectious diseases and outbreaks. A significant concern highlighted was the presence of measles, with approximately 650 cases in London and 19 confirmed in Harrow, including a recent case in a school. Low Measles, Mumps, and Rubella (MMR) vaccination rates among children were identified as a key reason for infection. Outreach programmes and vaccination clinics at schools are being implemented in affected areas, showing encouraging uptake.

Regarding flu vaccinations, the eligibility criteria remain the same as the previous year, and at-risk residents are encouraged to get vaccinated. The Board questioned the difference in timing between national and London-specific measles vaccination programmes, and was informed that while national campaigns may not always align with local initiatives, both aim to reduce infection. It was also noted that North West London has the highest number of measles cases among children, with Harrow, Brent, and Ealing being the most affected, partly due to demographic factors influencing targeted messaging for vaccine uptake. The Board proposed using methods like the Gold Bulletin newsletter, distributed to schools, to encourage vaccine uptake. The Chair requested that the Director of Public Health Partnership liaise with the Communications Team to include information on these proposals in the Gold Bulletin.

Health & Wellbeing Strategy Update: Prevention in Partnership

A report was presented on the application of a preventative strategy, using physical activity and falls as examples, and highlighting the role of partners in identifying prevention opportunities. The Prevention in the Partnership programme assesses the local provision of opportunities for residents of all ages to prevent adverse health outcomes or the worsening of existing health conditions. The strategy outlines three tiers of prevention:

1. Primary prevention: Universal measures to reduce the incidence of disease and health problems within the population, such as making healthier choices easier and raising awareness of the risks associated with inactivity.
2. Secondary prevention: Early detection of disease and intervention before full symptoms develop, such as identifying individuals at risk of falls and encouraging exercises to improve strength and balance.
3. Tertiary prevention: Mitigating the impact of ongoing illness or injury to improve functioning and quality of life, such as helping individuals manage long-term health conditions.

The Prevention in the Partnership approach is a systematic framework designed to identify gaps in prevention initiatives and will involve continuous monitoring. It will initially work through Integrated Neighbourhood Teams to ensure staff can recognise, promote, and refer residents appropriately. The Board discussed the prevalence of falls, noting that most occur at home, with some on public footpaths, which are reported to the Council's Highways Team. A proposal was made for an awareness programme, particularly for elderly residents, including the distribution of literature in places of worship, to reach those without digital access. The Chair requested the Director of Public Health to liaise with the Communications Team to include information on these proposals in the weekly newsletter.

Progress of 'Right Care, Right Person'

The Board received an update on the progress of the Right Care, Right Person initiative, implemented by the Metropolitan Police Service on 1 November 2023. Detective Superintendent Alastair Vanner explained that the initiative aims to ensure that individuals with mental health, health, and social care needs are seen by the appropriate professional. This model has reportedly generated positive outcomes, including reduced demand on various agencies in other areas. A key element of the approach is a threshold to guide police decisions on when to respond to incidents. The initiative went live on 1 November 2023, and statutory partners are continuing to collaborate for its safe implementation. Statistics and data presented to the Board indicated positive results from the initiative thus far.