The Health and Social Care Scrutiny Sub-Committee met on Tuesday 5 March 2024 to discuss winter pressures on the local health and care system and an update on mental health services in Harrow. The committee noted the reports presented on both topics.

Winter Pressures

The Sub-Committee received an update on the pressures faced by the Harrow Health and Care System during the winter period. It was reported that the system experienced its peak pressure in the first week of January, coinciding with a post-Christmas surge in patient attendances and a junior doctors' strike. Accident and Emergency (A&E) attendances averaged 2,170 per week, higher than the previous winter, and non-elective admissions to Northwick Park Hospital also remained high, averaging 600 per week.

While London Ambulance Service handover delays have reduced due to stricter time limits for ambulance crews at hospitals, this has led to an increase in long waits in A&E, with an average of 395 twelve-hour waits per week since October. Hospital bed occupancy was at an average of 97% during November and December, with patients frequently being boarded on wards. The number of individuals on social care caseloads post-discharge from hospital has tripled compared to the pre-Covid period.

Concerns were raised regarding the impact of junior doctors' strikes on elective care and staff stress, although emergency and cancer care were not significantly affected. The term boarding was clarified as patients being managed in corridors with clinical oversight until admitted, a measure to allow ambulances to respond to other emergencies. The Sub-Committee noted that Harrow's A&E waiting times were longer than in neighbouring boroughs, with Northwick Park Hospital being one of the busiest in the country and serving patients from surrounding areas.

Regarding staff sickness, it was reported that community services sickness rates had reduced to 1.1% over the winter period, down from an average of 3.9%, with previous higher rates attributed to common illnesses rather than stress. The committee was informed about ongoing evaluations of additional discharge funding and work on a long-term strategy to meet demand sustainably, including new schemes like the bridging care service. The effectiveness of GP access and walk-in centres in reducing A&E pressure was questioned, with the conclusion that while primary care access is important, walk-in centres have not shown a clear correlation with reduced A&E attendance. The Sub-Committee resolved to note the presentation.

Harrow Mental Health - CNWL

The Sub-Committee received an update on mental health services provided by the Central and North West London NHS Foundation Trust (CNWL) in Harrow. The presentation outlined the various services available, including Harrow Talking Therapies, Community Mental Health services, Perinatal Mental Health Services, Crisis Care, Inpatient Services, Older Adult Mental Health Services, and Community Learning Disability Services.

Members sought clarification on the range of mental health conditions addressed beyond perinatal issues, with officers explaining that services cover anxiety, depression, and reactions to life events. Support is also available for more severe conditions like psychosis and schizophrenia. The causes of mental health issues were discussed, including psychosocial and biological factors, with an increased understanding of the role of adverse life events and economic crises.

Information was requested regarding support for older adults and their families. It was noted that while services offer support to families and carers, memory services face staffing challenges and are primarily commissioned for dementia diagnosis, lacking resources for post-diagnostic support. Efforts to secure funding for Admiral Nurses were ongoing.

The Sub-Committee heard about the integrated approach to mental health services, operating as a single system across acute and community care. Weekly meetings involving GPs, police, and non-state agencies discuss complex cases to ensure a collaborative approach, aiming to minimise hospital admissions and focus on community support.

Statistics on self-referral and waiting times were provided, with a 28-day target for assessment and support in secondary mental health services consistently met. The Single Point of Access (SPA) service was described as assessing urgent cases and directing them to appropriate services, with non-urgent cases referred to community mental health teams or Talking Therapies.

Pathways for individuals with language or cultural barriers were discussed, with Harrow Talking Therapies being multicultural and employing translators. Efforts are underway to improve access for young black men. Talking Therapies has extended its age range to include clients as young as 16, complementing the Child and Adolescent Mental Health Service (CAMHS) which serves those under 16.

An update on the transition of the Mind contract to CNWL indicated it was in its early stages but anticipated to be beneficial, with close collaboration and monitoring planned. The partnership with Hestia, operating the Curves crisis drop-in centre, was confirmed as successful in managing cases and reducing A&E visits. The service is awaiting funding updates.

Members requested that the Children's Mental Health Service, the impact of junior doctors' strikes on operations, and the effects on cancer and maternity patients be discussed at a future meeting. The Sub-Committee resolved to note the report.