The North West London Joint Health Overview and Scrutiny Committee met to discuss preparations for the winter period, including the performance of the London Ambulance Service, and to review the North West London Health Equity Programme. The committee also received an update on the Integrated Care System and reviewed a tracker of previous recommendations.

North West London Winter Campaign and London Ambulance Performance

A significant portion of the meeting was dedicated to discussing the North West London winter campaign and the performance of the London Ambulance Service (LAS). The report pack outlined the comprehensive winter planning programme for the North West London Integrated Care System (NWL ICS), which aims to ensure resilience during peak demand periods. This planning is an ongoing, year-round process, involving regular reviews and implementation cycles.

Key risks identified for the winter period included workforce capacity, critical care and general bed capacity, avoidable hospital admissions, delays in patient discharge, medicine availability, A&E waiting times, ambulance handover and response times, and the impact of acute respiratory infections. The report highlighted that while wait times have improved, many residents still face difficulties accessing urgent care promptly, with a rise in demand for acute hospital beds driven by an increasing number of frail, elderly patients.

Actions detailed to mitigate these risks included enhancing hospital and LAS plans to manage seasonal pressures, ensuring patients needing acute care can access it without undue delays. Trusts have developed improvement plans reviewed by the Acute Provider Collaborative (APC), focusing on areas such as consistent patient streaming and redirection, maximising the use of Urgent Treatment Centres (UTCs) and Same Day Emergency Care (SDEC), providing Acute Frailty Unit responses, and reducing ambulance handover and A&E waiting times. A major focus for 999 pathways is the development of an Integrated Co-ordination Centre to improve the integration of 999, 111, and A&E services with community providers. Virtual wards are operational, with improved utilisation rates, and Urgent Community Response referrals are exceeding national targets.

The report also detailed plans for swift discharge to appropriate settings, involving joint planning between NHS, Local Authorities, Social Care, and Voluntary, Community, and Social Enterprise (VCSE) teams. The NWL ICS has utilised an Additional Discharge Fund (£20.2m) to improve discharge pathways, aiming to support patients in returning home earlier.

The immunisation strategy was also a key focus, with information provided on the COVID-19 vaccination campaign ending on 20 December 2024 and the seasonal influenza vaccine ending on 31 March 2025. The report detailed efforts to maximise uptake, including co-administration of flu and COVID-19 vaccines, outreach to vulnerable groups, and targeted communication campaigns for specific disease registers.

Support for those with Long Term Conditions (LTCs) was also outlined, including the adoption of NHS England's model for respiratory care to reduce exacerbations and hospital admissions for patients with COPD. This includes a Primary Care Respiratory Enhanced Service and increased referrals and completions for Pulmonary Rehabilitation (PR). Digital platforms are also being used to support patients with diabetes and cardiovascular disease.

Primary care services, including Enhanced Access and Out of Hours services, are being utilised to provide additional capacity. Urgent dental services are available 24/7, and the Pharmacy First initiative, which allows pharmacists to diagnose and treat seven common clinical conditions, was highlighted as a way to alleviate pressure on General Practice.

Specific attention was given to supporting individuals with mental health conditions and vulnerable patients. Actions include increasing flow through mental health crisis assessment services, providing additional mental health bedded capacity, and improving the tracking of patient pathways through A&E. Support for homeless individuals includes in-hospital homeless health teams and outreach services, with Severe Weather Emergency Protocol (SWEP) in place for rough sleepers.

The London Ambulance Service (LAS) 999 Winter Plan 2024/25 was also presented. This plan addresses an anticipated increase in 999 calls, with projections indicating a significant rise in Category 2 response times. The plan outlines baseline winter actions, a patient flow framework, and an escalation framework with new Red and Purple levels to manage sustained exceptional pressure. Key actions include increased operational staffing, maximised hear and treat initiatives, specific referrals to GPs, and a revised Fit to Sit criteria. The plan also details a patient flow framework with six escalation levels, from Business As Usual (BAU) to full closure, and an escalation framework with new Red and Purple levels to manage sustained system pressure.

North West London Health Equity Programme

The committee was scheduled to receive an update on the North West London Health Equity Programme. The report highlighted that data indicates people in the most diverse and deprived communities in North West London are dying earlier than their more affluent counterparts. This disparity is attributed to a range of factors, including wider social, economic, and environmental determinants, challenges in adopting healthy behaviours, and differing experiences with health and care services due to a lack of cultural competence.

The programme aims to tackle these inequalities through three pillars:

• Pillar 1: Clinical Care: Focusing on reducing healthcare inequalities through the NHS England Core20Plus5 framework, which targets the 20% most deprived neighbourhoods nationally, Plus groups, and five key clinical areas driving health disparities.
• Pillar 2: Population Health Management (PHM): Building capabilities in key skills to deliver the Focus-On PHM methodology and fostering a data-driven decision-making culture, with Integrated Neighbourhood Teams (INTs) as a key vehicle.
• Pillar 3: Wider Determinants of Health: Working with local authorities and the voluntary and community sector (VCS) to address wider determinants of health and promote healthy behaviours.

The programme's vision is to reduce disparities in healthy life expectancy, with proposed metrics including increasing the age at which the most deprived quintile becomes multi-morbid, reducing emergency admissions due to ambulatory care sensitive conditions, and reducing the inequality gap in life expectancy. The report detailed achievements across these pillars, including the establishment of a PHM and Health Equity Academy, progress in tackling wider determinants of health through initiatives like the WorkWell programme, and partnership working with VCS organisations.

Integrated Care System Update

An update was scheduled from the Chief Executive of the North West London Integrated Care System (ICS). This update was expected to cover the ICS's strategic direction, progress on its Joint Forward Plan, and its alignment with the emerging Ten Year Plan for the NHS. Key themes likely to be discussed include the shift from treatment to prevention, the move from analogue to digital services, and the focus on community-based care. The report indicated that the ICS is central to self-managing, self-improving systems and has primary responsibility for identifying population health needs and acting on reversible risk factors to improve healthy life expectancy.

North West London JHOSC Recommendations Tracker

The committee was to review the North West London Joint Health Overview Scrutiny Committee (JHOSC) Recommendations Tracker for the 2023/24 and 2024/25 municipal years. This tracker summarises scrutiny recommendations and information requests made by the committee to the NWL ICS and other relevant bodies, and tracks the progress of responses and implementation. The report indicated that updates to the tracker from the previous meeting were highlighted.

Councillor Chetna Halai was among the members present for this meeting.