The Health and Social Care Scrutiny Sub-Committee met on Tuesday 17 June 2025 to discuss services supporting women during menopause, review winter pressures, and examine the annual quality account of the Royal National Orthopaedic Hospital. The committee also received updates on adult social care performance and the emerging adult social care strategy.

Services to support Women during Menopause

The committee received a presentation on services supporting women during menopause, highlighting that the London Northwest services were established in 1991 and have evolved into a specialist menopause service. The 2022 Women's Health Strategy for England and the 2024 'Shattering the Silence about Menopause' report were key drivers for service development. The service provides weekly access to a consultant gynaecologist, GP, consultant pharmacist, and specialist psychologist, commissioned to care for three groups: premature ovarian insufficiency, perimenopausal patients, and those with induced and complex menopause. The service has seen over 700 new patients and over 800 patient callbacks, with a DNA rate of over 5%. Efforts are being made to create a supportive working environment for the 8,200 staff, many of whom are women experiencing menopause. Improvements planned include developing a pathway for cancer patients experiencing menopause, standardising data collection to tackle inequalities, increasing patient-initiated follow-up, and improving representation in research and drug trials.

Overview Scrutiny Report Winter Pressures 2024-2025

The committee received an update on the 2024/25 Winter Plan, a collaborative approach involving system partners such as the local acute trust, the Council, GP and primary care networks, and local and voluntary sector organisations. The plan's key objectives were preventative measures, effective communication, and addressing the wider determinants of health. Actions taken focused on interface, data and escalation, prevention, community-based admission avoidance, in-hospital care, discharge pathways, and schemes for admission avoidance. Members raised concerns about community-based admission avoidance actions being at risk and requested an update on discharge rates, with acknowledgement that more work was needed to gather comprehensive data. The Borough Director attributed increased winter pressures to an ageing population and increased activity post-COVID, noting Harrow's high rate of over 65 admissions. Discussions also covered pathways for unregistered residents and the disparity of funding between outer and inner London boroughs.

Annual Quality Account, Royal National Orthopaedics Hospital

The Chief Nurse of the Royal National Orthopaedic Hospital (RNOH) introduced the Annual Quality Account report, detailing the hospital's commitment to providing high-quality care. Key quality priorities for 2024/25 included the Go for Gold accreditation scheme, improving harms-free care, enhancing pain management, and introducing the safety incident response framework. The report highlighted a commitment to inclusion and patient engagement, with the organisation celebrating 10 years of volunteering. Priorities for the forthcoming year include the introduction of an electronic health record system, enhanced observation of care, improved care for patients with additional needs, and a further focus on harms-free care, specifically medicine safety. Members sought clarity on statistics for patient care priorities, and the Chief Nurse clarified the use of the friends and family test and CQC surveys. Feedback from Healthwatch patients indicated overall satisfaction, though issues with the automated phone system and appointment communication were noted. The Chief Nurse explained that the hospital uses the EPIC system in connection with University College Hospital (UCLH). Concerns were raised regarding the increase in patient safety incidents resulting in severe harm, which the Director of Risk explained was due to a change in criteria. Staff rota gaps due to visa delays were acknowledged as a challenge. The committee also discussed the reduction in opioid use, attributed to a focus from the pharmacy department and individual patient work. The report was noted by the Sub-Committee.

Adult Social Care Performance 2024-25

The Strategic Director of Public Health and Adult Services presented the Adult Social Care performance summary for 2024/25, noting a significant budget overspend attributed to increased demand, complexity of needs, and market pressures from inflation. Service provision challenges included occupational therapy, with a 15-20% increase in usage and a backlog of residents waiting for assessment. Safeguarding and liberty deprivation were also highlighted as service pressures, though waitlists and processing times had been reduced. Improvements were noted in children's health visiting and school nursing services, with a decrease in children with unfilled decaying teeth. Members questioned the inclusion of vapes in the smoking indicator and raised concerns about staff sickness, which was largely linked to long-term absence. The Chair recommended looking at staff sickness data in relation to service areas to identify patterns. Barriers to reaching the safeguarding processing target of 3 days were explained as lengthy recording processes. The Healthwatch representative commented on improvements in safeguarding. Concerns were raised regarding red indicators in the scorecard, particularly the rating of care homes, which would be removed from the corporate scorecard. The Chair asked how the balance between budget and quality service provision would be achieved, and the Strategic Director acknowledged this was a difficult balance. Concerns were also raised regarding the billing process for residents, with work underway to improve timelines and clarity. The Chair called for an update on healthcare providers and contract reviews.

Adult Social Care Strategy

The Strategic Director introduced a presentation on the emerging adult social care strategy, focusing on engagement with residents and frontline staff. Voluntary Action Harrow (VAH) was commissioned to engage with diverse residents and staff, identifying key themes such as the importance of social connection, health and mobility, and perceived barriers like poor transport and social isolation. Recommendations from residents and staff included more consistent, personalised care, accessible information, stronger staffing, adequate funding, trust, transparency, and holistic support. Findings from staff also suggested low-cost changes like enhanced internal communication and improved front-door signposting. The feedback will be used to draft the strategy. Members commended the success of the Conversation Café. Clarity was sought regarding the number of vulnerable residents contacted and voluntary groups commissioned. The Chair noted the strategy would be brought back in December and asked how relationships with the voluntary sector would be strengthened. The Healthwatch representative stressed the need for transparency and communication. The Chair highlighted prevention as the long-term route to success. Concerns were raised regarding the impact of NHS cuts and the need for a clear partnership with the Integrated Care Board (ICB). The Chair asked for a review of how ICB cuts had impacted Harrow to be presented in December. The impact of the Care Quality Commission (CQC) inspection was also discussed, with the adult social care rating being at the top end of requires improvement. Members commented on the success of health prevention work in schools. The Healthwatch representative highlighted the importance of inclusivity in prevention services. The Sub-Committee considered the direction of the emerging strategy and advised on areas needing particular focus.

The meeting also included the appointment of Councillor Maxine Henson as Vice-Chair and Deven Pillay as a non-voting adviser to the Health and Social Care Scrutiny Sub-Committee for the 2025/2026 Municipal Year. The minutes of the previous meeting held on 4 March 2025 were also signed as a correct record.