The Health and Social Care Select Committee met to discuss the proposed closure of the minor injuries unit at Mount Vernon Hospital, review adult social care spending, and receive an update on support for autistic people in the borough. The committee agreed to amend the draft final report on GP coverage in Hillingdon and requested a presentation on technology-enabled care plans at their November meeting.

Future of Minor Injuries Unit

The committee discussed a proposal from the Hillingdon Hospital NHS Foundation Trust to transfer services from the minor injuries unit at Mount Vernon Hospital to Hillingdon Hospital due to overspending and emergency department performance issues. Lesley Watts, Chief Executive of the Hillingdon Hospital NHS Foundation Trust, explained that the proposal aims to consolidate resources and improve care for the sickest patients, while also addressing financial challenges. Dr Alan McGlennan, Chief Medical Officer and Managing Director of the Hillingdon Hospital Trust, added that many patients currently seen at the minor injuries unit could be treated in primary care, social care, or pharmacies.

Councillor Nick Denys, Chair of the Health & Social Care Select Committee, raised concerns about access for residents in the north of the borough and questioned whether local provisions have the capacity to absorb patients who would have gone to Mount Vernon. Dr McGlennan responded that about 50% of patients require x-rays, necessitating a hospital visit, and that the remaining 50% should be managed by local services. He stated that Hillingdon Hospital's urgent treatment centre performs well, seeing, treating, and discharging patients within four hours 98% of the time, and has the capacity to absorb additional patients.

Councillor Kelly Martin questioned whether the decision to close the Mount Vernon service had already been made, and asked what metrics would be used to determine if the pressure on other services was too high. Dr McGlennan clarified that the decision was not predetermined and that the trust would review performance, patient numbers, and staff well-being, with a review planned for April. Watts added that the trust had engaged with surrounding boroughs and integrated care boards¹ (ICBs).

Councillor Reeta Chamdal, Deputy Mayor, Chair of Pensions Committee, asked if a formal consultation had been carried out with residents and staff. Watts confirmed that a formal consultation had not been conducted, following advice from the ICB, but that engagement had taken place with residents, councillors, and surrounding boroughs. Councillor Chamdal suggested a formal consultation should be considered, but Watts responded that they would not be doing so.

Councillor Becky Haggar OBE raised concerns about the patient experience, particularly for children with minor injuries, and asked if there would be a separate unit at Hillingdon Hospital. Dr McGlennan assured her that there is a separate paediatric emergency department with a dedicated waiting area and staff. He also confirmed that follow-up clinics and physiotherapy would remain at Mount Vernon.

Councillor Sital Punja, Deputy Leader of the Labour Group, questioned the timeline for integrating services with the integrated care hubs and how this would be communicated to residents. Dr McGlennan explained that minor illnesses would be directed to general practice or pharmacies, while injuries requiring x-rays would go to Hillingdon Hospital. He anticipated that the hubs would eventually offer more urgent care services, including diagnostics.

The committee noted that the transfer of services is scheduled for the end of the month, with ongoing monitoring of its impact. Councillor Denys expressed concerns about the timing of the transfer, given the upcoming hospital rebuild and the current state of the hubs. Watts responded that there is never an ideal time for such changes, but that the trust needs to address its financial challenges and improve services for the sickest patients. She said that the million pounds saved would underpin the rest of the work that the acute unit does.

Adult Social Care Budget

Sandra Taylor, Corporate Director of Adult Social Care, introduced the budget paper for adult social care, highlighting the financial challenges and increasing complexity of residents' needs. She noted that while the number of service users has remained relatively stable at around 3,030, the cost of care has increased significantly.

Matt Davis, from finance, drew attention to a projected £5.4 million overspend on adult social care placements for 2024-5, driven by the cost of care packages already in place, and an £8.2 million variance for 2025-6, which includes the full-year effect of the previous year's overspend and an estimate of future growth. He explained that care providers are facing increased costs due to the rise in the national living wage and changes to national insurance contributions.

Councillor Denys questioned the forecasting methods used for adult social care, noting that there always seems to be an overspend. Taylor responded that forecasting is difficult due to fluctuating prices, but that the council is developing a new finance model to improve modelling and understand demand drivers. She identified packages for people with learning disabilities in supported living as a significant cost driver.

Councillor Punja raised concerns about the reliability of the budget report, given that it was already period four, while the committee was reviewing period two. She requested clarification on the term underlying forecast and asked for more detailed analysis to support the budget figures. Davis explained that the underlying forecast represents the debits and credits charged against all cost centres, adjusted for earmarked reserves, provisions, and transformation funding. He expressed confidence in the underlying data, based on a detailed review of committed care amounts.

Councillor Martin asked about the impact of Covid-19 on adult social care needs and whether there was a push to help people exit the social care system. Taylor explained that while demand from older people has stabilised, there is increasing demand from people with learning disabilities and mental ill health. She said that the council invests heavily in early intervention and reablement services to promote independence and prevent hospital admissions.

Councillor Punja requested a glossary of terms in future reports and asked for reporting on income collections versus targets. She also sought clarification on large figures of movement in Table 5, which Davis explained related to adult social care placements, with one figure intended to be covered by reserves.

Councillor Burles asked for an explanation of the amber ratings in Table 6, which indicated varying degrees of risk to the delivery of savings.

The committee agreed to provide officers with feedback on how the budget report could be improved for future meetings.

Autism Update

Gary Collier introduced a report providing an update on support for autistic people in Hillingdon, noting that it had been some time since the committee last discussed this area. He highlighted the increase in demand for services and proposed to return with a draft strategy for consultation.

The report noted that there is no definitive way of measuring the number of people in Hillingdon with autism, but that national studies suggest that between 1 and 3% of children and young people are autistic. It also noted that there is a higher prevalence of autism in males than females, and among black, Asian and minority ethnic (BAME) communities.

The report also detailed key developments and achievements over the last three years, including:

• Establishing the All-age Autism Partnership Board
• Developing the Expert Reference Group (ERG)
• Completing the Joint Autism Needs Assessment
• Extending the CAAS Transition Pilot
• Providing waiting well support
• Establishing the Dynamic Support Register (DSR)

Councillor Punja asked for a breakdown of the 374 people with autism receiving care packages, to understand the severity of their needs. It was clarified that these individuals have Care Act eligibility, irrespective of their autism, and that the spectrum of needs varies widely.

Councillor Chamdal expressed concern about the significant growth in the number of diagnoses. It was explained that this is due to increased diagnostic activity and greater self-awareness of autism.

Councillor Denys asked about the 1,468 people awaiting a diagnosis after an initial assessment and what support they receive. It was explained that this number is managed by health services, and that there is a pre-diagnosis service for those in acute need. It was also noted that people do not need a diagnosis to access support from the local authority.

Councillor Burles asked if there was a map of the borough showing where autism was more prevalent. It was confirmed that this was in process.

Councillor Martin asked how the numbers compared with child diagnoses and what the variance was in the level of support required by someone with autism. It was explained that about 26% of young people with education and healthcare plans have a diagnosis of autism, and that the level of support varies from a few hours a week to full-time care.

Councillor Punja asked about the higher prevalence of autism in males and BAME communities and whether there was research to explain this. It was confirmed that this is a national picture, and that the council does not currently have specific services tailored to these groups. It was agreed that this would be considered as part of the strategy development.

Councillor Haggar raised concerns about the waiting time for assessments and how quickly services are put in place after a diagnosis. It was explained that referrals to adult social care are typically seen quickly, and that there should not be a significant delay in receiving services.

Councillor Chamdal asked how many of the 374 people with autism were already on a package of care, and whether this was contributing to the overspend in adult social care. It was clarified that these were all new packages of care, and that they were contributing to the increasing costs in adult social care.

GP Coverage in Hillingdon

The committee agreed to amend the draft final report on GP coverage in Hillingdon to reflect that while there is a surgery in Harlington, it may not be easily accessible for residents in Heathrow villages.

Cabinet Forward Plan

The committee reviewed the cabinet forward plan and requested that officers provide a presentation on technology-enabled care plans at their November meeting.

Work Programme

The committee reviewed the work programme and made no changes.